Index

Index

A - B - C - D - E - F - G - H - I - J - L - M - N - O - P - Q - R - S - T - U - V - W - X

AAPD periodicity guidelines

Abatacept (Orencia)

DFPS Abuse Hotline

Accessories, durable medical equipment (DME) (home health)

see Third Party Resources (TPR)

items not covered

prior authorization

Acronym dictionary

Texas Medical Board registration department

Administrative appeals

cervical cancer

communicable disease reporting

hyperlipidemia, screening for

Adoption agencies

Advance directives

Advanced practice registered nurse (APRN)

benefits and limitations

Aerosol treatment 1 2

see Automated inquiry system (AIS)

Allergy immunotherapy

Allergy services

claim form examples 1 2 3

origin and destination codes

place of service codes

disposable supplies

emergency transport

extra attendant

emergency transport

Medicaid qualified Medicare beneficiary (MQMB)

Medicare denials

Medicare disposition

nonemergency transport

prior authorization 1 2 3

nonemergency transport

retroactive eligibility

types, definitions 1 2

qualified Medicare beneficiary (QMB)

reimbursement 1 2

subscription plans

transport multiple clients

transport types

air or specialized vehicle 1 2

not medically necessary

nursing facility

to or from state institutions

Ambulatory blood pressure monitoring

Ambulatory electroencephalogram (A/EEG)

Ambulatory surgical center (ASC)

American Society of Anesthesiologists (ASA) physical status

benefits and limitations

claim form example 1 2

claim form example (hospital-based)

cochlear implants

colorectal cancer screening

dental services

documentation requirements

drugs and supplies

electrodiagnostic (EDX) testing

fluocinolone acetonide

global services

implantable infusion pump

neurostimulators

New York Heart Association heart disease classifications

planned admission

prior authorization 1 2

reimbursement 1 2

stereotactic radiosurgery

incomplete procedures

administered by surgeon

claim form example

for labor and delivery

multiple procedures 1 2

pain management

physician services

provided by the surgeon

medical direction

monitored anesthesia care

prior authorization requirements

reimbursement methodology

Antibiotics and steroids

Antihemophilic factor

120-day appeal deadline exception

24-month payment deadline exception

95-day filing deadline exception

deadline exception requirements

deadline exceptions

automated inquiry system (AIS)

Business Records Affidavit Form

cost report settlements

electronic data interchange (EDI) rejections

inpatient hospital

medical necessity

Medicare crossovers

medical necessity denials

other insurance denial

authorization denials

PCCM DRG adjustments

submitted incorrectly

utilization review

continued stay denials

cost/day outlier denials

final technical denials

see Hearing services

Authorization requirements

electrodiagnostic (EDX) testing

Automated Inquiry System

Automated inquiry system (AIS)

disallowed appeals

Bacillus Calmette-Guérin (BCG)

for treatment of bladder cancer

Bariatric surgery

prior authorization requirements

Bathroom equipment

documentation requirements

hand-held shower wand

payable procedure codes

prior authorization

battery charger

Behavioral health

court-ordered and DFPS-directed services

electroconvulsive therapy (ECT)

family therapy/counseling services

Ambulatory (Outpatient) Substance Abuse Counseling Extension Request Form

Outpatient Psychotherapy/Counseling Request Form

Psychological/Neuropsychological Testing Request Form

inpatient services

prior authorization

psychological and neuropsychological testing services

mental health (MH) mental retardation (MR) 1 2

benefits and limitations

documentation requirements

mental health rehabilitation

rehabilitative services limitations

service coordination contact codes

non-covered services

outpatient services

annual encounter/visit limitations

prior authorization

pharmacological management services

documentation requirements

indications for

prior authorization

pharmacological regimen oversight

indications for

prior authorization

psychiatric diagnostic interviews

documentation requirements

domains of a clinical evaluation

prior authorization

psychological and neuropsychological testing

documentation requirements

prior authorization

psychotherapy/counseling

documentation requirements

initial outpatient

insight oriented behavior modification

prior authorization

subsequent outpatient

supportive outpatient

screening, brief intervention, and referral to treatment (SBIRT)

benefits and limitations

brief intervention

brief treatment

documentation requirements

referral to treatment

see also Licensed clinical social worker (LCSW)

see also Licensed marriage and family therapist (LMFT)

see also Licensed professional counselor (LPC)

see also Licensed psychological associate (LPA)

see also Physician

see also Psychologist

substance use disorder (SUD) services

documentation requirements

medication assisted therapy (MAT)

non-covered services

prior authorization

prior authorization

Benefits and limitations

birthing centers

home health services (DME)

Bilevel positive airway pressure system

prior authorization

prior authorization

with backup (such as BiPAP ST)

without backup (such as BiPAP S)

Billing clients

Medicaid spend down

Birthing center

birthing centers

documentation requirements

Medicaid managed care enrollment

newborn eligibility process

newborn hearing screening

prior authorization

provider enrollment

benefits and limitations

Blepharoplasty procedures

Blind Children's Vocational Discovery and Development Program (BCVDDP)

behavioral health

claim form example

documentation requirements

Blood glucose monitors (DME)

prior authorization

Blood pressure devices 1 2

prior authorization

hemoglobin type

Bone marrow aspiration

Botulinum toxin type A

Brachytherapy, radiation therapy

Medicaid for breast and cervical cancer (MBCC)

Breast cancer screening

prognostic breast cancer studies

Breast imaging studies

prior authorization

Breast reconstruction

bladder cancer, Bacillus Calmette-Guérin (BCG) for treatment

breast cancer screening

colorectal cancer screening

colonoscopies 1 2

sigmoidoscopies

Prognostic breast and gynecological cancer studies

Canes, crutches, walkers

Cardiac blood pool imaging 1 2

Cardiac nuclear imaging

Cardiopulmonary resuscitation (CPR)

Case Management for Children and Pregnant Women (CPW)

assistance with program concerns

behavioral health

benefits and limitations

claim form example

documentation requirements

prior authorization

referral process

technical assistance

Catheters, implantation

see Comprehensive Care Program

Certified nurse-midwife (CNM)

claim form example

Certified registered nurse anesthetist (CRNA)

benefits and limitations

claims filing 1 2

claim form example

interpreting the R&S report

reimbursement 1 2

Certified respiratory care practitioner (CRCP)

benefits and limitations

claim form example

documentation requirements

prior authorization

procedure codes

reimbursement 1 2

Cervical cancer

Medicaid for breast and cervical cancer (MBCC)

Cervical cancer screening

Change of ownership

Chelating agents

deferoxamine mesylate (Desferal)

edetate calcium disodium

edetate disodium

Chemical dependency

Chemical dependency treatment facility (CDTF)

procedure codes

Chest physiotherapy devices

Child Abuse Reporting Guidelines

Child Abuse Reporting Guidelines, Checklist for HHSC Monitoring

reporting sexual abuse

Children with Special Health Care Needs (CSHCN) Services Program

Children's hospitals

CHIP perinatal program

newborn transfer claims

Chiropractic services

benefits and limitations

claim form example

reimbursement 1 2

2010 filing deadlines

2011 filing deadlines

95-day filing deadline exceptions

ambulatory surgical center (ASC)

appeal deadlines

behavioral health

blank sample UB-04 CMS-1450

Blind Children's Vocational Discovery and Development Program (BCVDDP)

Case Management for Children and Pregnant Women (CPW)

certified respiratory care practitioner (CRCP)

CHIP perinatal newborn transfer claims

claim form example

certified respiratory care practitioner (CRCP)

physical therapy (PT)

skilled nursing visit 1 2

claim form examples

ambulance 1 2 3

Ambulatory surgical center (ASC) 1 2

Comprehensive Outpatient Rehabilitation Facility (CORF) (CCP Only)

