Index
A -
B -
C -
D -
E -
F -
G -
H -
I -
J -
K -
L -
M -
N -
O -
P -
R -
S -
T -
U -
V -
W
A
Abdominal flat plate (AFP)
Abuse and neglect reporting requirements
Accident resources and refunds
Accident-related claims
Accounts receivables
ACD
see Augmentative communication devices (ACDs)
Acquired immunodeficiency syndrome (AIDS)
Acronyms and Initialisms Dictionary
Acute lymphoblastic leukemia (ALL) 1 2
Acute medical episodes
Acute nonlymphoblastic leukemia (ANLL)
Adaptive feeder seats
Adaptive strollers
authorization requirements
Add date
Addresses
administrative review requests 1 2
CLIA applications
CLIA number notification
DSHS-CSHCN Enrollment
DSHS-CSHCN Provider Relations 1 2
information change requests
TMHP Provider Enrollment
TMHP Publications
TMHP-CSHCN Appeals and Adjustments
TMHP-CSHCN Claims
TMHP-CSHCN electronic claims and rejected reports
TMHP-CSHCN Enrollment
TMHP-CSHCN other correspondence
TMHP-CSHCN Prior Authorization and Authorization
TMHP-CSHCN TPR
Adjustment to claims
Administrative review
authorizations
prior authorizations
Advanced practice nurse (APN)
authorization requirements
benefits and limitations
claims information
electronic claims submission
enrollment
reimbursement
Aerosol treatments
pentamidine
AFP
see Abdominal flat plate (AFP)
AIDS
see Acquired immunodeficiency syndrome (AIDS)
Air transportation (deceased clients)
authorization requirements
benefits and limitations
AIS
see Automated inquiry system (AIS)
ALL
see Acute lymphoblastic leukemia (ALL)
Allergy services
benefits and limitations
Ambulance
billing for ambulance services
claims information
emergency air ambulance
emergency ground ambulance transportation
nonemergency ground ambulance
electronic claims submission
emergency air ambulance transportation
authorization requirements
emergency air ambulance transportation
benefits and limitations
emergency ground transportation
authorization requirements
benefits and limitations
enrollment
nonemergency ground transportation
authorization requirements
benefits and limitations
origin and destination modifiers
reimbursement
Ambulation aids
ambulation belts
canes
crutches
gait
gait trainers
prescription shoes
prone/supine standers
authorization requirements
benefits and limitations
walkers
Ambulation belts
Ambulatory electroencephalogram (EEG)
diagnosis codes
Ambulatory surgery
authorization requirements
Ambulatory surgical center (ASC)
authorization requirements
benefits and limitations
hospital-based
authorization requirements
benefits and limitations
electronic claims submission
freestanding surgical centers
reimbursement
Americans with Disabilities Act
Anesthesia
administered by surgeon
anesthesiology/anesthesiologists
conversion factor
dental
anesthesia provided in a ASC/HASC
dental (general)
modifiers
monitored care
regional
reimbursement
time-based fees
services incidental to anesthesia
services incidental to surgery
services not incidental to anesthesia
services not incidental to surgery
Anesthesiology
medical direction
see Anesthesia
ANLL
see Acute nonlymphoblastic leukemia (ANLL)
Anterior temporal lobectomies 1 2
authorization requirements
Antibiotic desensitization
APN
see Advanced practice nurse (APN)
Apnea monitors 1 2
Appeals
120-day
administrative review 1 2
address 1 2
requirements
AIS appeals
allowed AIS appeals
authorization or prior authorization
claims filed prior to enrollment
clients eligible for Medicaid
disallowed AIS appeals
electronic
advantages of electronic appeal submission
disallowed electronic appeals
electronic submission
rejections
exceptions to claims filing deadlines
address
fair hearing
address
methods for appealing
paper
provider enrollment
submitted incorrectly
telephone appeals
time limits
ASC
see Ambulatory surgical center (ASC)
Assistant surgeons
Audiological testing
Audiometry/hearing services
Augmentative communication devices (ACDs)
authorization requirements
modifications
repairs
benefits and limitations
claims information
electronic claims submission
enrollment criteria
excluded items
modifications
prior authorization requirements
Prior Authorization Request for Augmentative Communication Devices
purchases or rental
replacement
purchases or rentals
reimbursement
repairs
replacement
Authorization/prior authorization 1 2
additional medical nutritional services
nutritional assessment, counseling, and products services
Prior Authorization Request for Additional Nutritional Assessment, Counseling, and Products
address
advanced practice nurse (APN)
ambulance
emergency air ambulance transportation
emergency ground transportation
nonemergency ground transportation
ambulatory surgical center (ASC)
anterior temporal lobectomies
appeals
augmentative communication devices (ACDs)
modifications
Prior Authorization Request for Augmentative Communication Devices (ACDs)
purchase and rental
repairs
replacement
authorization deadline calendar for 2007
authorization deadline calendar for 2008 1 2 3
authorization deadline calendar for 2009
authorization deadline calendar for 2010
Authorization Request for Extension of Outpatient Therapy (TP2)
Authorization Request for Hemophilia Blood Factor Products
authorizations
blood pressure devices and supplies
bone growth stimulators
bone marrow/stem cell transplants
bone-anchored hearing aid (BAHA)
certified registered nurse anesthetist (CRNA)
certified respiratory care practitioner
certified respiratory care practitioner (CRCP) 1 2
chemotherapy
cleft/craniofacial surgeries
clinician-directed care coordination services
Authorization Request for Non-Face-to-Face Clinician-Directed Care Coordination Services
cochlear implants
cranial molding orthoses
denials
dental
diagnostic procedures
orthodontia
preventive services
Prior Authorization Request for Dental or Orthodontia Services
therapeutic services
treatment in ASC/HASC
diabetic equipment and supplies
diagnostic radiology services
diapers, pull-ups, briefs, or liners
diapers, pull-ups, underpads, briefs, or liners
durable medical equipment (DME) 1 2 3
adaptive strollers
car seats
continuous passive motion device
custom commode chair
enuresis alarms
foot rest
gait trainers
gastrostomy devices
heavy-duty commode chair
hospital beds
hospital cribs and enclosed beds
hygiene equipment
mobile commode chair
Prior Authorization and Authorization Request for Durable Medical Equipment (DME)
replacement pail or pan
standers, prone or supine
stationary commode chair
travel chairs
wheelchairs
electrodiagnostic (EDX) testing
expendable medical supplies
fair hearing
general information
glucose monitors
hearing services
home health (skilled nursing) 1 2
hospice
Prior Authorization Request for Hospice Services
hospital
inpatient behavioral health
hospital inpatient/outpatient
hospital, inpatient
Prior Authorization Request for Inpatient Hospital Admission
rehabilitation
immunizations 1 2
inpatient admission
after hours
inpatient behavioral health
Prior Authorization Request for Inpatient Psychiatric Care
inpatient rehabilitation services
Prior Authorization Request for Inpatient Rehabilitation Admission
insulin pumps
limitations
magnetic resonance imaging (MRI)
medical foods 1 2
medical nutritional counseling services
medical nutritional products
formulary
medical nutritional services
counseling
medical foods
Prior Authorization Request for Medical Foods
products
neurostimulator devices and supplies
Omalizumab
Authorization Request for Omalizumab
oral surgery procedures
orthotic and prosthetic devices
outpatient hospital
outpatient physical therapy and occupational therapy
physician 1 2
podiatry
prescription shoes
Prior Authorization Request for Chest Physiotherapy Devices
Prior Authorization Request for Inpatient Surgery-For Surgeons Only
Prior Authorization Request for Outpatient Surgery-For Outpatient Facilities and Surgeons
prior authorizations
radiation therapy services
stereotactic radiosurgery
radiation therapy services
reconstructive and cosmetic procedures
reduction mammoplasty
renal (kidney) transplants
renal dialysis 1 2
Prior Authorization Request for Renal Dialysis Treatment
respiratory equipment
Authorization Request for Apnea Monitor
Prior Authorization Request for Pulse Oximeter Devices
Prior Authorization Request for Respiratory Care-CRCP
respiratory equipment and supplies
respiratory syncytial virus
Prior Authorization Request for Palivizumab (Synagis) 1 2
respiratory syncytial virus (RSV) 1 2
rhizotomy
