Before receiving incentive payments from the Texas Medicaid Electronic EHR Incentive/PI Program, eligible professionals and eligible hospitals are subject to review of certain program eligibility requirements. The pre-payment review process is not a formal audit and approval for payment does not preclude a provider from being selected for a more detailed formal audit after payment. During the pre-payment review, if a provider is determined ineligible for an incentive payment or for participating in the program, the provider can appeal.
Pre-Payment Appeal Instructions
A provider can submit an appeal through the program’s attestation portal (MI360), which is accessed through the provider’s online account with the Texas Medicaid & Healthcare Partnership. Upon accessing MI360, the provider can click on the “Appeals” tab at the top of any page. If appealing, the provider must include the provider’s name, National Provider Identifier number, the Texas Medicaid Provider Identifier number, and the reason for the appeal. The appeal will be reviewed by program staff, in consultations with the Health and Human Services Commission, as necessary. The provider will be notified of the appeal outcome by email.
Providers are expected to meet all program deadlines. Appeals will not be considered if the provider missed the program’s deadlines. An exception can be granted only if the provider’s attestation was delayed by a system error in MI360, or if there was a problem with the Centers for Medicare & Medicaid Services EHR Incentive Program Registration and Attestation System. No other exceptions are allowed.
There is a separate process for notification and appeals of post payment audit findings. For more details on the post payment audit appeal process, visit the following page.