Diagnosis and Treatment (Referral from THSteps Checkup)

Durable Medical Equipment (CCP Only)

Early Childhood Intervention (CCP Only)

Family Planning Services for Hospitals, FQHCs

FQHC Encounter (T1015)

hospital outpatient

hospital-based ambulatory surgical center (HASC)

independent laboratory

Inpatient Psychiatric Hospital/Facility (CCP Only)

Inpatient Rehabilitation Hospital (CCP Only)

medical nutritional counseling (CCP only)

office visit with lab and radiology

Orthotic and Prosthetic Services (CCP Only)

physical therapy (PT) (CCP Only)

portable X-ray supplier

Private Duty Nurses (CCP Only)

radiological and physiological laboratory

renal dialysis facility CAPD Training

renal dialysis facility CAPD/CCPD

renal dialysis facility CMS-1500

rural health clinic (RHC) (immunization)

rural health clinic (RHC) hospital-based

rural health clinic freestanding

School Health and Related Services (SHARS)

Speech-Language Pathologists (CCP Only)

THSteps Established Patient and Referral, TB Skin Test, and Physical Examination by a Physician

THSteps New Patient/Immunization, Physical Examination by a Nurse Practitioner, and FQHC Billing (medical checkup)

claim form requirements

clients with a designated provider

CMS-1500 instruction table

CMS-1500 instructions

type of service (TOS)

Crossover Claim Type 30 TMHP Standardized MRAN Form

Crossover Claim Type 30 TMHP Standardized MRAN Form instructions

Crossover Claim Types 31 and 50 TMHP Standardized MRAN form

Crossover Claim Types 31 and 50 TMHP Standardized MRAN form instructions

dental claim form instruction table

diagnosis coding

durable medical equipment (DME)

Early Childhood Intervention (ECI)

claim acceptance

family planning claims

provider check amounts

third-party billing agents

third-party software

expediting paper claims

family planning

Titles V, X, XX

Family Planning 2017 Claim Form instruction table

federally qualified health center (FQHC)

filing a Medicare-adjusted claim

filing a Medicare-denied claim

general information

group providers

gynecological services

health maintenance organization (HMO) copayments

hearing devices

hearing services

HHSC payment deadline

holidays extending deadlines

home health services 1 2

hospice clients

hospice lab and X-ray

hospital-based ambulatory surgical center (HASC)

instructions 1 2

radiological and physiological

licensed clinical social worker (LCSW)

licensed marriage and family therapist (LMFT)

licensed professional counselor (LPC)

Medically Needy Program (MNP)

Medicare advantage plans (MAP)

Medicare primary paper

Medicare/Medicaid deadlines

mental health (MH) mental retardation (MR)

modifier requirements

assistant surgery

interpretations

technical components

multipage claim forms

national drug code (NDC)

network hospitals

newborn claim hints

NorthSTAR Program

occupational therapy (OT) 1 2

occurrence codes

other insurance

other insurance credits

other insurance deductibiles

other insurance verbal denial

patient status codes

payment error rate measurement (PERM)

pharmacological management services

pharmacological regimen oversight

physical therapy (PT) 1 2

place of service (POS) coding

portable X-ray supplier

preferred provider organization (PPO)

prior authorization number (PAN)

procedure code levels

procedure coding

processing procedures

provider designations

provider signatures

Remittance and Status (R&S) Report

renal dialysis facility

retroactive client eligibility

rural health clinic (RHC)

sample blank CMS-1500

sample blank Family Planning 2017 Claim Form

sample dental claim form

screening, brief intervention, and referral to treatment (SBIRT)

specialist services

speech therapy (ST)

STAR Health Program

mental health rehabilitation

third party resources (TPR)

filing deadlines

forwarded other insurance claims

tips for outpatient claims

tuberculosis clinic

UB-04 CMS-1450 instruction table

UB-04 CMS-1450 instructions

vision claim form

vision services

Women's Health Program (WHP)

zero paid claims appeals

Claims filing instructions

home health services

Claims Resources

Client eligibility

CHIP perinatal program

deceased individuals

dual eligibility

Medicaid Buy-In (MBI) Program

Medicaid for breast and cervical cancer (MBCC)

Medicaid limited program 1 2

Medicaid qualified Medicare beneficiary (MQMB)

Medicare Part B Crossovers

Medicare/Medicaid

clients without QMB, MQMB status

contract with outside parties

qualified Medicare beneficiary (QMB)

renal dialysis facility

restricted Medicaid coverage

THSteps medical checkup

Medicaid Access Card

Medicaid ID 1 2

Women's Health Program (WHP)

Client enrollment

see specific program rules

Clinical nurse specialist (CNS)

benefits and limitations

reimbursement 1 2

Clinical pathology consultations

Clinical records

Clinician-directed care coordination services

Comprehensive Care Program (CCP)

see Clinical nurse specialist (CNS)

Cochlear implants 1 2 3 4

Colony stimulating factors

Colorectal cancer

genetic testing

prior authorization

Colorectal cancer screening

colonoscopies 1 2

genetic testing

sigmoidoscopies

Communicable disease reporting 1 2

fee-for-service providers

managed care providers

Complete blood count (CBC) 1 2

Comprehensive Care Program (CCP) 1 2

benefits and limitations

client eligibility

clinician-directed care coordination services

claims information

documentation requirements

medical home clinician telephone consult with specialist

specialist/subspecialist telephone consult with medical home clinician

face-to-face services

medically complex health care

multidisciplinary health care

non-face-to-face services

care plan oversight

clinician supervision of a home health client

clinician supervision of a hospice client

general requirements

medical conferences

medical team conference

other supervision

prolonged services

supervision of a nursing facility client

telephone consultation

prior authorization

clinician-directed care coordination services (CCP)

benefits and limitations

clinician-directed coordination services

face-to-face services

general requirements

comprehensive outpatient rehabilitation facility (CORF)

benefits and limitations

claims information

documentation requirements

prior authorization

diagnosis coding

documentation requirements

drug and medical device approval

durable medical equipment (DME)

benefits and limitations

cardiorespiratory apnea monitor

benefits and limitations

documentation requirements

prior authorization

claims information

benefits and limitations

documentation requirements

prior authorization

DME certification and receipt form

documentation requirements

donor human milk

benefits and limitations

documentation requirements

prior authorization

electronic blood pressure monitoring device

equipment adjustments

equipment modification

equipment repairs

hospital beds and safety enclosure

hospital beds, cribs, and equipment

benefits and limitations

positioning devices

prior authorization

repair or replacement

in-home total parental nutrition (TPN)

prior authorization and documentation

incontinence supplies

benefits and limitations

documentation requirements

prior authorization

benefits and limitations

documentation requirements

portable lifts for outside the home

prior authorization

prior authorization

documentation requirements

prior authorization

documentation requirements

prior authorization

nutritional products

noncovered services

prior authorization

women, infants and children program (WIC)

phototherapy devices

benefits and limitations

documentation requirements

prior authorization

retroactive eligibility

policies specific to CCP

prior authorization

benefits and limitations

documentation requirements

prior authorization

purchase vs. rental

special needs car seats

benefits and limitations

documentation requirements

prior authorization

travel restraints

benefits and limitations

documentation requirements

prior authorization

durable medical equipment (DME) supplier

blood pressure devices

prior authorization and documentation

croup tent/pulse oximeter

prior authorization

documentation of supply delivery

in-home total parental nutrition (TRN)

