Provider Appeals

The Tejas appeals process provides a mechanism for providers (or their authorized representatives) to appeal adverse determinations other than utilization management or resource allocation decisions.

Adverse Determination

  • An adverse determination is any decision by Tejas or its review agent to:
  • Reduce or suspend a provider’s network participation;
  • Terminate a provider’s network participation with cause;
  • Delay or deny payments; or
  • Deny reappointment to the network.

An adverse determination does not:

  • Deny a provider’s initial appointment the network;
  • Allow for the issuance of a letter of warning or reprimand, or termination without cause.

A provider has 15 calendar days to file an appeal after notification. For assistance in filing an appeal and for additional information, please call the Tejas Ombudsman at (512) 440-4086 or Ombudsman@TejasBHS.com.