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2.3.7 Provider Certification/Assignment
Providers of the CSHCN Services Program are required to certify compliance with, or agreement to, various provisions of state laws and regulations. Upon submitting a signed claim to the TMHP-CSHCN Services Program, the provider certifies that the following provisions were upheld:
• Services were personally rendered by the billing provider or under the personal supervision of the billing provider.
Exception: As allowed under substitute physician and telemedicine services rulings. Refer to: Section 29.2.36, "Telemedicine Services".
Section 29.3.1, "Substitute Physician".
•The information contained on the claim form is true, accurate, and complete.
•All services, supplies, or items billed were medically necessary for the diagnosis or treatment of the client.
•Medical records document all services billed.
•All billed charges are usual and customary for the services provided. The charges must not be higher than the fees that are charged to private pay clients.
•Services were provided without regard to race, color, sex, national origin, age, disability, political beliefs, or religion.
•Before providing services, providers should always discuss with, and inform clients and their families of their liability for services not a benefit of the CSHCN Services Program.
•The provider of medical care and services files a claim with the CSHCN Services Program, agreeing to accept CSHCN Services Program reimbursement as payment in full for services that are a benefit of the CSHCN Services Program. The CSHCN Services Program client, or others on the client's behalf, must not be billed for amounts above the amount the CSHCN Services Program paid on allowed services, or for services denied or reduced as a result of errors made in claims filing, claims preparation, missed filing deadlines, or failure to follow the appropriate appeal process. The client may be billed for services that are not a CSHCN Services Program benefit.
•The provider understands that endorsing or depositing a CSHCN Services Program check is accepting money from state or federal funds and that any falsification or concealment of material fact related to payment may be grounds for prosecution under state or federal laws.
Payment for services is made on behalf of clients to the provider of the service by TMHP in accordance with the limitations and procedures of the program.
If the claim is prepared by a billing service or printed by data processing equipment physically removed from the provider's office, it is permissible to print "Signature on File" in place of the provider's signature. The billing service must obtain and retain a letter on file signed by the provider authorizing the submission of his or her claims. Providers delegating signatory authority to a member of the office staff or to a billing service remain responsible for the accuracy of all information on a claim submitted for payment.
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