Early Childhood Intervention (ECI) (CCP)

inpatient psychiatric hospital (freestanding)

benefits and limitations

claims information

clinical criteria for inpatient psychiatric care

continued stays

court-ordered services

documentation requirements

continuity of eligibility through change of ownership

prior authorization

prior authorizations

retrospective utilization review

utilization review

inpatient rehabilitation hospital (freestanding)

benefits and limitations

claims information

comprehensive treatment

documentation requirements

continuity of eligibility through change of ownership

prior authorization

client transfers

medical nutrition counseling services

benefits and limitations

claims information

nutritional products

enteral feeding pumps

prior authorization

enteral supplies

prior authorization

nasogastric, gastrostomy, or jejunostomy feeding tube

prior authorization

occupational therapy (OT)

benefits and limitations

claims information

documentation requirements

prior authorization

orthotic and prosthetic services

claims information

orthotics services

benefits and limitations

orthopedic shoes

wedges and lifts

lower-limb orthoses

noncovered orthotic services

other orthopedic devices

dynamic splints

protective helmets

prior authorization

related services

spinal orthoses

upper-limb orthoses

prosthetic services

benefits and limitations

craniofacial prostheses

external breast prostheses

lower-limb prostheses

ankle prosthesis

foot prostheses

knee prostheses

microprocessor-controlled

substitutions or additions

noncovered prosthetic services

prior authorization

related services

upper-limb prostheses

orthotics and prosthetics

cranial molding orthotics

benefits and limitations

documentation requirements

prior authorization

thoracic-hip-knee-ankle orthoses (THKAO)

benefits and limitations

documentation requirements

benefits and limitations

prior authorization

standing frame/brace

benefits and limitations

vertical stander

benefits and limitations

outpatient rehabilitation facility (ORF)

benefits and limitations

claims information

documentation requirements

prior authorization

personal care services (PCS)

benefits and limitations

claims information

client eligibility

accessing the PCS benefit

primary practioner's role

documentation requirements

place of service

prior authorization

provided in group settings

provider responsibilities

retrospective review

physical therapy (PT)

benefits and limitations

claims information

documentation requirements

prior authorization

physician signature

prior authorization

private duty nursing

authorization appeals

authorization for revision of current services

benefits and limitations

CCP Prior Authorization Request Form

claims information

client/provider notification

amount and duration of PDN

client eligibility

medical necessity

place of service

documentation requirements

home health plan of care

Nursing Addendum to Plan of Care (CCP) Form

prior authorization

initial requests

recertifications of authorizations

responsible adult or identified contingency plan requirement

retroactive client eligibility

retrospective review

skilled nursing visit

TPN administration education

start of care (SOC)

termination of authorization

School Health and Related Services (SHARS)

appealing denied claims

benefits, limitations, and prior authorization

billing units based on 15 minutes

billing units based on an hour

counseling services

documentation requirements

eligibility verification

Medicaid Managed Care enrollment

nonschool SHARS enrollment

nursing services

occupational therapy (OT)

personal care services (PCS)

physical therapy (PT)

physician services

prior authorization

private school enrollment

psychological services

psychological testing

record retention

speech therapy (ST)

description of services

provider and supervision requirements

transportation services

speech therapy (ST)

benefits and limitations

claims information

documentation requirements

prior authorization

texas health steps (THSteps)

texas health steps (THSteps) dental

change of provider

complaints and resolution

dental therapy under general anesthesia

Medicaid Managed Care enrollment

therapy services

Comprehensive health center (CHC)

Comprehensive outpatient rehabilitation facility (CORF)

Computer-aided detection (CAD)

Contact information

Continuous glucose monitoring (CGM)

prior authorization requirements

Continuous passive motion device

prior authorization

Continuous positive airway pressure (CPAP)

Cost report settlements

prior authorization

prior authorization renewal

see Case Management for Children and Pregnant Women

Credentialing Committee

Crime Victims' Compensation Program

Custom manual wheelchair

prior authorization

Cytogenetics testing for leukemia and lymphoma

Cytopathology studies other than gynecological

Darbepoetin alfa

Deferoxamine mesylate (Desferal)

adjunctive general services

client eligibility

diagnostic services

doctor of dentistry practicing as a limited physician

emergency services

clients over 21 1 2

first dental home

handicapping labiolingual deviation (HLD)

HLD score sheet 1 2

hospitalization

ICF-MR dental services

implant services

informed consent

mandatory prior authorization

oral/maxillofacial surgery

orthodontic procedure codes

orthodontic services

comprehensive treatment

mandatory prior authorization

special orthodontic appliances

transfer of services

treatment plans

periodontal services

preventive services

prosthodontics, removable

reimbursement 1 2

space maintenance (passive appliance)

supernumerary tooth identification

tests and examinations

Texas Health Steps (THSteps) guidelines

therapeutic services

third party resources

THSteps dental services 1 2 3 4

TMHP information and assistance

tooth identification (TID) and surface identification (SID)

treatment plans

utilization review

Dentist (Doctor of Dentistry)

Department of Assistive and Rehabilitative Services (DARS), Blind Services

Diabetic supplies

procedure codes

Diagnostic tests

claim form example

Direct supervision

DME benefits for Medicare/Medicaid clients

DME home health services

augmentative communication device (ACD) system

benefits limitations prior authorization

prior authorization

supply procedure codes

DME medical supplier

Doctor of dentistry

claim form example

limited physician

diagnosis codes

mandatory prior authorization

Medicaid Managed Care enrollment

Document retention

prior authorization

Documentation requirements

birthing centers

Donor human milk

Dual eligibility

see Client eligibility

Durable medical equipment (DME)

accessories (home health)

bath and bathroom equipment

blood pressure devices 1 2

claim form example (CCP)

cochlear implants

continuous passive motion device

modifications (home health)

Early Childhood Intervention (ECI)

benefits and limitations

claim form example

claim form example (CCP only)

Comprehensive Care Program (CCP)

documentation requirements

prior authorization

referral requirement

statutory requirements

targeted case management services

Echoencephalography

see Electroconvulsive therapy (ECT)

Edetate calcium disodium

Edetate disodium

see Electronic data interchange (EDI) 1 2

see electrodiagnostic (EDX) testing

see Electronic funds transfer (EFT)

Electrical percussor

prior authorization

Electrocardiogram (EKG)

Electroconvulsive therapy (ECT)

Electrodiagnostic (EDX) testing 1 2

authorization requirements

electromyography (EMG)

maximum number of studies

nerve conduction studies (NCS)

Electromyography (EMG)

electrodiagnostic (EDX) testing

Electronic blood pressure monitoring device

Electronic data interchange (EDI) 1 2

automated maintenance process

claim acceptance files

claim submission

claims filing options

electronic services

electronic transmission reports

file rejections

Claim Status Inquiry (CSI) Authorization Form

Electronic Remittance and Status (ER&S) Agreement

provider check amounts

supported file types

third-party billing agents

third-party software

third-party vendor implementation

Electronic funds transfer (EFT)

Electronic Funds Transfer (EFT) Authorization form

enrollment procedures

Electronic Remittance and Status (ER&S) Reports

see Remittance and Status (R&S) Reports

see Client eligibility

Endodontics 1 2

cystourethroscopy

endoscopic retrograde cholangiopancreatography (ERCP)

lower gastrointestinal endoscopy

sinus endoscopy

upper gastrointestinal endoscopy

see Provider enrollment 1 2 3 4 5 6 7 8 9 10 11

Epidural, implantable infusion pumps

Epoetin alfa (EPO)

see also Texas Health Steps (THSteps)

Esophageal pH probe monitoring

External insulin pumps

documentation requirement

prior authorization

Extracorporeal membrane oxygenation (ECMO)

