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5.3.1.4 Verification of Medical Checkups
The first source of verification that a THSteps medical checkup has occurred is a paid claim or encounter. THSteps encourages providers to file a claim either electronically or on a CMS-1500 paperclaim form as soon as possible after the date of service (DOS), as the paid claim updates client information, including the Medicaid Identification (Form H0387).
A second source of acceptable verification is a physician's written statement that the checkup occurred. If the provider chooses to give the client written verification, it must include the client's name, Medicaid ID number, date of the medical checkup, and a notation that a complete THSteps medical checkup was performed.
Note: Verification of medical checkups must not be sent to THSteps but must be maintained by the client to be provided as needed by an HHSC eligibility caseworker.
If neither the first nor the secondary source of verification is available, a THSteps outreach worker may contact the provider's office for verification.
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