services that require authorization
services that require prior authorization
specialty team/center 1 2
speech-language pathology (SLP) services
stem cell transplant
submitting a prior authorization request
submitting a request
surgery
Prior Authorization Request for Inpatient Surgery-For Surgeons Only
Prior Authorization Request for Outpatient Surgery-For Outpatient Facilities and Surgeons
telemedicine services
therapeutic apheresis
total parenteral nutrition (TPN)
transportation
deceased client
vision related services 1 2 3 4
Authorizations
see Authorization/prior authorization
Automated inquiry system (AIS)
claim corrections
services provided
User's Guide
verifying client eligibility
B
Bacille Calmette-Guérin (BCG)
Banner messages
Banner pages
BCG
see Bacille Calmette-Guérin
Bi-level positive airway pressure (BiPAP) systems 1 2
Bilateral procedures
Billing clients
BiPAP
see Bi-level positive airway pressure (BiPAP) systems
Blood factor products 1 2
inpatient/outpatient
benefits and limitations
procedure codes
Blood pressure devices and supplies
authorization requirements
benefits and limitations
claims information
diagnosis codes
documentation of receipt
enrollment
reimbursement
Blue Cross Blue Shield
nonparticipating physicians
Bone growth stimulators
internal
noninvasive
ultrasound
prior authorization requirements
Bone marrow/stem cell transplants 1 2
authorization requirements
physician reimbursement
Bone-anchored hearing aid (BAHA)
prior authorization requirements
reimbursement
Botulinum toxin, types A and B
type A diagnosis codes
type B diagnosis code
Breast reconstruction
Bus transportation (deceased clients)
authorization requirements
benefits and limitations
C
Calendars
authorization and filing deadline calendar for 2008 1 2
authorization and filing deadline calendar for 2009 1 2
authorization and filing deadline calendar for 2010 1 2
fair hearing and administrative review 1 2 3
Cancer screening
benefits and limitations
colorectal diagnosis codes
procedure codes
Canes
CAPD
see Continuous ambulatory peritoneal dialysis (CAPD)
Car seats
prior authorization requirements
Cardiac blood pool imaging
Cardiorespiratory (apnea) monitors
Casting
CBC
see Complete blood count (CBC)
CCPD
see Continuous cycling peritoneal dialysis (CCPD)
Cerebrovascular accident (CVA) 1 2 3
Certificate
independent laboratory waiver
physician-performed microscopy procedure
Certified registered nurse anesthetist (CRNA)
authorization requirements
benefits and limitations
claims information
electronic claims submission
enrollment
reimbursement
Certified respiratory care practitioner (CRCP)
authorization requirements 1 2 3
claims information
electronic claims submission
enrollment criteria
reimbursement
CHAMPUS/CHAMPVA
Chemistry tests
Chemotherapy
authorization requirements
benefits and limitations
inpatient/outpatient
benefits and limitations
procedure codes
Child support
Children's Health Insurance Program of Texas (CHIP)
eligibility
CHIP
see Children's Health Insurance Program of Texas (CHIP)
Cidofovir
Circumcision
Claim number, explanation
Claim refunds
Claim reissues
Claim status inquiry (CSI)
Claim voids
Claims
accidents
third-party liability
processed by the Vendor Drug Program
Claims filing
ADA Dental Claim Form
adjustments
billing 1 2
CMS-1450
dates on claims
deadlines
exceptions
extensions
fiscal agent payment
dental emergency claims
dental paper billing
electronic claims submission 1 2
exception requests
exceptions, holiday or weekend
hospital
inpatient claims
interim claims
outpatient claims
hospital-based ambulatory surgical center (HASC) claims
incomplete information
inpatient claims
laboratory tests
outpatient claims
processed by date of service
refunds
span dates
TMHP processing procedures
when a service is a benefit of Medicare
Claims filing instructions
ADA Dental Claim Form
CMS-1450
CMS-1500
deadlines
dental
DSHS
modifier requirements
multipage claim forms
processed by date of service
provider types and selection of claim forms
TMHP
TPR
Claims in process
Claims information
advanced practice nurse (APN)
ambulance emergency air transportation
ambulance emergency ground transportation
ambulance nonemergency ground transportation
augmentative communication devices (ACDs)
blood pressure devices and supplies
certified registered nurse anesthetist (CRNA)
certified respiratory care practitioner (CRCP)
dental 1 2
diabetic equipment and supplies
diagnostic radiology services
durable medical equipment (DME)
expendable medical supplies
hearing services
home health (skilled nursing)
hospice
hospital
laboratory services
medical foods
medical nutritional counseling services
medical nutritional products
neurostimulator devices and supplies
occupational therapy
orthodontics
orthotic and prosthetic devices
outpatient
behavioral health
physical therapy
physician
group billing procedure
radiation therapy services
reimbursement
national drug codes (NDC)
renal dialysis
respiratory equipment
speech-language pathology (SLP) services
substitute physician
total parenteral nutrition (TPN)
transportation of remains of deceased clients
vision-related services
Claims payment summary
claims - paid or denied
claims in process
EOB codes appendix
Cleft lip/palate
Cleft/craniofacial center team approval requirements
Cleft/craniofacial surgery
authorization requirements
benefits and limitations
physician
surgical procedures
CLIA
see Clinical Laboratory Improvement Amendments (CLIA) of 1988
Client benefits
claims processed by the Vendor Drug Program
Medical Transportation Program
program limitations and exclusions
services provided outside Texas
Client eligibility 1 2
CHIP/CSHCN benefits
financial eligibility criteria
Medicaid/CSHCN benefits
Medically Needy Program (MNP)
claims filing
provider assistance to clients
spend down processing
renal dialysis
telephone appeals
verifying
Clients eligible for Medicaid
Medically Needy Program (MNP)
Clinical brachytherapy (radiation therapy)
procedure codes
Clinical brachytherapy (surgery)
procedure codes
Clinical Laboratory Improvement Amendments (CLIA) of 1988
regulations
requirements 1 2
Clinical laboratory services
outpatient services
Clinical pathology services
Clinical treatment
planning
Clinician-directed care coordination services
authorization requirements
benefits and limitations
face-to-face
non-face-to-face
CML
see Chronic myelogenous leukemia (CML)
CMS-1500
claim form example
claim form instructions
Cochlear implant
postsurgery rehabilitation
authorization requirements
Cochlear implants 1 2
authorization requirements
benefits and limitations 1 2
sound processor replacement
Codes
coding
diagnosis coding
procedure coding
CPT
HCPCS
ICD-9-CM
Colorectal cancer screening
Commode chair
heavy duty
authorization requirements
level 1 stationary
prior authorization requirements
level 2 mobile
prior authorization requirements
level 3 custom
prior authorization requirements
replacement pail or pan
authorization requirements
Complete blood count (CBC) 1 2
Computed tomography (CT) scan 1 2 3
Confidential information
release of
Consultations
Contact information
CSHCN regional offices
CSHCN telephone and fax communication
TMHP Contact Center
TMHP-CSHCN regional representatives
TMHP-CSHCN Services Program Contact Center
Continuous ambulatory peritoneal dialysis (CAPD) 1 2 3 4 5 6
Continuous cycling peritoneal dialysis (CCPD) 1 2 3 4 5
Continuous positive airway pressure (CPAP) systems 1 2
Controlled dose inhalation drug delivery system
Corrections and resubmissions (appeals)
time limits
Cosurgery
Cough stimulating devices
CPAP
see Continuous positive airway pressure (CPAP) systems
CPT codes
see Codes
Cranial molding orthoses
Craniofacial anomaly
CRCP
see Certified respiratory care practitioner (CRCP)
Critical care 1 2
intensive (noncritical) low birth weight services
newborn resuscitation critical care services
pediatric services
CRNA
see Certified registered nurse anesthetist (CRNA)
Crutches
CSHCN
central and regional offices
Eligibility Form
program history
Provider Manual
regional offices
Region 1
Region 11
Region 2
Region 3
Region 4
Region 5 North
Region 5 South and 6
Region 7
Region 8
Region 9 and 10
CSI
see Claim status inquiry (CSI)
CT
see Computed tomography (CT) scan
Custom DME
car seats
travel restraints
see Durable medical equipment (DME)
CVA
see Cerebrovascular accident (CVA)
Cytogenetics testing for leukemia and lymphoma
Cytopathology