Family planning

claim form example

family planning services

nurse practitioner/clinical nurse specialist

Sterilization Consent Form 1 2

laboratory services

natural family planning

see also Family planning, Titles V, X, XX

encounter filing

see also Family planning, Titles V, X, XX

FQHC claims filing

benefits and limitations

intrauterine device

drugs and supplies

laboratory procedures

CLIA requirements

documentation requirements

reference laboratory

specimen handling

medical counseling

non-family planning services during visit

outpatient visits

radiology services

undocumented aliens

natural family planning

see also Family planning, Titles V, X, XX

wrap-around services

Titles V, X, XX

FQHC reimbursement

benefits and limitations

intrauterine device

medroxyprogesterone acetate/estradiol cypionate

documentation requirements

drugs and supplies

medical nutrition Therapy

outpatient services

FQHC reimbursement

incomplete sterilization

third party liability

Family planning services

physician services

Federal financial participation (FFP)

Federally qualified health center (FQHC)

after-hours care

benefits and limitations 1 2

claim form example 1 2 3

crossover claims

documentation requirements

managed care referral

migrant farm workers

prior authorization

Fluocinolone acetonide 1 2

see Medicaid ID

see Medicaid ID

see Medicaid ID

see Medicaid ID

see Medicaid ID

Abortion Certification Statements Form 1 2

Ambulatory (Outpatient) Substance Abuse Counseling Extension Request Form

Authorization for Use and Release of Health Information

Authorization to Release Confidential Information

Behavioral Health Consent Form

Business Records Affidavit Form

ECI Request for Outpatient Therapy

Prior Authorization Request for Non-Face-to-Face Clinician-Directed Care Coordination Services

Prior Authorization Request Form

Private Duty Nursing 6 Month Authorization

Child Abuse Reporting Guidelines

Child Abuse Reporting Guidelines, Checklist for HHSC Monitoring

Claim Status Inquiry (CSI) Authorization Form

Crossover Claim Type 30 TMHP Standardized MRAN Form

Crossover Claim Type 30 TMHP Standardized MRAN Form instructions

Crossover Claim Types 31 and 50 TMHP Standardized MRAN form

Crossover Claim Types 31 and 50 TMHP Standardized MRAN form instructions

DME Certification and Receipt Form 1 2 3

Donor Human Milk Request Form

Electronic Funds Transfer (EFT) Authorization form

Electronic Remittance and Status (ER&S) Agreement

Extended Outpatient Psychotherapy/Counseling Request Form

External Insulin Pump 1 2

Family Planning 2017 Claim Form

Hearing Evaluation, Fitting, and Dispensing Report (Form 3503)

Addendum to Home Health Services (Title XIX) DME/Medical Supplies Physician Order Form

Home Health Services (Title XIX) DME/Medical Supplies Physician Order Form

Home Health Services (Title XIX) DME/Medical Supplies Physician Order Form Instructions

Home Health Services Plan of Care (POC) 1 2

Prior Authorization Checklist 1 2

Home Health Plan of Care

Home Health Services (Title XIX) DME/Medical Supplies Physician Order Form

Home Health Services Plan of Care (POC) 1 2

Hospital Report (Form 7484) 1 2

Hysterectomy Acknowledgement Form

Hysterectomy Acknowledgment Form 1 2

Informational Claims Submission Form

Medicaid Certificate of Medical Necessity for Chest Physiotherapy Devices

Extended Request

Initial Request

Medicaid Certificate of Medical Necessity for CPAP/BiPAP or Oxygen Therapy

Medicaid Certificate of Medical Necessity for Reduction Mammaplasty

Newborn Child or Children Report (Form 7484)

Nonemergency Ambulance Prior Authorization Request 1 2

Nonemergency Ambulance Prior Authorization Request Form

Nursing Addendum to Plan of Care

Other Insurance Form

Outpatient Psychotherapy/Counseling Request Form

PCCM Community Health Services Referral Request Form

Physician's Examination Report

Primary Care Case Management (PCCM) FQHC and RHC Medical Staff Update Form

Primary Care Case Management (PCCM) Inpatient/Outpatient Authorization Form 1 2 3 4

Primary Care Case Management (PCCM) Pre-Contractual/Recredentialing Site and Medical Record Evaluation Form

Primary Care Case Management (PCCM) Referral Form

Primary Care Case Management (PCCM)- Medicaid Primary Care Provider Selection Form

Private Pay Agreement

Provider Information Change (PIC) Form

Provider Information Change Form

Psychiatric Hospital Inpatient Initial Admission Request Form

Psychiatric Inpatient Extended Stay Request Form

Psychological/Neuropsychological Testing Request Form

Pulse Oximeter Form 1 2

Radiology Prior Authorization Request Form 1 2

Request for Extension of Outpatient Therapy (Form TP-2)

Request for Initial Outpatient Therapy (Form TP-1)

Special Medicaid Prior Authorization (SMPA) Request Form

Special Medical Prior Authorization (SMPA) Request

Statement for Initial Wound Therapy System In-Home Use

Sterilization Consent Form 1 2 3

Texas Health Steps

Child Health Clinical Records

Dental Criteria for Dental Therapy Under General Anesthesia 1 2

Dental Mandatory Prior Authorization Request 1 2 3 4

Referral Form Instructions

Risk Assessment for Lead Exposure Parent Questionnaire, Form Pb-110 1 2

Specialist or Subspecialist Telephone Consultation Form for Non-Face-to-Face Clinician-Directed Care Coordination Services-Comprehensive Care Program (CCP)

Texas Health Steps (THSteps)

Child Health History

Child Health Record

13 Months-2 Years

Hearing Checklist for Parents

Hearing Checklist for Parents (Spanish)

Mental Health Interview Tool/Referral Form

Ages 10-12 Years

Ages 13-20 Years

Mental Health Parent Questionnaire

Ages 13-20 Years (Spanish

Mental Health Parent Questionnaire (Ages 10-12 Years)

Mental Health Parent Questionnaire (Ages 13-20 Years)

Mental Health Parent Questionnaire (Ages 3-9 Years)

Mental Health Parent Questionnaire (Ages Birth-2 Years)

PPD Agreement for Texas Health Steps Providers

Tuberculosis Questionnaire

Tuberculosis Questionnaire (Spanish)

TVFC Patient Eligibility Screening Record

TVFC Patient Eligibility Screening Record (Spanish)

TVFC Provider Enrollment

TVFC Questions and Answers

Texas Medicaid Refund Information Form

Dental Mandatory Prior Authorization Request

Tort Response Form

Ventilator Service Agreement

Vision Care Eyeglass Patient Certification Form

Wheelchair Seating Assessment Form 1 2

Wound Therapy System In-Home Use

Recertification

Gamma globulin/immune globulin

Genetic testing

colorectal cancer screening

claim form example

genetic evaluation and counseling

reimbursement 1 2

Group clinical visits

Gynecological services

prior authorization

assays for vaginitis

benefits and limitations

documentation requirements

endometrial cryoablation

hysterectomy acknowledgment form

prior authorization

surgery for masculinized females

uterine suspension

Health Insurance Premium Payment (HIPP) Program

managed care not an option

Health maintenance organization (HMO)

prior authorizations

Hearing aids and audiometric evaluations

Hearing devices

auditory brainstem implant (ABI)

prior authorization

benefits and limitations

bone-anchored hearing aid (BAHA)

prior authorization

claim form example

cochlear implants 1 2

prior authorization

documentation requirements 1 2 3 4

benefits and limitations

limitations 1 2

Medicaid managed care

nonimplantable 1 2

prior authorization

related services

see also Hearing services

sound processor

prior authorization

third party liability

Hearing screening

early hearing detection and intervention

Hearing services

benefits and limitations

claim form example

documentation requirements 1 2

evaluation and diagnostic services

Hearing Evaluation, Fitting, and Dispensing Report (Form 3503)

hearing screening

abnormal results

inpatient facilities

Medicaid managed care

school districts

School Health and Related Services (SHARS) 1 2 3

see also Hearing devices

third party liability (TPL)

Heart transplants

Heavy duty wheelchair

prior authorization

Helicobacter pylori (H. pylori)

