Reminder About Claims Submissions for $10 Million or More

Date: May 19, 2026

Attention: All Providers

Important Update (August 4, 2026):
Texas Children's Health Plan (TCHP) has updated this Provider Alert originally published May 26, 2026, to clarify that the guidance below pertains to TMHP claims processing requirements.

Call to action: TCHP is sharing this reminder from the Texas Health and Human Services Commission (HHSC) regarding claims processing requirements through Texas Medicaid & Healthcare Partnership (TMHP) for fee-for-service inpatient claims totaling $10 million or more.

To support appropriate processing by TMHP, providers should split inpatient claims of $10 million or more into separate interim claims. Each interim claim should total less than $10 million and be submitted using the following Type of Bill (TOB):

• First interim claim (TOB 112): Covers most of the inpatient stay
• Subsequent claims (TOB 113): Cover any subsequent inpatient stay charges, if applicable
• Final discharge claim (TOB 114): Covers the remaining days billed and charges

Providers should submit at least a first interim claim and the final discharge claim. Subsequent claims can include any additional charges.

TMHP may initially deny the claims. Providers should contact TMHP at 800-925-9126 to request that the claims be escalated to TMHP’s Claims Department for manual review and processing.

On June 1, 2026, TMHP will add this information to the Texas Medicaid Provider Procedures Manual (TMPPM), Inpatient and Outpatient Hospital Services Handbook, section 3.7.4.7.1, “Inpatient Hospital Claims for $10 Million or More.”

Next step for Providers: Providers should share this information 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.