About the Provider ManualThis edition of the CSHCN Services Program Provider Manual supersedes all previous editions. Read this manual carefully. The CSHCN Services Program Provider Manual is intended primarily for those providers who submit claims to the Texas Medicaid & Healthcare Partnership (TMHP); however, information is provided for services reimbursed by the Texas Medicaid/Children's Health Insurance Program (CHIP) Vendor Drug Program and the Texas Medical Transportation Program. The CSHCN Services Program Provider Manual provides sufficient information to help providers submit claims and correct first-time claims to the Computerized Medicaid Claims Processing Assessment System, COMPASS21. By focusing on accurate and complete claims submission, providers can minimize resubmissions and appeals and help conserve resources for themselves and the CSHCN Services Program. Additional information is also provided on the TMHP website at www.tmhp.com. To find information about the various TMHP resources, visit the TMHP website, where the following can be accessed:
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• Important: Natural disasters, such as floods or hurricanes, can impact the delivery of health care to CSHCN Services Program clients. When disaster strikes, providers should monitor the TMHP website for special instructions. New provider services continue to be added to the website. Visit the TMHP website at www.tmhp.com or call the Electronic Data Interchange (EDI) Help Desk at 1-888-863-3638 for the latest information about online services. The CSHCN Services Program Provider Manual provides program policy information to providers that submit claims to TMHP. CSHCN Services Program policy published in this manual represents program and policy implemented on or before January 1, 2009, including the annual HCPCS updates. Policy and program updates effective after January 1, 2009, are published bimonthly in the CSHCN Services Program Provider Bulletins. TMHP publishes quarterly CSHCN Services Program provider bulletins to advise providers of changes in CSHCN Services Program policies that are due to the evolution of health-care and new government programs and regulations. Provider bulletins contain updates to information published in the provider manual. Retain all CSHCN Services Program provider bulletins for future reference. The CSHCN Services Program Provider Manual and CSHCN Services Program provider bulletins are also used throughout the year to supplement provider workshops presented by TMHP representatives. Providers must be thoroughly familiar with the contents of the CSHCN Services Program Provider Manual, the provider bulletins, and banner messages published on the R&S Reports as they apply to services provided for CSHCN Services Program clients. According to the CSHCN Services Program Provider Agreement, providers must comply with the following:
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• This manual is intended to notify providers about the CSHCN Services Program policies, procedures, and related information, including information about correct coding. The CSHCN Services Program regrets that, due to copyright limitations, Current Procedural Terminology (CPT), Current Dental Terminology (CDT), and Healthcare Common Procedure Coding System (HCPCS) code descriptions cannot be published in CSHCN Services Program publications. Consult reference manuals published or authorized by the American Medical Association (AMA), the American Dental Association (ADA), and the Centers for Medicare & Medicaid Services (CMS) for code descriptions. Specific procedure or diagnosis codes related to program benefits and coverage are included in the manual to provide helpful information, but should not be considered all-inclusive. From time to time, codes are added, deleted, or revised. |
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