Hematopoietic agents

Hematopoietic injections

Hemoglobin type

Hepatitis B immunizations

documentation requirements

High-volume providers

CDC recommendations for testing

testing procedure codes

where to go for help

workplace guidelines

ability to work

confidentiality and privacy

coworker concerns

employee education

employment rights

performance standards

see Health maintenance organization (HMO)

Home health (DME)

manual wheelchairs

Home health services

benefit period 1 2

benefits and limitations

blood glucose monitors

change of address/telephone number

claim form example

DME/medical supplies

physical therapy (PT)

skilled nursing visit

occupational therapy (OT)

physical therapy (PT)

claims information

client eligibility

client evaluation

documentation requirements

dual eligible clients

durable medical equipment (DME)

nursing and therapy

external insulin pump and supplies

Home Health Services (Title XIX) DME/Medical Supplies Physician Order Form

Home Health Services Plan of Care (POC) 1 2

Home Health Services Prior Authorization Checklist

group 1 support surfaces

group 2 support surfaces

group 3 support surfaces

home health aide (HHA)

documentation requirements

prior authorization requirements

provider responsibilities

services not prior authorized

hospital beds and equipment procedure code

incontinence supplies

insulin and insulin syringes

intravenous (IV) therapy equipment and supplies

manual wheelchairs

heavy duty and extra heavy duty

standard, standard hemi, standard reclining, tilt-in-space

medical supplies

medication administration limitations

mobility aids that are not a benefit

nursing and therapy

nutritional (enteral) products, supplies, and equipment

occupational therapy (OT)

prior authorization

procedure codes

pending agency certification

physical therapy (PT)

prior authorization

procedure codes

plan of care (POC)

possible Medicare clients 1 2

prior authorization 1 2

dual eligible clients

prior authorization cancellation

prior authorization external insulin pump and supplies

professional nursing

prohibition of Medicaid payment 1 2

provider information changes

reimbursement 1 2

respiratory equipment and supplies

procedure codes and limitations

documentation requirements

skilled nurse (SN)

prior authorization requirements

provider responsibilities

services not prior authorized

skilled nursing visit

claim form example

supervision of home health aides (HHA)

supplies submitted with a plan of care

vocational nursing

Home mechanical ventilation equipment

Home oxygen therapy

documentation requirements

Hospice Program

Medicaid services unrelated to terminal illness

physician oversight services

ambulance services

change of ownership 1 2

client transfer

day surgery services

emergency department services

general information

inpatient claim form example

inpatient reimbursement

newborn services

observation to inpatient admission

outpatient claims information

outpatient reimbursement

outpatient services

revenue codes (outpatient)

aerosol treatment

cochlear implants

colorectal cancer screening

contraction stress testing

fetal nonstress testing

hyperbaric oxygen therapy

hysterectomy services

pentamidine aerosol

pulmonary function studies

radiation therapy

radiology services

submission of birth information to TVSU

teaching hospitals

third party liability reporting

Hospital visits

physician services

Hospital-based ambulatory surgical center (HASC)

American Society of Anesthesiologists (ASA) physical status

benefits and limitations

claim form example

cochlear implants

colorectal cancer screening

documentation requirements

drugs and supplies

electrodiagnostic (EDX) testing

fluocinolone acetonide

global services

implantable infusion pump

neurostimulators

New York Heart Association heart disease classifications

planned admission

prior authorization 1 2

stereotactic radiosurgery

incomplete procedures

Human donor milk

Humidification Units

Hyperbaric oxygen therapy (HBOT), physician services

see Internal control number (ICN)

Ilizarov device, physician services

how to report records

Immune globulin (Cytogam)

administrations and immunizations

exemption for schools and child-care facilities

general recommendations

how to report records

physician services

recommended childhood schedule

requirements for TVFC

Texas Health Steps

TVFC requirements

Vaccine Adverse Event Reporting System (VAERS)

Texas Health Steps (THSteps)

Implantable fusion pump

Implantable infusion pumps 1 2

In-home total parenteral nutrition

procedure codes with limitations

documentation requirements

prior authorization

Independent laboratory

Independent practitioners

Indian Health Services

prior authorization

abatacept (Orencia)

antibiotics and steroids

antihemophilic factor

botulinum toxin type A

chelating agents

edeferoxamine mesylate (Desferal)

edetate calcium disodium

edetate disodium

family planning

gamma globulin/immune globulin

hematopoietic agents

darbepoetin alfa

epoetin alfa (EPO)

implantable infusion pumps

joint and trigger point

leuprolide acetate (Lupron Depot)

maternal serum alpha-fetoprotein

Internal control number (ICN)

Intestinal transplants

Intraocular lens (IOL)

Intraocular lenses

Intrathecal infusion, implantable infusion

Intravitreal drug delivery system

prior authorization

Iron injections

prior authorization

documentation requirements

JCIH 2007 position statement

Joint injections

ATP Level Pricing

automated tests

fee calculations

claim form example

independent laboratory

office visit with lab and radiology

radiological and physiological

clinical laboratory procedures

repeat procedures

colorectal cancer genetic testing

prior authorization

complete blood count (CBC)

family planning

follow-up care guidelines

Radiology Prior Authorization Request Form

HIV drug resistance testing

benefits and limitations

CLIA Certificates

Clinical Laboratory Improvement Amendments (CLIA)

documentation requirements

electronic claims filing

laboratory panels

fee calculations

outpatient hospital

radiological and physiological

benefits and limitations

cardiac nuclear imaging

computed tomography (CT)

diagnosis requirements

documentation requirements 1 2

enrollment for mammography providers

intraoperative MRI

magnetic resonance imaging (MRI)

modifier requirements

positron emission tomography (PET)

prior authorization

prior authorization 1 2

renal dialysis facility

continuous ambulatory peritoneal dialysis (CAPD)

nonroutine laboratory

routine laboratory

required tests for medical checkups

newborn screening 1 2

see also Independent laboratory

THSteps services

Laboratory services 1 2

clinical lab panel implementation

clinical pathology consultations

see Licensed clinical social worker (LCSW)

measuring blood lead levels

prevention materials

symptoms of lead poisoning

Leuprolide acetate (Lupron Depot)

Licensed clinical social worker (LCSW)

behavioral health services

benefits and limitations

claim form example

documentation requirements

prior authorization

court-ordered and DFPS-directed services

more than 30-encounters per year

subsequent prior authorization requests

Licensed marriage and family therapist (LMFT)

behavioral health services

benefits and limitations

documentation requirements

prior authorization

court-ordered and DFPS-directed services

more than 30-encounters per year

subsequent prior authorization requests

Licensed professional counselor (LPC)

behavioral health services

benefits and limitations

claim form example

documentation requirements

prior authorization

court-ordered and DFPS-directed services

more than 30-encounters per year

subsequent prior authorization requests

Licensed psychological associate (LPA)

behavioral health services

benefits and limitations

12-hour system limitation

formula applied

procedure codes

retrospective review

Liver transplants

see Licensed marriage and family therapist (LMFT)

see Licensed professional counselor (LPC)

Lung transplants

Lung volume reduction surgery (LVRS)

Magnetic resonance angiography (MRA)

Magnetic resonance imaging (MRI)

Maintenance of provider information

see Provider information

administrator-initiated HMO plan changes

advance directives

after-hours guidelines

automatic reenrollment

behavioral health

client eligibility

see specific program rules

client enrollment

see specific program rules

client responsibilities

client-initiated HMO plan changes

continuous access

cultural competency

health plan changes

limited English proficiency

primary care provider

eligible provider types

primary care provider changes

primary care provider changes

prior authorization

provider-to-client ratio

see also STAR Health Program

see also STAR Program

see also STAR+PLUS Program

third party liability (TPL)

unacceptable telephone arrangements

Manual wheelchair

prior authorization

Manual wheelchairs

seating assessment

Maternal and child health

Maternal serum alpha-fetoprotein

Maternity clinics

Maternity service clinic (MSC)

