TMPPM 2008 > Texas Medicaid Services > Hospital (Medical/Surgical Acute Care Facility) > Inpatient

25.2.5 Claims Information

Claims for inpatient hospital services must be submitted to TMHP in an approved electronic format or on the UB-04 CMS-1450 claim form. Providers may purchase UB-04 CMS-1450 claim forms from the vendor of their choice. TMHP does not supply the forms.

When completing 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.

Hospitals may submit information only claims to TMHP when one of the following situations exists. Hospitals should use TOB 110 to file these claims:

•Inpatient 30-day spell of illness benefit is exhausted.

•Payment made by a third party resource/other insurance exceeds the Medicaid allowed amount.

Additional claims information can be found within individual topic areas in this section.

Refer to: "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" . Blocks that are not referenced are not required for processing by TMHP and may be left blank.