CSHCN 2009 > Renal Dialysis > Claims Information

31.4 Claims Information

Renal dialysis facilities must submit claims to TMHP in an approved electronic format or on the UB-04 CMS-1450 claim form. Claims for separately billable drugs and laboratory fees must be submitted to TMHP in an approved electronic format or on the CMS-1500 claim form. Providers may purchase both claim forms from the vendor of their choice. TMHP does not supply the forms.

When completing both claim forms, all required information must be included on the claim, as information is not keyed from attachments. Superbills, or itemized statements, are not accepted as claim supplements.

Home health DME providers must use benefit code DM3 on all claims and authorization requests. All other providers must use benefit code CSN on all claims and authorization requests.

Refer to: Chapter 36, "TMHP Electronic Data Interchange (EDI)" for information about electronic claims submissions.

Chapter 5, "Claims Filing, Third-Party Resources, and Reimbursement" for general information about claims filing.

Section 5.7.1.3, "CMS-1500 Claim Form Instructions" and Section 5.7.1.7, "Instructions for Completing the UB-04 CMS-1450 Claim Form" for instructions on completing paper claims. Blocks that are not referenced are not required for processing by TMHP and may be left blank.