Medicaid for breast and cervical cancer (MBCC)

client eligibility

client eligibility verification

Hospice Program

Medicaid Access Card

Medicaid limited program

presumptive eligibility

Medicaid limited program

definition of medical necessity for

see Client eligibility

hospital services

selection of provider/pharmacy

waste, abuse, and fraud

Medicaid managed care

Medicaid relationship to Medicare

Medical checkup (THSteps)

birth through 20 years of age

procedures and tests 1 2

Medical necessity

definition for Medicaid limited program

Medical nutrition counseling

Medical nutritional counseling

CCP claim form example

Medical record documentation requirements

Medical supplies

prior authorization

Medical Transportation Program (MTP)

client eligibility

contact information

Health Care Provider Statement of Medical Need

verification of service

Medically Needy Clearinghouse (MNC)

see Medically Needy Program (MNP)

Medically Needy Program (MNP)

closing MNP case

claims deadlines

crossover reimbursement

participation as a condition of enrollment

Medicare and Medicaid DME prior authorization

Medicare and Medicaid Prior Authorization

Medicare Part C

Mental health case management

claim form example

Mental health claims

Military hospital

benefits and limitations

claim form example (emergency inpatient)

claims information

inpatient services

see Medically Needy Program (MNP)

prior authorization

procedure codes and limitations

Modifications to durable medical equipment (DME) home health

See Medical Transportation Program (MTP)

Mucous clearance valve

Muscular Dystrophy Association

Myocardial perfusion imaging

National Provider Identifier (NPI)

NPI Verification

see National drug code (NDC)

prior authorization

Negative pressure ventilators

prior authorization

Nerve conduction studies (NCS)

electrodiagnostic (EDX) testing

Neurostimulators

blood screening

STAR Health Program

STAR+PLUS Program

hearing screening

1-3-6 Month Practitioner's Guide

outpatient rescreen

screening, statutory requirements

THSteps examination

Newborn eligibility process

Newborn hearing screening

NorthSTAR Program

authorization exceptions

behavioral health billing

claims processing exceptions

client eligibility

client enrollment

enrollment broker

hospital billing

prior authorization requirements

provider requirements

quality improvement monitoring

see nurse practitioner

see National Provider Identifier (NPI)

NPWT wound care system

see certified nurse midwife, nurse practitioner, clinical nurse specialist, or certified registered nurse anesthetist

Nurse practitioner

benefits and limitations

reimbursement 1 2

Nursing facility

less than 24 hours

Observation services 1 2

Obstetrics/prenatal care

Occupational therapy (OT)

benefit criteria

benefits and limitations

home health services

documentation requirements

home health services

in a nursing facility

noncovered services

procedure codes

rehabilitative services

School Health and Related Services (SHARS) 1 2

Online Fee Lookup (OFL)

Online Provider Lookup (OPL) 1 2

Ophthalmology 1 2

see Vision services

see Vision services

see Abatacept (Orencia)

Organ procurement

Organ transplant

Orthodontic services

mandatory prior authorization

procedure codes

special orthodontic appliances

Orthotic and prosthetic services

claim form example

Osteogenic stimulation 1 2

documentation requirements

invasive electrical osteogenic stimulator

noninvasive electrical osteogenic stimulator

prior authorization

professional services

ultrasound osteogenic stimulator

Osteopathic manipulation treatment (OMT)

Out-of-state Medicaid providers 1 2

physician services in an outpatient hospital setting

Outpatient rehabilitation facility (ORF)

refunds to TMHP 1 2

home delivery system types

prior authorization

recertification

Parental accompaniment 1 2

statutory requirements

Payment error rate measurement (PERM) 1 2

Payment Information

access and availability standards

annual adult well-check

facility services

observation services

authorization appeals

authorization exceptions

appeal of denials

newborn admission notification

notification of admission

out-of-network inpatient services

scheduled admissions

behavioral health services 1 2

case management fee

emergency outpatient services

network hospitals

non-emergency outpatient clinic services

out-of-network hospitals

specialist services

claims processing exceptions

client eligibility

client enrollment

client helpline

client responsibilities

client support services

community health services

Community Health Services

complaints to HHSC

confidentiality of medical records

conflict resolution

covered services

credentialing committee

frequency and logistics

grievance committee

family planning services

federally qualified health center (FQHC)

medical staff changes

PCCM Community Health Services Referral Request Form

Primary Care Case Management (PCCM) FQHC and RHC Medical Staff Update Form

Primary Care Case Management (PCCM) Pre-Contractual/Recredentialing Site and Medical Record Evaluation Form

Primary Care Case Management (PCCM) Referral Form

Primary Care Case Management (PCCM)- Medicaid Primary Care Provider Selection Form

Provider Information Change Form

hospital enrollment

linguistic services

medical records audit

medical records standards

migrant farm worker services

OB/GYN services

open specialty referral network

PCCM Referral Form

personal care services (PCS)

primary care provider

primary care provider changes

primary care provider referrals

primary care provider services

primary care providers

additional criteria

prior authorization

prior authorizations

provider complaints

provider disenrollment

provider enrollment

provider responsibilities

provider support services

rural health clinic (RHC)

medical staff changes

School Health and Related Services (SHARS)

self-referred services

specialist-to-specialist referrals

specialist's responsibilities

spell of illness

Texas Health Steps (THSteps) services

transportation services

verifying primary care provider

vision services

Pediatric nurse practitioner

see nurse practitioner

Pediatric pneumogram

Percutaneous transluminal coronary intervention

Periodicity schedule (THSteps)

see Payment error rate measurement (PERM) 1 2

Personal care services

School Health and Related Services (SHARS)

Personal care services (PCS)

Personal supervision

Medicaid limited program

Phototherapy devices

Comprehensive Care Program (CCP)

see Comprehensive Care Program (CCP)

Physical examinations, sports

Physical therapy (PT)

benefit criteria

benefits and limitations

claim form example 1 2

claim form examples (CCP only)

home health services

documentation requirements

home health services

in a nursing facility

noncovered services

procedure codes

rehabilitative services

behavioral health services

benefits and limitations

retrospective review

dentistry, doctor of

domiciliary, rest home, or custodial care

evaluation and management services

group clinical visits

inpatient hospital services

concurrent care

hospital admissions, initial visits, and subsequent visits

hospital discharge

nursing facility services

kidney transplant

office or other outpatient hospital services

consultation services

new and established patient services

observation services

preventive care visits

services outside of business hours

outpatient hospital reimbursement

prior authorization

see also PCCM, referrals

reimbursement 1 2

aerosol treatment

allergy immunotherapy

allergy testing

direct nasal mucous membrane test

inhalation bronchial challenge testing

ophthalmic mucous membrane test

patch or application tests

percutaneous and intracutaneous skin test

photo or photo patch skin test

RAST/MAST tests

for labor and delivery

for THSteps dental

multiple procedures 1 2

pain management

provided by the surgeon

Bacillus Calmette-Guérin (BCG) for treatment of bladder cancer

bariatric surgery

prior authorization requirements

cardiopulmonary resuscitation (CPR)

procedure codes

cochlear implants

colorectal cancer screening

sigmoidoscopies

colorectal screening

colonoscopies 1 2

genetic testing

continuous glucose monitoring (CGM)

prior authorization

corneal transplants

diagnostic tests

ambulatory blood pressure monitoring

ambulatory electroencephalogram (A/EEG)

bone marrow aspiration

cytopathology studies other than gynecological

echoencephalography

electrocardiogram (EKG)

electrodiagnostic (EDX) testing

esophageal pH probe monitoring

Helicobacter pylori (H. pylori)

myocardial perfusion imaging

pediatric pneumogram

cystourethroscopy

endoscopic retrograde cholangiopancreatography (ERCP)

lower gastrointestinal endoscopy

sinus endoscopy

upper gastrointestinal endoscopy

extracorporeal membrane oxygenation (ECMO)

family planning

Helicobacter pylori

hospital visits

hyperbaric oxygen therapy (HBOT)

