Avoid Extra Steps by Submitting Documentation Requests on Time

If TrailBlazer Health Enterprises, the Texas Medicare carrier, requests medical records for additional documentation of a claim you've filed, and it receives the records you submit past deadline, it no longer routinely reopens the claim.

If TrailBlazer does not receive the records within 45 days following the request, it likely will deny your claim as not reasonable and necessary based on lack of documentation. You will have to submit a reopening or redetermination request for the claim.

Submit requests for reopenings or redeterminations on these forms:

Complete information is available at Internet-Only Manual Pub. 100-04  ( PDF ), Chapter 34, Section 10.3.

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