TMPPM 2008 > Texas Medicaid Services > Texas Medicaid (Title XIX) Home Health Services > Claims Information

24.8 Claims Information

Use only type of business (TOB) 331 in Form Locator (FL) 4 of the UB-04 CMS-1450. Other TOBs are invalid and result in claim denial.

Home Health services must be submitted to TMHP in an approved electronic format or on a CMS-1500 or a UB-04 CMS-1450 claim form. Submit home health DME and medical supplies to TMHP in an approved electronic format, or on a CMS-1500 or on a UB-04 CMS-1450 claim form. Providers may purchase UB-04 CMS-1450 and CMS-1500 claim forms from the vendor of their choice. TMHP does not supply them.

When completing a CMS-1500 or a UB-04 CMS 1450 claim form, 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.

Refer to: Section 3, "TMHP Electronic Data Interchange (EDI)." for information on electronic claims submissions.

"Claims Filing" for general information about claims filing.

"UB-04 CMS-1450 Claim Filing Instructions" .

"CMS-1500 Claim Filing Instructions" for instructions on completing paper claims. Blocks that are not referenced are not required for processing by TMHP and may be left blank.

The prior authorization number must appear on the UB-04 CMS-1450 claim in Block 63 and in Block 23 of the CMS-1500. The certification dates or the revised request date on the POC must coincide with the DOS on the claim. Prior authorization does not waive the 95-day filing deadline requirement.