Provider Appeals to HHSC Medical and UR Appeals

A written appeal request with all required documentation must be received by Medical and Utilization Review (UR) Appeals within 120 calendar days of the date of the decisions letter.

HHSC Medical and UR Appeals may ask for additional documentation. If requested, it must be received within 21 calendar days of the date of the request.

If you have questions about the appeals process, you can email the HHSC Medical and UR Appeals team. Learn more about the HHSC Medical and UR Appeals Email Box (PDF).

Texas Medicaid Policies

Texas Medicaid Provider Procedures Manual (TMPPM) Volume 1: Section 7: Appeals (PDF) (7.3.3 for Utilization Review Appeals) 
TMPPM Volume 2: Inpatient and Outpatient Hospital Services Handbook (PDF)

Texas Administrative Code (TAC) Rules

1 TAC § 354.2201 – General/Definitions
1 TAC § 354.2217 – Provider Appeals and Reviews
1 TAC § 371.208 – Appeals Related to Utilization Review Department Review Decisions

Additional Resources