02.08.24: SMMCAC Complaints, Appeals, and Fair Hearings Subcommittee Recap

The Complaints, Appeals, and Fair Hearings Subcommittee’s session provided an in-depth examination of Texas Medicaid’s MCO internal appeal requirements and the process for addressing provider complaints. John Huffine from the Office of Policy, MCS, HHSC, detailed the internal appeals and External Medical Review (EMR) processes, while Esmeralda Rodriguez discussed the management of provider complaints. TAHP MCOs will be presenting their internal appeals processes at the May meeting.

Check out the recap.

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