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6.12 Other Insurance Claims Filing
The following information must be provided in the "Other Insurance" field on the paper claim and in the appropriate field of electronic claims. On the CMS-1500 paper claim form, Fields 9 or 11, and 29 must contain the appropriate information:
• Name of the other insurance resource
•Address of the other insurance resource
•Policy number and group number
•Policyholder
•Effective date if available
•Date of disposition by other insurance resource (used to calculate filing deadline)
•Payment or specific denial information
Important: Important: By accepting assignment on a claim for which the client has Medicaid coverage, providers agree to accept payment made by insurance carriers and Texas Medicaid when appropriate as payment in full. The client cannot be held liable for any balance or copays related to Medicaid-covered services.
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