sites other than vaginal, cervical, and uterine
studies
vaginal, cervical, and uterine sites
D
Darbepoietin
diagnosis codes 1 2
Dates on claims
Day surgery
inpatient stays
Denials
authorization/prior authorization
verbal 1 2
Denileukin diftitox
Dental
adjunctive general services
procedure codes
anesthesia (general)
anesthesia provided in an ASC/HASC
Criteria for Dental Therapy Under General Anesthesia
anesthesia provided in an office setting
procedure codes
benefits and limitations
claims filing information 1 2
electronic billing
emergency claims
instructions
paper billing
dental treatment in ASC/HASC
anesthesia
dental rehabilitation or restoration services
diagnostic procedures
clinical oral evaluation
first dental home
prior authorization requirements
radiographs or diagnostic imaging
tests and oral pathology procedures
diagnostic services
doctor of dentistry services as a limited physician
anesthesia
cleft/craniofacial surgery
evaluation and management
laboratory
surgery
surgical procedure codes
X-ray
enrollment
implants
procedure codes
maxillofacial prosthetics
procedure codes
noncovered counseling services
dental nutrition counseling
tobacco counseling
oral and maxillofacial surgery
procedure codes
orthodontia services
local codes
prior authorization requirements
Prior Authorization Request for Dental or Orthodontia Services
required documentation
periodontic services
procedure codes
preventive services
authorization requirements
benefits and limitations
dental prophylaxis and topical fluoride treatment
noncovered counseling services
oral hygiene instruction
sealants
space maintainers
prior authorization requirements
prophylaxis and topical fluoride treatment
procedure codes
prosthetic services, fixed
procedure codes
prosthodontic services, fixed
procedure codes
prosthodontics (removable) and maxillofacial prosthetics
procedure codes
pulp caps
procedure codes
reimbursement
tooth identification and surface identification systems
restorations
procedure codes
root canals
procedure codes
screening
supernumerary tooth identification
therapeutic services
adjunctive general services
anesthesia
authorization requirements
interrupted treatment plan
dental behavior management
endodontics
pulp caps
root canals
implants
internal bleaching of tooth
maxillofacial prosthetics
oral and maxillofacial surgery
periodontics
prior authorization requirements
prosthodontics (removable) and maxillofacial prosthetics
prosthodontics, fixed
restorations
treatment in ASC/HASC
authorization requirements
treatment in hospitals
Diabetic equipment and supplies
authorization requirements
benefits and limitations
claims information
enrollment
glucose monitors
insulin pumps
reimbursement
Diabetic supplies
Diabetic supplies and equipment
documentation of receipt
Diagnosis codes
adalimumab
allogenic transplants
ambulatory electroencephalogram (EEG)
autologous transplants
blood pressure devices and supplies
botulinum toxin type A
botulinum toxin type B
cancer screening, colorectal
clubfoot casting
darbepoietin 1 2
denileukin diftitox
dorsal column neurostimulation (DCN)
electroencephalogram (EEG) (ambulatory)
electromyography (EMG)
epirubicin hydrochloride
erythropoietin alfa (EPO) 1 2
extracorporeal shock wave lithotripsy
gamma globulin
glucose monitors
granisetron hydrochloride
high frequency chest wall compression system (HFCWCS)
ibutilide fumarate
infliximab
intracranial neurostimulation (ICN)
intraoperative echography
multiple latency test
orthodontia
pediatric pneumogram
polysomnography
porfimer sodium
positron emission tomography
renal dialysis
respiratory syncytial virus (RSV) prophylaxis
cardiac
congenital airway anomalies
rhizotomy
septoplasty 1 2
stem cell transplants
Strontium 89
therapeutic apheresis
Topotecan HCL
total parenteral nutrition (TPN)
Trastuzumab
vision examinations 1 2
vision related services
Diagnosis coding
Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV)
Diagnostic dental procedures
clinical oral evaluation
first dental home
prior authorization requirements
radiographs or diagnostic imaging
tests and oral pathology procedures
Diagnostic dental services
Diagnostic radiology services
authorization requirements
benefits and limitations
cardiac blood pool imaging
claims filing
computed tomography (CT) scan
contrast material
enrollment
hospital
magnetic resonance angiography (MRA)
magnetic resonance imaging (MRI) 1 2
noncovered
positron emission tomography (PET)
provided by hospitals
provided by physician or at physician offices or clinics
abdominal flat plates
provided by physician, APN, physician groups, and clinics
reimbursement
radiologist
provided by or at an ASC/HSCS
X-rays and ultrasounds
Diapers
Prior Authorization Request for Diapers, Pull-ups, Briefs, or Liners
Diapers, briefs, pull-ups, or liners
Direct supervision
DME
see Durable medical equipment (DME)
DO
see Doctor of osteopathy
Docetaxel
Doctor of dentistry services as a limited physician
anesthesia
cleft/craniofacial surgery
procedure codes
evaluation and management
laboratory procedures
X-ray procedures
Doctor of osteopathy
Documentation of receipt
blood pressure devices and supplies
diabetic supplies and equipment
orthotic and prosthetic devices
Documentation requirements
medical records
Dorsal column neurostimulation (DCN)
diagnosis codes
procedure codes
DSHS Health Region map
DSM-IV
see Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision
DTaP-IPV-Hib vaccine (Pentacel)
vaccines and toxoids
DTaP-IPV-Hib (Pentacel)
Durable medical equipment (DME)
adaptive feeder seats
adaptive strollers
authorization requirements
ambulation aids
ambulation belts
authorization
Prior Authorization and Authorization Request for Durable Medical Equipment (DME)
authorization requirements
benefits and limitations
canes
car seats
prior authorization requirements
car seats and travel restraints
claims filing
claims information
cochlear implant
authorization requirements
cochlear implants 1 2
commode chair
prior authorization requirements
continuous passive motion device
authorization requirements
crutches
custom commode chair
authorization requirements
custom DME
documentation of receipt
Documentation of Receipt form
Documentation of Receipt form (Spanish)
enrollment
custom DME
Enuresis alarms
prior authorization requirements
foot rest
authorization requirements
gait
gait trainers
authorization requirements
gastrostomy devices
authorization requirements
nonobturated
obturated
heavy-duty commode chair
authorization requirements
hospital beds
authorization requirements
hospital beds (manual and electric)
hospital cribs and enclosed beds
prior authorization requirements
hygiene equipment
authorization requirements
infusion pumps
mobile commode chair
authorization requirements
modifier requirements
noncovered rehabilitative and therapeutic DME
portable hydrocollator units
portable paraffinn units
portable wheelchair ramps
pressure reducing pads
program overview and guidelines 1 2
prone/supine standers
authorization requirements
reimbursement
repairs and modifications
replacement pail or pan
authorization requirements
respiratory equipment
enrollment
standard DME
standard wheelchairs
standers, prone and supine
authorization requirements
TENS units
transfer boards
travel chairs
prior authorization requirements
walkers
wheelchairs
authorization requirements
custom manual wheelchairs
manual wheelchairs
positioning equipment
power wheelchairs
approval criteria
ramps
Wheelchair Seating Evaluation Form
Dysphagia (swallowing disorder)
E
E/M
see Evaluation and management (E/M) services
ECG
see Electrocardiogram (ECG)
Echoencephalography
EDI
see Electronic Data Interchange (EDI)
EEG
see Electoencephalogram (EEG)
EFT
see Electronic funds transfer (EFT)
Electrocardiogram (ECG)
Electrodiagnostic (EDX) testing
authorization requirements
benefits and limitations
inpatient/outpatient
benefits and limitations
Electroencephalogram (EEG) (ambulatory)
benefits and limitations
diagnosis codes
procedure codes
Electromyography (EMG)
diagnosis codes
procedure codes 1 2
Electronic analysis for implantable neurostimulators
procedure codes
Electronic claim submission
Electronic Data Interchange (EDI)
electronic submitters
automated maintenance process
electronic transmission reports
forms
gaining access
getting help
overview
services available
submitting claims
supported file types
TexMedConnect
third-party billing agents
third-party vendor implementation
