Electronic TexMedConnect Claims

All claims and encounters for clients at Title X clinics must have Title X checked in the Title X Payment Level section under the Patient tab of the electronic claim form. This selection ensures that the required fields on the claim form are completed. Electronic claims filed for services provided to clients eligible for Title V, XIX, or XX must have the Funding Source box to which the claim is billed (Family Planning Program Block) checked on the Patient tab. The level of practitioner, in the General section of the Claim tab of the electronic claim form, must also be selected by a clinic that uses Title X funds.

For Title X-only, the Title X box must be checked and the payment level must be selected in the Title X Payment Level block under the Patient tab. Depending on family size and income, the agency designates Title X clients as full pay, partial pay, or no pay for services. The Level of Practitioner in the General section of the Claim tab of the electronic claim form must also be selected.

Family Planning 2017 paper claim forms

Claims filed for services provided to clients eligible for Title V, XIX, or XX must have the funding source to which the claim is billed checked in Block 1 of the Family Planning 2017 claim form. Block 28, Level of Practitioner, must be completed for every Family Planning 2017 claim form submitted by a clinic that uses Title X funds.

For Title X-only, The payment level must be selected in the Title X Only section of Block 1a. Depending on family size and income, the agency designates Title X clients as full pay, partial pay, or no pay for services. Block 28, Level of Practitioner, must also be completed.

Other Electronic Claims (other than TexMedConnect)

Electronic claims that are not submitted through TexMedConnect must follow the specifications for electronic claim submission. Providers should contact their commercial software vendor or TMHP through the TMHP website at www.tmhp.com or call the TMHP Electronic Data Interchange (EDI) Help Desk at 1-888-863-3638 for more information.