Preparing for the Upcoming Fiscal Year 2025 Fee-for-Service Claims Billing Closeout

Date: June 10, 2025

Attention: Providers

Call to action: As the new state fiscal year approaches, providers must carefully review and reconcile all claims listed on their Remittance & Status (R&S) Reports. To prepare for the fiscal year closeout on August 31, 2025, providers should promptly submit claims for any unbilled services to be paid by the Health and Human Services Commission (HHSC). HHSC will publish additional details regarding cutoff dates for fiscal year 2025 in an upcoming HHSC information letter once the dates are available.

How this impacts providers: Providers should report any invalid claims to the appropriate state office staff, as available here.

For questions about the R&S report, please contact the Texas Medicaid & Healthcare Partnership at 800-626-4117, Option 1.
Invalid recoupments should be immediately reported to HHSC Provider Recoupments & Holds at (512) 438-2200, Option 3.
For more information, see the Remittance and Status (R&S) Reports for LTC Providers Quick Reference Guide.

Twelve-Month Filing Rule

Providers must ensure that billing is current for all services provided and that any problems related to the claims are resolved within the 12-month filing deadline.
Claims that are submitted or adjusted more than 12 months after the date of service will be denied because of untimely filing.

Miscellaneous Fee-for-Service Claims

Miscellaneous claims refer to those claims with service dates earlier than two prior fiscal years plus the current fiscal year.
Claims for services that are less than eight years old and/or claims that total less than $50,000 owed to a single legal entity are reimbursed on a first-come, first-served basis using funds appropriated during each legislative session.
Miscellaneous claims over $50,000 or claims that involve services more than eight years old cannot be paid unless they are specifically authorized as a line item in the state budget.

Next step for Providers: Providers should share this communication with their staff.

If you have any questions, please email Provider Relations at: providerrelations@texaschildrens.org.

For access to all provider alerts: www.texaschildrenshealthplan.org/provideralerts.