TMHP website
training
vendor software
Electronic funds transfer (EFT) 1 2 3 4
advantages
enrollment procedures
Electronic Remittance and Status (ER&S) report
Electronic Remittance and Status (ER&S) Agreement
Electronic transmission reports
Eligibility Form sample
Eligibility verification (EV)
client
Medicaid
Embalming
authorization requirements
benefits and limitations
Emergency air ambulance transportation
Emergency ground ambulance transportation
Emergency Medical Transportation and Labor Act (EMTALA) 1 2
Emergency services
benefits and limitations
defined 1 2
emergency room
hospital emergency room
hospital-based emergency department
observation room
prolonged physician services
EMG
see Electromyography (EMG)
EMTALA
see Emergency Medical Transportation and Labor Act
Enrollment
advanced practice nurse (APN)
ambulance
augmentative communication devices (ACDs)
blood pressure devices and supplies
certified registered nurse anesthetist (CRNA)
certified respiratory care practitioner (CRCP)
dental/orthodontia
diabetic equipment and supplies
diagnostic radiology services
durable medical equipment (DME) 1 2
custom DME
electronic funds transfer (EFT)
expendable medical supplies
hearing services
home health (skilled nursing)
hospice
hospital
laboratory services
medical foods
medical nutritional services
counseling
neurostimulator devices and supplies
occupational therapy
orthotic and prosthetic devices
outpatient behavioral health
outpatient physical therapy
physician
independent practices
specialty team/center
substitute
radiation therapy
renal dialysis
respiratory equipment
specialty team/center
speech-language pathology (SLP) services
TMHP-CSHCN address
total parenteral nutrition (TPN)
vision related services
Enuresis alarms
prior authorization requirements
EOB
see Explanation of benefits 1 2
see Explanation of benefits (EOB)
EOPS
see Explanation of pending status (EOPS)
Epirubicin hydrochloride
EPO
see Erthropoietin Alfa (EPO)
Epoprostenol
ER&S
see Electronic Remittance and Status (ER&S) Report
Erythropoietin alfa (EPO)
diagnosis codes 1 2
ESWL
see Extracorporeal shock wave lithotripsy (ESWL)
EV
see Eligibility verification (EV)
Evaluation and management (E/M) services
benefits and limitations
consultations
emergency services
initial and subsequent hospital care
inpatient professional services
new or established patient visits
observation room services
office and outpatient services
prolonged physician services
Excluded orthoses
Expendable medical supplies
authorization requirements
benefits and limitations
claims information
diapers, pull-ups, and liners
enrollment
examples of covered supplies
gastrostomy devices
reimbursement
Explanation of benefits (EOB) 1 2 3 4
codes appendix
Explanation of pending status (EOPS) 1 2
Extracorporeal shock wave lithotripsy (ESWL)
Eye prostheses
F
Fair hearing
Fair hearing requests
authorizations
prior authorizations
Family nurse practitioner (FNP)
enrollment
Fees
global
lab handling
Ferritin and iron studies
Filing deadlines
120-day
90-day
95-day 1 2
calendars 1 2 3 4 5 6
exceptions
fair hearing and administrative review calendars 1 2 3
third-party resources
Financial transactions
void and stop
Fiscal agent payment deadline
Fluocinolone acetonide intravitreal implant (Retisert)
inpatient/outpatient
benefits and limitations
Foot rest
authorization requirements
Form instructions
Authorization Request for Apnea Monitor Rental
Authorization Request for Extension of Outpatient Therapy (TP2)
Authorization Request for Hemophilia Blood Factor Products
Authorization Request for Non-Face-to-Face Clinician-Directed Care Coordination Services
Authorization Request for Omalizumab
Authorization Request for Outpatient Therapy (TP1), Initial
Home Health (Skilled Nursing) Referral and Treatment Plan
Instructions for Completing the Provider Information Change Form
Physician/Dentist Assessment Form (PAF) Instructions
Physician/Dentist Assessment Form (PAF) Instructions (Spanish)
Prior Authorization Request for Additional Nutritional Assessment, Counseling, and Products
Prior Authorization Request for Augmentative Communication Devices (ACDs)
Prior Authorization Request for Bone Marrow, Stem Cell, or Renal Transplant
Prior Authorization Request for Chest Physiotherapy Devices
Prior Authorization Request for Dental or Orthodontia Services
Prior Authorization Request for Diapers, Pull-ups, Briefs, or Liners
Prior Authorization Request for Durable Medical Equipment (DME)
Prior Authorization Request for External Insulin Pump
Prior Authorization Request for Hospice Services
Prior Authorization Request for Inpatient Hospital Admission
Prior Authorization Request for Inpatient Psychiatric Care
Prior Authorization Request for Inpatient Rehabilitation Admission
Prior Authorization Request for Inpatient Surgery-For Surgeons Only
Prior Authorization Request for Medical Foods
Prior Authorization Request for Outpatient Surgery-For Outpatient Facilities and Surgeons
Prior Authorization Request for Palivizumab (Synagis) 1 2
Prior Authorization Request for Pulse Oximeter Devices
Prior Authorization Request for Renal Dialysis Treatment
Prior Authorization Request for Respiratory Care-CRCP
Wheelchair Seating Evaluation Form
Forms
Authorization and Prior Authorization Request
Authorization Request for Apnea Monitor Rental
Authorization Request for Extension of Outpatient Therapy (TP2)
Authorization Request for Hemophilia Blood Factor Products
Authorization Request for Non-Face-to-Face Clinician-Directed Care Coordination Services
Authorization Request for Omalizumab
Authorization Request for Outpatient Therapy (TP1), Initial
Claim Status Inquiry (CSI) Authorization
Criteria for Dental Therapy Under General Anesthesia
Criteria for Dental Therapy Under General Anesthesia, Attachment 1
Department of State Health Services Form to Release CSHCN Services Program Claims History 1 2
Documentation of Receipt
Documentation of Receipt (Spanish)
Electronic Funds Transfer (EFT) Information and Authorization Agreement
Electronic Remittance and Status (ER&S) Agreement
Home Health (Skilled Nursing) Referral and Treatment Plan
Physician/Dentist Assessment Form (PAF)
Prior Authorization and Authorization Request for Durable Medical Equipment (DME) 1 2
Prior Authorization Request for Additional Nutritional Assessment, Counseling, and Products 1 2
Prior Authorization Request for Augmentative Communication Devices
Prior Authorization Request for Augmentative Communication Devices (ACDs)
Prior Authorization Request for Bone Marrow, Stem Cell, or Renal Transplant
Prior Authorization Request for Chest Physiotherapy Devices
Prior Authorization Request for Dental or Orthodontia Services 1 2
Prior Authorization Request for Diapers, Pull-ups, Underpads, Briefs, or Liners
Prior Authorization Request for External Insulin Pump
Prior Authorization Request for Hospice Services
Prior Authorization Request for Inpatient Hospital Admission
Prior Authorization Request for Inpatient Psychiatric Care
Prior Authorization Request for Inpatient Rehabilitation Admission
Prior Authorization Request for Medical Foods
Prior Authorization Request for Outpatient Surgery-For Outpatient Facilities and Surgeons
Prior Authorization Request for Palivizumab (Synagis) 1 2
Prior Authorization Request for Pulse Oximeter Devices
Prior Authorization Request for Renal Dialysis Treatment
Prior Authorization Request for Respiratory Care-CRCP
Provider Information Change Form
Refund Information Form
Reimbursement Request for Transportation of the Remains of Deceased Clients
Specialist or Subspecialist Telephone Consultation Form for Non-Face-to-Face Clinician-Directed Care Coordination Services
Tort Response Form
Vision Care Eyeglass Client Certification Form
Vision Care Eyeglass Client Certification Form (Spanish)
Wheelchair Seating Evaluation Form
Formula
Freestanding ambulatory surgical centers
electronic claims submission
G
Gait
Gait trainers
authorization requirements
Gamma globulin
diagnosis codes
Gastrostomy devices 1 2
authorization requirements
benefits and limitations
electronic claims submission
Genetic services 1 2
electronic claims submission
Global fees
anesthesiologists
surgeons
Glucose monitors
diagnosis codes
prior authorization requirements
Granisetron hydrochloride
Group
billing procedure
practices
practices enrollment
Gynecological
cytopathology studies
Pap smears
H
HASC
