Texas RAC
a service of 
- Notices & Updates
- Overview
- Resources
- Training Videos
- Approved Scenarios
- Frequently Asked Questions
- Contact Information
Notices & Updates
The Texas RAC Appeal Information Form is now available for download. A fillable PDF version will also be available soon. Please check back here or "Sign Up for Updates and invites to Trainings" form below to be notified when the fillable PDF version is available for download. The form will also be included within all HMS Uphold Decision Letters.
For additional information about the review and appeal process, click here.
Extensions Due to COVID-19 End May 31, 2021
Effective June 1, 2021, the Texas Health and Human Services Commission Office of the Inspector General is ending all Covid-19 related deadline extensions.
Deadlines will revert to pre-pandemic requirements:
- Request for medical records – deadline to submit records is 30 days from the date of the request letter.
- Preliminary technical denial – deadline to submit missing documentation is 30 days from the date of the request letter.
- Notice of Adverse Determination – deadline to submit a first-level appeal is 30 days from the date of the notice letter.
NOTE: Deadlines for second-level appeals were not extended and are not affected by this notice.
Notice for Providers
Please note that HMS has launched new portal features. Below is a link with the details on the new benefits and features and how to register for the portal.
Overview
HMS (hms.com) is under contract with The Texas Health and Human Services Commission (HHSC) as Texas’ Medicaid Recovery Audit Contractor pursuant to Section 6411 of the Patient Protection and Affordable Care Act of 2010. HMS is authorized to audit provider payments and associated financial records to identify under and over payments and recover any overpayments made to the provider.
HMS will conduct two types of audits:
- AUTOMATED REVIEWS—Claim data elements are analyzed using algorithms that are based on Medicaid policy and rules.
- COMPLEX REVIEWS—Claim data elements that cannot be automatically validated or that require medical documentation are reviewed by qualified Registered Nurses, certified coding specialists, and physicians.
Resources
Automated Review Letters
- Findings Letter
- Untimely Filing of Your Rebuttal First-Level Appeal
- First-Level Appeal/Rebuttal – Adverse Determination Overturned
- First-Level Appeal/Rebuttal – Adverse Determination Upheld
Complex Review Letters
- Findings Letter
- Formal Appeal Exhaust Letter
- Medical Record Request Letter
- No Affidavit Received Letter
- No Finding Letter
- No Medical Records Received Letter
- Untimely Filing of Your First-Level Appeal
- First-Level Appeal – Adverse Determination Overturned
- First-Level Appeal – Adverse Determination Upheld
- Technical Denial Letter
Training Videos
Approved Scenarios
Contact Information
HMS Contacts
HMS Provider Services at 877.401.3635
HHSC OIG Contact Information
Providers needing assistance with TX RAC issues that cannot be resolved by HMS should contact RAC program management at the HHSC Office of Inspector General at txracprogram@hhsc.state.tx.us
| Inquiry Type | Appropriate Contact | Contact Information |
|
Claim/Review Status Questions |
HMS Provider Services | 1-877-401-3635 |
| Address updates in HMS Provider Portal | HMS Provider Services | 1-877-401-3635 |
| Providing a Password for a CD or DVD | HMS Provider Services | MDG-PSR-Password-DataNotify@hms.com |
| Questions about registering for the HMS Provider Portal | HMS Service Desk | 855-554-6747 |
| Questions about troubleshooting for the HMS Provider Portal | HMS Service Desk |
855-554-6747 |
| HHSC Escalations | HHSC TX RAC | txracprogram@hhsc.state.tx.us |
| HMS Escalations | HMS TX RAC | txrac@hms.com |
| Medical Records Address | Mailed to HMS | HMS 5615 High Point Drive Mail Stop #200 - TX Irving, TX 75038 |
| Medical Records Fax | Faxed to HMS | 855-278-3502 (maximum one record at a time) |
| Medical Records 1st Level Appeal Address | Mailed to HMS | HMS 5615 High Point Drive Mail Stop #200 - TX Irving, TX 75038 |
| Medical Records 2nd Level Appeal Address | Mailed to HMS | HHSC Medical and UR Appeals C/O HMS 5615 High Point Drive Mail Stop #200 – TX Irving, TX 75038 |