Ilizarov device

abatacept (Orencia)

antibiotics and steroids

antihemophilic factor

botulinum toxin type A

chelating agents

deferoxamine mesylate (Desferal)

edetate calcium disodium

edetate disodium

gamma globulin/immune globulin

hematopoietic agents

darbepoetin alfa

epoetin alfa (EPO)

implantable infusion pumps

joint and trigger point

leuprolide acetate (Lupron Depot)

intraocular lenses

clinical lab panel implementation

clinical pathology consultations

long term care nursing facility

magnetic resonance angiography (MRA)

magnetic resonance imaging (MRI)

mastectomy and breast reconstruction

neuromuscular electrical stimulation (NMES)

neurostimulators

doral column neurostimulator (DCN)

intracranial neurostimulators (ICN)

NMES and TENS supplies

NMES/TENS garments

percutaneous electrical nerve stimulators (PENS)

prior authorization

sacral nerve stimulators (SNS)

transcutaneous electrical nerve stimulators (TENS)

nuclear medicine

obstetrics/prenatal care

occupational therapy

orthognathic surgery

physical therapy

radiation therapy

reduction mammoplasties

stereotactic radiosurgery

transplant prior authorization

vaccinationsee Immunizations

vagal nerve stimulators (VNS)

ventilation assist and management

sign language interpreting services

substitute physician

teaching attending physician and resident physician

supplies, trays, and drugs

wearable cardiac defibrillator

Physician assistant (PA)

benefits and limitations

reimbursement 1 2

Physician services

School Health and Related Services (SHARS)

Physiological laboratory

Podiatrist services

clubfoot casting

flat foot treatment

routine foot care

Portable X-ray supplier

diagnosis requirements

reimbursement 1 2

Positive airway pressure system devices

Power elevating leg lifts

documentation requirements

Power seat elevation system

documentation requirements

see Preferred provider organization (PPO)

Preferred provider organization (PPO)

Premature infants

Primary Care Case Management (PCCM)

Prior authorization

acknowledgement statement

nonemergency transport

retroactive eligibility

ambulatory surgical center (ASC) 1 2

and retroactive eligibility

appealing denials

auditory brainstem implant (ABI)

birthing centers

bone-anchored hearing aid (BAHA)

by telephone 1 2

Case Management for Children and Pregnant Women (CPW)

certification statement

certified respiratory care practitioner (CRCP)

clients with private insurance

cochlear implants

codes awaiting a rate hearing

colorectal cancer genetic testing

Comprehensive Care Program (CCP)

continuous glucose monitoring (CGM)

document requirements and retention

dual eligible clients

Early Childhood Intervention (ECI)

emergency transport

federally qualified health center (FQHC)

Addendum to Home Health Services (Title XIX) DME/Medical Supplies Physician Order Form

CCP ECI Request for Outpatient Therapy

CCP Prior Authorization Private Duty Nursing 6 Month Authorization

CCP Prior Authorization Request for Non-Face-to-Face Clinician-Directed Care Coordination Services

CCP Prior Authorization Request Form

Donor Human Milk Request Form

Extended Outpatient Psychotherapy/Counseling Request Form

External Insulin Pump 1 2

Home Health Services (Title XIX) DME/Medical Supplies Physician Order Form

Home Health Services (Title XIX) DME/Medical Supplies Physician Order Form Instructions

Home Health Services Plan of Care (POC) 1 2 3 4

Home Health Services Plan of Care (POC) Instructions

Home Health Services Prior Authorization Checklist 1 2

Medicaid Certificate of Medical Necessity for Chest Physiotherapy Devices

Extended Request

Initial Request

Medicaid Certificate of Medical Necessity for CPAP/BiPAP or Oxygen Therapy

Medicaid Certificate of Medical Necessity for Reduction Mammaplasty

Nonemergency Ambulance Prior Authorization Request

Primary Care Case Management (PCCM) Inpatient/Outpatient Authorization Form 1 2 3 4

Psychiatric Hospital Inpatient Initial Admission Request Form

Psychiatric Inpatient Extended Stay Request Form

Pulse Oximeter Form 1 2

Radiology Prior Authorization Request Form

Request for Extension of Outpatient Therapy (Form TP-2)

Request for Initial Outpatient Therapy (Form TP-1)

THSteps Dental Mandatory Prior Authorization Request Form 1 2 3 4 5

general information

gynecological services

health maintenance organization (HMO)

hearing devices

home health aide (HHA)

home health services (DME)

hospital ambulatory surgical center (HASC) 1 2

inpatient behavioral health services

radiological and physiological

Licensed clinical social worker (LCSW)

Licensed marriage and family therapist (LMFT)

Licensed professional counselor (LPC)

mandatory prior authorization (dental)

neurostimulators

newly enrolled providers

nonemergency transport

NorthSTAR Program

orthodontic services

outpatient behavioral health services

PCCM outpatient prior authorization

pharmacological management services

pharmacological regimen oversight

positron emission tomography (PET)

programmable pumps

psychiatric diagnostic interviews

psychological and neuropsychological testing

psychotherapy/counseling

renal dialysis facility

retroactive authorization

skilled nurse (SN)

sound processor

submitting claims with

submitting through TMHP website

substance use disorder (SUD) services

terms and conditions

THSteps and ICF-MR dental prior authorization

tissue transplant services

total in-home parental nutrition

verifying status

Private duty nursing

claim form examples (CCP only)

Procedure codes

THSteps dental 1 2 3

Prognostic breast and gynecological cancer studies

Programmable pumps, prior authorization

professional organizations

resolution of problems

Provider complaints

Provider enrollment

advanced practice registered nurse (APRN)

ambulatory surgical center (ASC)

application 1 2

Certificate of Authority

Certificate of Filing

Certificate of Formation

Certificate of Good Standing

Certificate of Incorporation

Corporate Board of Directors Resolution

Disclosure of Ownership and Control of Interest Statement

HHSC Medicaid Provider Agreement

Medicaid Audit Information Form

Provider Information Form

temporary license/certification

birthing center

birthing center Medicaid managed care

certified registered nurse anesthetist (CRNA)

certified respiratory care practitioner (CRCP)

chiropractic services

clinical nurse specialist (CNS)

criteria for out-of-state providers

DME home health services

federally qualified health center (FQHC)

group information changes

hearing services

hospital ambulatory surgical center (HASC)

licensure renewal

Medicaid managed care programs

STAR and STAR+PLUS Programs

Medicare participation

nurse practitioner (NP)

occupational therapy (OT)

online enrollment

miscellaneous provisions

physical therapist

physician assistant (PA)

presumptive eligibility determination

provider responsibilities

change in principal information

change in provider status

change of ownership

change of physical address

new Medicare number

renal dialysis facility

rural health clinic (RHC)

speech therapy (ST)

Texas Health Steps (THSteps)

tuberculosis clinic

performing provider

vision services

Provider information

change in principal information

change in provider status

change of physical address

NPI Verification

Online Provider Lookup (OPL)