see Hospital-based ambulatory surgical center (HASC)
HBOT
see Hyperbaric oxygen therapy (HBOT)
HCPCS
see Healthcare common procedure coding system (HCPCS)
Health Insurance Portability and Accountability Act (HIPAA) 1 2 3 4 5
Health maintenance organization (HMO)
Healthcare common procedure coding system (HCPCS)
Level I codes
Level II codes
modifiers
place of service coding
Hearing aids
processed by Program for Amplification for Children of Texas (PACT)
Hearing services
audiological testing
authorization requirements
benefits and limitations
claims information
enrollment
reimbursement
see Audiometry
Helicobacter pylori (H. pylori)
physician
HFCWCS
see High frequency chest wall compression systems (HFCWCS)
High frequency chest wall compression systems (HFCWCS) 1 2 3 4 5 6
Hip orthoses (HO) 1 2
Hip, knee, ankle, and foot orthoses (HKAFO)
HIPAA
see Health Insurance Portability and Accountability Act (HIPAA)
HIV
see Human immunodeficiency virus (HIV)
HKAFO
see Hip, knee, ankle, and foot orthoses (HKAFO)
HLA
see Human leukocyte antigen (HLA)
HO
see Hip orthoses (HO)
Home health (skilled nursing)
authorization requirements 1 2
Home Health (Skilled Nursing) Referral and Treatment Plan
benefits and limitations
claims filing
claims information
enrollment
reimbursement
Hospice
authorization requirements
benefits and limitations
claims filing
enrollment
prior authorization requirements
Prior Authorization Request for Hospice Services
reimbursement
Hospital
ambulatory surgical center (ASC)
authorization requirements
benefits and limitations
freestanding surgical center
authorization requirements
inpatient
outpatient
beds (manual and electric)
billing 1 2
blood factor products
change of ownership
chemotherapy
claims information
cribs and enclosed beds
prior authorization requirements
dental treatment in hospital/ambulatory surgical centers
authorization requirements
dental treatment in hospital/ambulatory surgical centers (HASCs)
diagnostic radiology services
eligibility
emergency inpatient hospital admissions
enrollment
inpatient
claims filing
hospital extensions
rehabilitation services
renal (kidney) transplants
stem cell transplants
inpatient behavioral health
authorization requirements
Prior Authorization Request for Inpatient Psychiatric Care
benefits and limitations
inpatient rehabilitation
authorization requirements
benefits and limitations
inpatient services
authorization requirements
benefits and limitations
inpatient/outpatient
authorization requirements
benefits and limitaitons
laboratory services 1 2
magnetic resonance angiography (MRA)
magnetic resonance imaging (MRI)
outpatient mental health services
outpatient services
authorization requirements
benefits and limitations
claims filing
hospital-based emergency services
observation
positron emission tomography (PET)
radiation treatment delivery/port films
rehabilitation services
Prior Authorization Request for Inpatient Rehabilitation Admission
reimbursement
hospital-based emergency services
inpatient services
outpatient services
renal (kidney) transplants
specialty team/center
stem cell transplants 1 2
Strontium-89
Technetium TC 99M
Hospital beds
authorization requirements
Hospital-based ambulatory surgical center (HASC)
claims filing
Hospital-based emergency department professional services
Human immunodeficiency virus (HIV) 1 2 3
Human leukocyte antigen (HLA) 1 2 3
Hydrochloride
diagnosis codes
Hygiene equipment
authorization requirements
Hyperbaric oxygen therapy (HBOT)
benefits and limitations
I
Ibutilide fumarate
ICN
see Internal control number (ICN)
IEP
see Individualized education plan (IEP)
Immune globulin
Immunizations
administrations fee
assessment
authorization requirements 1 2
benefits and limitations 1 2 3 4
noncovered vaccines/toxoids
reimbursement
reporting
Texas Vaccines for Children (TVFC) Program 1 2
vaccine information statement (VIS)
vaccines/toxoids
Incomplete claims
appeal deadlines
Independent laboratory
electronic claims submission
physician-performed microscopy procedure certificates
reimbursement
services
waiver certificate
Independent practices
Individualized education plan (IEP) 1 2
Infliximab
Information change requests
Infusion pumps
Inhalation therapy
see Aerosol treatments
Initial and subsequent hospital care
benefits and limitations
Injectable medications
benefits and limitations
botulinum toxin
cidofovir
darbepoietin
denileukin diftitox
docetaxel
epirubicin hydrochloride
epoprostenol
erythropoietin alfa (EPO)
granisetron hydrochloride
ibutilide fumarate
immune globulin
immunizations
infliximab
lioresal
porfimer sodium
rituximab
sumatriptan succinate
topotecan HCL
trastuzumab
valrubicin
Injection administration
benefits and limitations
Injections
billed by physician
modifiers
Inpatient
claims filing
hospital extensions
professional services
benefits and limitations
critical care
emergency services
hospital-based emergency department
initial and subsequent hospital care (nonintensive)
observation room services
rehabilitation services
Inpatient behavioral health
authorization requirements
benefits and limitations
Inpatient hospital services
Inpatient rehabilitation
authorization requirements
benefits and limitations
Inpatient stays
scheduled day surgery
Inpatient/outpatient
benefits and limitations
blood factor products
chemotherapy
electrodiagnostic (EDX) testing
fluocinolone acetonide intravitreal implant (Retisert)
Inpatient/outpatient benefits and limitations
laboratory services
Insulin pumps
Insulin Pumps
prior authorization requirements
Insurance Premium Payment Assistance Program (IPPA)
Intensity modulated radiation therapy (IMRT)
Intermittent peritoneal dialysis (IPD)
Intermittent positive pressure breathing (IPPB)
Internal control number (ICN)
International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM)
Intracranial neurostimulation (ICN)
diagnosis codes
procedure codes
Intracranial pressure monitoring
Intraocular lenses (IOL)
Intraoperative echography
diagnosis codes
IOL
see Intraocular lenses (IOL)
IPD
see Intermittent peritoneal dialysis (IPD)
IPPA
see Insurance Premium Payment Assistance Program (IPPA)
IPPB
see Intermittent positive pressure breathing (IPPB)
IRS levies
J
Juvenile rheumatoid arthritis (JRA) 1 2 3
K
Kidneys, ureters, and bladder (KUB)
Knee orthoses (KO)
Knee, ankle, and foot orthoses (KAFO)
L
Laboratory panel tests
complete blood count (CBC)
organ or disease
panel tests
Laboratory services
authorization requirements
benefits and limitations 1 2 3
chemistry tests
claims filing for lab tests
claims information
CLIA
clinical pathology
cytogenetics testing for leukemia and lymphoma
cytopathology of sites other than vaginal, cervical, and uterine
cytopathology of vaginal, cervical, and uterine sites
cytopathology studies
enrollment
ferritin and iron studies
handling fee
handling fees
Helicobacter pylori (H. pylori)
hospital
reimbursement
hospital laboratory services
independent laboratory
inpatient/outpatient benefits and limitations
latex sensitivity testing
organ or disease panels
panel tests
pathology consultation
physician
physician-owned laboratory services 1 2
reference labs
reimbursement 1 2
urinalysis
Laboratory tests
claims filing
Land transportation (deceased clients)
authorization requirements
benefits and limitations
Latex sensitivity testing
LBW
see Low birth weight (LBW)
LDL
see Low density lipoprotein (LDL)
Limitations and exclusions
Lioresal
Low birth weight (LBW)
Low density lipoprotein (LDL)
M
Magnetic resonance angiography (MRA) 1 2
abdomen
chest
head and/or neck
lower extremities
pelvis
Magnetic resonance imaging (MRI)
Magnetic resonance imaging (MRI)
authorization requirements
benefits and limitaitons
Manual pricing
reimbursement
Manufacturer's suggested retail price (MSRP) 1 2
Maximum allowable fee schedule
reimbursement
Medicaid
eligibility
spend down claims filing
Medical foods
authorization requirements 1 2
Prior Authorization Request for Medical Foods
benefits and limitations
electronic claims submission
enrollment 1 2
Medical nutritional counseling services
Prior Authorization Request for Additional Nutritional Assessment, Counseling, and Products
Prior Authorization Request for Nutritional Assessment, Counseling, and Products (Additional) 1 2
Medical nutritional products
authorization requirements
benefits and limitations
claims information
enrollment
Medical nutritional products and services
electronic claims submission
Medical nutritional services
authorization requirements
medical nutritional products formulary
enrollment
medical foods
medical foods
authorization requirements
benefits and limitations
claims information
enrollment
reimbursement
medical nutritional counseling services
authorization requirements 1 2
benefits and limitations
claims information
enrollment
reimbursement
medical nutritional products
authorization requirements 1 2
benefits and limitations
enrollment
reimbursement
medical nutritional products and services
Medical radiation physics, dosimetry, treatment devices, and special services
Medical record documentation requirements
Medical Transportation Program (MTP) 1 2
Medically Needy Program (MNP) 1 2
Medications
injectable
oral
Methylmalonic acidemia and maple syrup urine disease (MSUD) 1 2 3 4
MNP
see Medically Needy Program (MNP)
Modifier requirements for DME
Modifiers
ambulance
assistant surgeons
injections and oral medications
MRA
see Magnetic resonance angiography (MRA)
MRI
see Magnetic resonance imaging (MRI)
MSRP
see Manufacturer's suggested retail price (MSRP)
Mucus clearance valve
Multiple sleep latency test
Multiple surgeries
N
Natalizumab 1 2
National drug codes (NDC)
claims information
reimbursement
National provider identifier (NPI) 1 2
NCS
see Nerve conduction studies (NCS)
NDC
see National drug codes (NDC)
Nebulizers
Neonatal critical care services
Nerve conduction studies (NCS)
procedure codes 1 2
Neuromuscular electrical stimulation (NMES)
clients with spinal cord injuries (SCI)
muscle atrophy
procedure codes
Neurostimulator devices and supplies
authorization requirements
benefits and limitations
claims information
dorsal column neurostimulation (DCN)
enrollment
intracranial neurostimulation (ICN)
noncovered services
percutaneous electrical nerve stimulation (PENS)
reimbursement
sacral nerve stimulation (SNS)
supplies
transcutaneous electrical nerve stimulation (TENS
vagal nerve stimulation (VNS)
Neurostimulators
devices and supplies
neuromuscular electrical stimulation (NMES)
Neutron-beam delivery
New or established patient visits
Noncovered
benefits and limitations
rehabilitative and therapeutic DME
Noncovered devices
shoes or shoe inserts
Noncovered services
outpatient behavioral health services
reconstructive and cosmetic procedures
Nonemergency ground transportation
Nonobturated gastrostomy devices
O
Observation room services
benefits and limitations
Obturated gastrostomy devices
Occupational therapy (OT) 1 2 3 4 5 6 7
authorization requirements
benefits and limitations
Office procedures
surgery
Omalizumab
Authorization Request for Omalizumab
OMT
see Osteopathic manipulative treatment (OMT)
Online provider check amounts
Ophthalmology
benefits and limitations
intraocular lenses (IOL)
Vitrasert ganciclovir implant
Oral medications
benefits and limitations
modifiers
Oral surgery procedures
authorization requirements
Orthodontia
claims filing
diagnosis codes
local codes
prior authorization requirements
required documentation
Orthoses
Orthotic and prosthetic devices
authorization requirements
benefits and limitations
claims information 1 2
cranial molding orthoses
documentation of receipt
enrollment
excluded orthoses
eye prostheses
noncovered shoes or shoe inserts
orthoses
prescription shoes and lifts
prostheses
reimbursement
Osteopathic manipulative treatment (OMT) 1 2
benefits and limitations
OT
see Occupational therapy (OT)
Out-of-office services
benefits and limitations
physician
Out-of-state providers 1 2
Outpatient
claims filing
Outpatient (hospital)
authorization requirements
benefits and limitations
Outpatient behavioral health services
authorization requirements 1 2
benefits and limitations
claims information
electronic claims submission
enrollment
noncovered services
reimbursement
Outpatient hospital services
Outpatient observation
Outpatient physical therapy and occupational therapy
authorization requirements
Authorization Request for Outpatient Therapy (TP2), Extension
benefits and limitations
claims information
coordination with the public school system
enrollment
reimbursement
Outpatient services
Outpatient speech-language pathology (SLP) services
authorization requirements
benefits and limitations
claims information
coordination with the public school system
enrollment
reimbursement
Outpatient therapy
electronic claims submission
Oxygen concentrators
P
PACT
see Program for Amplification for Children of Texas (PACT)
PAF
see Physician/Dentist Assessment Form
Paid or denied claims
Pap smears
Pathology services
Payouts
Pediatric nurse practitioner (PNP)
enrollment
Pediatric pneumogram
Pentamidine aerosol
Percutaneous electrical nerve stimulation (PENS)
Personal supervision
PET
see Positron emission tomography
Phenylketonura (PKU) 1 2 3
Physical medicine 1 2
Physical therapy (PT)
benefits and limitations 1 2
Physician
after-hours services
allergy services
anesthesia
administered by surgeon
anterior temporal lobectomy
assistant surgeons
audiometry/hearing services
augmentative communication devices (ACDs)
authorization requirements
benefits and limitations
bilateral procedures
bone growth stimulators
bone marrow/stem cell transplants
casting
chemotherapy
authorization requirements
circumcision
claims information
group billing procedure
substitute physician
cleft/craniofacial procedures
CLIA requirements
clinician-directed care coordination services
benefits and limitations
face-to-face
non-face-to-face
clinician-directed care coordinaton services
authorization for nonface-to-face
cochlear implants
benefits and limitations
colorectal cancer screening
consultations
cosurgery
critical care services
intensive (noncritical) low birth weight
neonatal
newborn resuscitation
pediatric
cytogentics testing
documentation requirements
echoencephalography
electroencephalogram (EEG) (ambulatory)
electronic claims submission
emergency services
enrollment 1 2
independent practices
specialty team/center
substitute
evaluation and management (E/M) services
evaluation and management (E/M) services
emergency
emergency room
initial and subsequent hosptial care (nonintensive)
inpatient
new or established patients
observation room services
office and outpatient services
preventive care services
teaching physicians
extracorporeal shock wave lithotripsy
genetics
global fees
group practices
helicobacter pylori (H. pylori)
hyperbaric oxygen therapy (HBOT)
immunizations
authorization requirements
Bacille Calmette-Guérin
benefits and limitations 1 2
reimbursement
immunizations, noncovered
injections and oral medications
administration billed by a physician
botulinum toxin (type A and B)
cidofovir
clofarabine
denileukin diftitox
docetaxel
epirubicin hydrochloride
epoprostenol
erythropoietin alfa (EPO) and darbepoietin
granisetron hydrochloride
ibutilide fumarate
immune globulins
infliximab
lioresal
natalizumab 1 2
omalizumab
porfimer sodium
rituximab
sumatriptan succinate
topotecan HCL
trastuzumab
valrubicin
internal bone growth stimulators
intracranial pressure monitoring
intraoperative echography
laboratory services 1 2 3
cytopathology studies (gynecological, Pap smears)
handling fee
multiple surgeries
noncovered reconstructive and cosmetic procedures
noninvasive bone growth stimulators 1 2
office procedures
ophthalmological services
intraocular lenses (IOL)
vitrasert ganciclovir implant
ostepathic manipulative treatment (OMT)
outpatient hospital setting
physical medicine
physical therapy
podiatry
primary surgeons
prolonged services
psychological testing
reconstructive and cosmetic procedures
medical review requirements
reduction mammoplasty
referrals to other providers
reimbursement
renal (kidney) transplants
rhizotomy
second opinions
septoplasty
services incidental to surgery or anesthesia
sign language interpreting services
stem cell transplant 1 2
allogenic
autologous
substitute
supervision
surgery
telemedicine
therapeutic apheresis
transplants
unlisted surgical procedures
physician services
Physician/Dentist Assessment Form
PKU
see Phenylketonura
Place of service (POS)
see Place of service
Podiatry
authorization requirements
benefits and limitations
electronic claims submission
reimbursement
Polysomnography
Porfimer sodium
diagnosis codes
Portable hydrocollator units
Portable paraffin units
Positron emission tomography (PET) 1 2
Prescription shoes and lifts
Preventive care checkups
preventive health/medicine services
Preventive services
authorization requirements
benefits and limitations
dental prophylaxis and topical fluoride treatment
noncovered counseling services
dental nutrition counseling
tobacco counseling
noncovered dental counseling services
oral hygiene instruction
sealants
space maintainers
Primary surgeons
Prior authorization number (PAN)
Prior authorizations
Procedure codes
adjunctive general services
anesthesia
incidental services
nonincidental services
audiometric testing
augmentative communication devices (ACDs)
blood factor products 1 2
body and upper extremity
casts
splints
strapping
bone marrow transplants
botulinum toxin type A
breast reconstruction
cancer screening
cardiac blood pool imaging 1 2
cast removal or repair
chemotherapy
cleft and craniofacial procedures
clinical brachytherapy (radiation therapy)
clinical brachytherapy (surgery)
clinical treatment planning
critical care services
cytopathology, vaginal, cervical, and uterine sites 1 2
dental
anesthesia provided in an office setting
dental implants
dental restorations
dental surgery
dentist-physician
anesthesia
cleft/craniofacial surgery
evaluation and management
laboratory
X-ray
dorsal column neurostimulation (DCN)
dosimetry
electroencephalogram (EEG) (ambulatory)
electromyography (EMG) 1 2
electronic analysis for implantable neurostimulators
end stage renal disease (ESRD)
eye examinations and ophthalmoscopy or ophthalmological services
eye prostheses
gastrostomy devices
genetics
helicobacter pylori (H. pylori)
hospital beds (manual and electric)
immune globulins 1 2
immunizations
intracranial neurostimulation (ICN)
lenses
bifocal
contact
high-power
single vision
trifocal
lioresal
lower extremity
casts
splints
strapping
magnetic resonance angiography (MRA)
abdomen
chest
lower extremities
pelvis
maxillofacial prosthetics
medical radiation physics
neonatal critical care
nerve conduction studies (NCS) 1 2
neuromuscular electrical stimulation (NMES)
noncovered reconstructive and cosmetic services
occupational therapy
oral and maxillofacial surgery
oral surgery procedures
other vision services
outpatient behavioral health 1 2
outpatient physical therapy 1 2 3
periodontic services
physical medicine
positron emission tomography (PET)
pressure reducing pads
preventive care
prolonged physician services
prophylaxis and topical fluoride treatment
prosthetic services, fixed
prosthodontic services, fixed
prosthodontics (removable) and maxillofacial prosthetics
proton-beam delivery
pulp caps
radiation treatment delivery/port films
radiation treatment devices
radiation treatment management
reconstructive and cosmetic services requiring medical review
renal dialysis
supplies
renal transplant
rhizotomy 1 2 3
root canals
sacral nerve stimulation (SNS)
special lenses
special radiation services
special vision services
stereotactic radiosurgery
surgery
incidental services
nonincidental services
surgical procedures
total parenteral nutrition (TPN)
transcutaneous electrical nerve stimulation (TENS)
vaccines/toxoids
vagal nerve stimulation (VNS)
vision examination 1 2
waiver certificate
Procedure coding
CPT
modifiers
place of service (POS)
Program for Amplification for Children of Texas (PACT)
hearing aids
Program limitations and exclusions
Prolonged services
benefits and limitations
physician
Prone/supine standers
authorization requirements
benefits and limitations
Protective helmets
Proton- and neutron-beam delivery
Provider Agreement
Provider and principal information forms
Provider certification/assignment
Provider check amounts
online
Provider enrollment
appeals
changes in enrollment
cleft/craniofacial specialty teams
determinations
FQHCs and RHCs
general information
information change requests
out-of-state providers
Provider Agreement
provider and principal information forms
Provider Enrollment Application
provider's license
providers paid by DSHS-CSHCN
request for taxpayer identification number
requirements for cleft/craniofacial center team approval
transplant specialty centers
types of providers
Provider responsibilities
billing clients
general requirements
provider certification/assignment
release of confidential information
retention of records
utilization review
waste, abuse, and fraud
Provider types and selection of claim forms
Provider's license
Psychological testing
PT
see Physical therapy (PT)
Public school system
coordination with outpatient physical and occupational therapy
coordination with speech-language pathology (SLP) services
Pulse oximeters 1 2
R
R&S
see Remittance and Status (R&S) Reports
Radiation therapy services
authorization requirements
benefits and limitations
claims filing 1 2
clinical treatment management
proton- and neutron-beam delivery
clinical treatment planning
enrollment
intensity modulated radiation therapy (IMRT)
medical radiation physics, dosimetry, treatment devices, and special services
noncovered services
procedure code limitations
radiation treatment management and delivery
radioisotope therapy
reimbursement
stereotactic radiosurgery
authorization requirements
Strontium-89
Technetium TC 99M
Radiation treatment delivery/port films
Radioallergosorbent (RAST) 1 2 3
Radioisotope therapy
Radiologist
reimbursement
Radiology services
claims filing 1 2
see Diagnostic radiology services
Rail transportation (deceased clients)
benefits and limitations
RAST
see Radioallergosorbent (RAST)
Reciprocating gait orthoses (RGO)
Reciprocating gait orthoses (RGO)
Reconstructive and cosmetic procedures
authorization requirements
benefits and limitations
medical review requirements
noncovered
Record retention
Reduction mammoplasty
authorization requirements
benefits and limitations
Reference labs and handling fees
Referrals to other providers
Refunds
accident resources
other insurance
Refund Information Form
Regional anesthesia
Regional offices
DSHS
TMHP
Rehabilitation
inpatient claims filing
Reimbursement
advanced practice nurse (APN)
ambulance
anesthesia
time-based fees
anesthesiology
augmentative communication devices (ACDs)
blood pressure devices and supplies
bone marrow/stem cell transplants 1 2
bone-anchored hearing aid (BAHA)
certified registered nurse anesthetist (CRNA)
certified respiratory care practitioner (CRCP)
claims information
national drug codes (NDC)
clinical laboratory services
outpatient services
dental/orthodontia
diabetic equipment and supplies
diagnostic radiology services
durable medical equipment (DME)
expendable medical supplies
home health (skilled nursing)
hospice
hospital
hospital-based emergency services
inpatient services
laboratory
outpatient services
immunizations
laboratory services
manual pricing
maximum allowable fee schedule
medical nutritional services
medical foods
medical nutritional counseling services
medical nutritional products
medical services provided outside of Texas 1 2
neurostimulator devices and supplies
orthotic and prosthetic devices
out-of-state providers
outpatient behavioral health
outpatient physical therapy and occupational therapy
physician
podiatrists
radiation therapy services
renal dialysis
respiratory equipment
speech-language pathology (SLP) services
telemedicine services
Texas Medicaid Reimbursement Methodology (TMRM)
total parenteral nutrition (TPN)
transportation of remains of deceased clients
vision related services
Release of confidential information
Remittance and Status (R&S) reports
examples
accounts receivable
adjustments
backup withholding penalty information
banner page
claims - paid or denied
explanation of EOB messages
explanation of EOPS messages
IRS levy information
manual payouts
refunds
summary
system payouts
explanation of benefits (EOB) codes
explanation of row headings
explanation of section headings
financial transactions
void and stop
general formatting guidelines
general information
incomplete claims
IRS levies
payouts
stale-dated checks
voids and stops
Remittance and Status (R&S) Reports
accounts receivables
adjustments to claims
banner pages
claim refunds
claim reissues
claim voids
claims - paid or denied, incomplete claims
claims in process
claims payment summary
electronic
see Electronic Remittance and Status (ER&S) Report
Renal (kidney) transplants
authorization requirements
benefits and limitations
hospital
Renal dialysis
authorization requirements
benefits and limitations
claims filing
claims information
client eligibility
dialysis services
dialysis training
enrollment
evaluation and management
maintenance hemodialysis
method II (dealing direct)
prior authorization requirements
Prior Authorization Request for Renal Dialysis Treatment
reimbursement
ultrafiltration
Rentals
transcutaneous electrical nerve stimulation (TENS) device
Respiratory equipment
apnea monitors
Authorization Request for Apnea Monitor
benefits and limitations
rental or purchase
cardio respiratory (apnea) monitors
claims information
enrollment
high frequency chest wall compression systems (HFCWCS) 1 2
nebulizers
other unspecified equipment
oxygen concentrators
prior authorization requirements
Prior Authorization Request for Respiratory Care-CRCP
pulse oximeters 1 2
Prior Authorization Request for Pulse Oximeter Devices
reimbursement
suction equipment
tracheostomy tubes 1 2
Respiratory equipment and supplies
authorization requirements
benefits and limitations
bi-level positive airway pressure (BiPAP) systems
continuous positive airway pressure (CPAP) systems
controlled dose inhalation drug delivery system
mucus clearance valve
Respiratory syncytial virus (RSV)
authorization requirements
prior authorization requirements
Prior Authorization Request for Palivizumab (Synagis) 1 2
prophylaxis
Revenue codes
hospital
emergency services
RGO
see Reciprocating gait orthoses (RGO)
Rhizotomy
authorization requirements
Rituximab
S
Sacral nerve stimulation (SNS)
procedure codes
Second opinions
see Acquired immunodeficiency syndrome (AIDS)
Septoplasty
Services incidental to surgery or anesthesia
benefits and limitations
Services not incidental to surgery or anesthesia
benefits and limitations
Services outside of business hours
benefits and limitations
physician
Services provided outside of Texas
50 or fewer miles from Texas border
50 or more miles from Texas border
benefits and limitations
Sign language interpreting services
Skilled nursing
see Home health (skilled nursing)
Sleep studies
multiple sleep latency test
pediatric pneumogram
polysomnography
SLP
see Speech-language pathology (SLP) services
SO
see Spinal orthoses (SO)
Span dates
Specialty team/center
authorization requirements
enrollment
procedures
services
Speech-language pathology (SLP) services 1 2
authorization requirements
benefits and limitations
claims information
cochlear implants surgery
coordination with the public school system
dysphagia (swallowing disorder)
enrollment
reimbursement
Spend down processing
Medically Needy Program (MNP)
Spinal orthoses (SO)
Stale-dated checks
Standard DME
Standers, prone or supine
authorization requirements
Stem cell transplant
authorization requirements
Stereotactic radiosurgery
authorization requirements
Strontium-89
Suction equipment
Sumatriptan succinate
Supernumerary tooth identification
Surgery
anesthesia administered by surgeon
assistant surgeons
authorization requirements
Prior Authorization Request for Inpatient Surgery-For Surgeons Only
Prior Authorization Request for Outpatient Surgery-For Outpatient Facilities and Surgeons
benefits and limitations
bilateral procedures
bone growth stimulators
casting
circumcision
cleft/craniofacial by dentist physician
cochlear implants
cosurgery
extracorporeal shock wave lithotripsy
global fees
incidental services
internal bone growth stimulators
multiple surgeries
noninvasive bone growth stimulators 1 2
office procedures
primary surgeons
second opinions
septoplasty
services not incidental to surgery
unlisted surgical codes
Vitrasert ganciclovir implant
T
Team/center requirements
Technetium TC 99M tetrofosmin
Telemedicine services
authorization requirements
benefits/limitations
reimbursement
Telephone numbers
CSHCN regional offices
TMHP-CSHCN regional representatives
TMHP-CSHCN Services Program Contact Center 1 2
TENS
see Transcutaneous electric nerve stimulator (TENS)
Texas Family Code compliance
abuse and neglect reporting requirements
child support
Texas Health Steps (THSteps)
client eligibility
Comprehensive Care Program (THSteps-CCP)
outpatient behavioral health benefits
Texas Medicaid & Healthcare Partnership (TMHP)
Contact Center 1 2 3 4
Electronic Data Interchange (EDI)
appeal submission
provider enrollment
regional representatives
website
banner messages
file libraries
publications
online searches
Texas Medicaid Reimbursement Methodology (TMRM)
Texas State Board of Dental Examiners (TSBDE) 1 2
Texas Vaccines for Children (TVFC) Program 1 2
TexMedConnect
orthodontia claims
overview
Therapeutic apheresis
authorization requirements
Therapeutic services
adjunctive general services
procedure codes
anesthesia provided in an office setting
procedure codes
dental
anesthesia
behavior management
restorations
dental restorations
procedure codes
endodontics
procedure codes
pulp caps
root canals
implants
procedure codes
internal bleaching of tooth
interrupted treatment plan
maxillofacial prosthetics
procedure codes
oral and maxillofacial surgery
procedure codes
periodontics
procedure codes
prior authorization requirements
prosthetics, fixed
procedure codes
prosthodontics (removable) and maxillofacial prosthetics
procedure codes
prosthodontics, fixed
procedure codes
Therapy
hyperbaric oxygen (HBOT)
occupational
physical
speech-language pathology (SLP) services
Third-party liability
claims involving accidents
Third-party resources (TPR) 1 2
accident resources
accident-related claims
address 1 2
Blue Cross Blue Shield nonparticipating providers
claims filing
filing deadlines
health maintenance organization (HMO)
payment sources
refunds involving claims for accidents
refunds to TMHP resulting from other insurance
verbal denials
Third-party vendor implementation for TMHP EDI services
THKAO
see Thoracic hip, knee, and ankle orthoses (THKAO)
Thoracic hip, knee, and ankle orthoses (THKAO)
THSteps
see Texas Health Steps (THSteps)
THSteps-CCP
see THSteps-Comprehensive Care Program (THSteps-CCP)
TID
see Tooth identification (TID)
TMHP
see Texas Medicaid & Healthcare Partnership (TMHP)
TMRM
see Texas Medicaid Reimbursement Methodology (TMRM)
Tooth identification (TID) 1 2 3
surface identification
Topotecan HCL
Total parenteral nutrition (TPN) 1 2 3
authorization requirements
benefits and limitations
claims information
electronic claims submission
enrollment
reimbursement 1 2
TPN
see Total parenteral nutrition (TPN)
Tracheostomy tubes 1 2
Transcutaneous electric nerve stimulator (TENS)
Transcutaneous electrical nerve stimulation (TENS)
procedure codes
purchase
rental
Transfer boards
Transplant specialty centers
Transplants
allogenic transplants
autologous
renal (kidney) 1 2
authorization requirements
stem cell 1 2 3
authorization requirements
Transportation
ambulance
deceased client
air transportation
authorization requirements
benefits and limitations
bus transportation
claims information
embalming
land transportation
rail transportation
reimbursement
emergency air ambulance
authorization requirements
benefits and limitations
emergency ground ambulance
authorization requirements
benefits and limitations
nonemergency ground ambulance
authorization requirements
benefits and limitations
Trastuzumab
Travel chairs
prior authorization requirements
Travel restraints 1 2
TriCare (formerly CHAMPUS/CHAMPVA)
TSBDE
see Texas State Board of Dental Examiners (TSBDE)
TVFC
see Texas Vaccines for Children (TVFC) Program
U
UB04 (CMS 1450)
claim form instructions
example
Unlisted surgical procedures
Urinalysis
Utilization review
V
Vaccine information statement (VIS)
Vaccines/toxoids
authorization requirements
benefits and limitaitons 1 2
noncovered
procedure codes
reimbursement
Vagal nerve stimulation (VNS)
procedure codes
Valrubicin
Vendor Drug Program (VDP)
Verifying client eligibility
Very low birth weight (VLBW)
Vision related services
authorization requirements 1 2 3 4
benefits and limitations
bifocal lenses
contact lenses
electronic claims submission
enrollment
examinations
frames, lenses, and contact lenses
high-power lenses
ophthalmology
other services
reimbursement
single vision lenses
specialized lenses
trifocal lenses
Vision Care Eyeglass Client Certification Form
Vision Care Eyeglass Client Certification Form (Spanish)
Vitrasert ganciclovir implant
Vision-related services
claims information
Vitrasert ganciclovir implant
VLBW
see Very low birth weight (VLBW)
W
Waiting list information
Walkers
Waste, Abuse, and Fraud
Wheelchairs
authorization requirements
custom manual wheelchairs
manual wheelchairs
portable ramps
positioning equipment
power wheelchairs
approval criteria
ramps
standard
  
|