Provider Information Change (PIC) Form

requirement to notify of changes

Provider Information Change (PIC) Form

Provider Information Change Form

Provider payments

see also Electronic Funds Transfer (EFT)

stale-dated checks

Provider responsibilities

billing clients

Client Acknowledgment Statement

billing requirements

certification of submitted claims

compliance with

Americans with Disabilities Act of 1990

Civil Rights Act of 1964

Rehabilitation Act of 1973

Texas Family Code

compliance with federal legislation

delegation of signature authority

informing pregnant clients about CHIP benefits

Medicaid access to records and premises

medical record documentation requirements

release of confidential information

reporting child abuse

reporting suspected sexual abuse

retention of records

tamper-resistant prescription pads

tuberculosis clinic

utilization control

Provider-specific visits

Psychiatric Hospital/Facility

claim form example (Inpatient - CCP only)

behavioral health services

benefits and limitations

12-hour system limitation

formula applied

procedure codes

retrospective review

claim form example

Pulsatile jet irrigation wound care system

prior authorization

Pumps, implantation

Qualified Medicare Beneficiary (QMB)

Quick Reference Guide

Texas Health Steps

see Remittance and Status (R&S) Report

Radiation services

Radiation therapy

claim form example

procedure code limitations

Radiological laboratory

Radiology services 1 2

diagnosis requirements

therapeutic radiopharmaceuticals

RAST/MAST tests

Record retention

electronic transmission reports

Reduction mammoplasties

see Provider enrollment

Case Management for Children and Pregnant Women (CPW)

family planning

genetic services

Reflux, slings, and wedges

prior authorization

Refunds to TMHP

as a result of other insurance payments

as a result of overpayment

Registered nurse

additional THSteps educational requirements

Texas Health Steps (THSteps)

Rehabilitation hospital

claim form example (inpatient - CCP only)

Rehabilitation hospital (freestanding) (CCP)

ambulatory surgical center (ASC) 1 2

birthing centers

case management

for children and pregnant women

for children who are blind and visually impaired

for early childhood intervention

certified nurse-midwife

certified registered nurse anesthetist

certified respiratory care practitioner

certified respiratory care practitioner (CRCP)

chemical dependency treatment facility

chiropractic services

clinical nurse specialist (CNS)

cost reimbursement

drugs/biologicals

durable medical equipment

family planning services

federal financial participation (FFP)

federally qualified health center (FQHC)

genetic services

hearing aid and audiometric evaluations

high-volume providers

home health services

hospital-based ambulatory surgical center (HASC)

in-home total parenteral nutrition

independent laboratory 1 2

independent practitioners

Indian Health Services

radiological and physiological

licensed clinical social worker

licensed marriage and family therapist

licensed professional counselors

maternity service clinic

Medicare crossover

nurse practitioner

Online Fee Lookup (OFL)

out-of-state Medicaid providers

personal care services

physical therapy

physician assistant 1 2

physician services in outpatient hospital setting

physiological laboratory

portable X-ray supplier 1 2

provider-specific visits

radiological laboratory

reasonable cost/interim rates

renal dialysis facility 1 2

rural health clinic (RHC)

School Health and Related Services (SHARS) 1 2

certification of funds

cost reconciliation and cost settlement

random moment time study (RMTS)

static fee schedules

tuberculosis clinic

tuberculosis clinics

vision services

Reimbursement methodology

Reimbursement reductions

Remittance and Status (R&S) Report

adjustments to claims

claims being processed

claims payment summary

delivery options

example accounts receivable

example adjustments

example appendix

example backup withholding penalty

example banner page

example claims in process

example IRS levy

example managed care refunds

example manual payouts

example Medicaid refunds

example paid or denied hospital claims

example paid or denied physician claims

example reissues

example sub-owner recoupments

example summary

example system payouts

example void and stop pay

explanation of benefit codes

explanation of pending status codes

explanation of sections Report

section explanation

field explanations

financial transactions

internal control number (ICN)

paid or denied claims

paper reports eliminated

Remittance and Status (R&S) Reports

Renal dialysis facility

benefits and limitations

blood transfusions

claim form example 1 2 3

client eligibility

continuous ambulatory peritoneal dialysis (CAPD)

continuous cycling peritoneal dialysis (CCPD)

dealing direct-support services

documentation requirements

hematopoietic injections

intermittent peritoneal dialysis (IPD)

laboratory services

continuous ambulatory peritoneal dialysis (CAPD)

physician supervision

prior authorization

radiology services

reimbursement 1 2

self-dialysis training

Repairs to client-owned equipment

Replacement of equipment/accessories

Reporting abuse and neglect, statutory requirements for

Reservoirs, implantation

Respiratory care

Respiratory equipment

prior authorization

Respiratory equipment and supplies

Retroactive eligibility

see Client eligibility

Root canal therapy

Rural health clinic (RHC)

after-hours care

benefits and limitations

claim form example 1 2 3

cost reporting 1 2

documentation requirements

freestanding 1 2

hospital-based 1 2

managed care referral

record retention

see Behavioral health

School Health and Related Services (SHARS)

claim form examples

hearing services 1 2 3

personal care services

documentation requirements

prior authorization

Screening services

Screening, brief intervention, and referral to treatment (SBIRT)

see Behavioral health

Seat lift mechanisms

documentation requirements

Seating assessment

documentation requirements

prior authorization

Seating assessments

manual wheelchairs

Second opinions

Secretion clearance devices

Sign language interpreting services, physician

Silver nitrate applicators

Special needs car seats 1 2

Special needs travel restraints

Speech therapy (ST)

aural rehabilitation

benefit criteria

benefits and limitations

documentation requirements

in a nursing facility

noncovered services

rehabilitative services

School Health and Related Services (SHARS)

Speech-language pathology

claim form examples (CCP only)

see Medically Needy Program (MNP)

Sports physical examinations

Standard manual wheelchair

prior authorization

documentation requirements

Standing frame/brace

STAR Health Program

authorization exceptions

mental health rehabilitation

claims processing exceptions

client eligibility

client enrollment

STAR Health model

client eligibility

client enrollment

national drug code (NDC)

prescription drugs

primary care provider changes

spell of illness

STAR+PLUS Program

client eligibility

dual eligible clients

ineligible clients

client enrollment

mental health claims

primary care provider changes

spell of illness

State Legalization Impact Assistance Grant (SLIAG)

State requirements

early childhood intervention (ECI)

parental accompaniment

reporting abuse and neglect

Texas Health Steps (THSteps)

newborn blood screening

State Supported Living Centers

Statutory requirements

communicable disease reporting

Early Childhood Intervention (ECI)

newborn screening

parental accompaniment

reporting abuse and neglect

teen confidentiality issues

Texas Health Steps (THSteps)

Stereotactic knife radiosurgery

Subcutaneous injection port

documentation requirements

prior authorization

Subcutaneous injection ports

Submission of birth information to TVSU

Substance use disorder (SUD) services

documentation requirements

medication assisted therapy (MAT)

non-covered services

prior authorization

Supplemental Security Income (SSI)

anesthesia administered by surgeon

assistant surgeons

prior authorization requirements

bilateral procedures

lung volume reduction

office procedures

orthopedic hardware

second opinions

Syphilis testing

Tax Equity and Fiscal Responsibility Act (TEFRA)

physician reimbursement

provider enrollment

see Tuberculosis

Teen confidentiality issues, statutory requirements

see Tax Equity and Fiscal Responsibility Act (TEFRA)

Telephone numbers

Texas Band of Kickapoo Equity Health Program

Texas Board of Nursing (BON)

Texas early hearing detection and intervention (TEHDI)

Texas Health Steps

Mental Health Parent Questionnaire (Ages 10-12 Years)

Texas Health Steps (THSteps)

acute care visits

administrative information

assistance contacts

benefits and limitations

anticipatory guidance

dental screening

fluoride varnish

intermediate oral evaluation

cervical cancer screening

claim form examples

THSteps medical checkup

diagnosis and treatment claim form example

claims filing and reimbursement

client eligibility

communicable disease reporting

Comprehensive Care Program (CCP)

claim filing resources

claims information

orthodontic services

premature removal of appliances

general anesthesia

orthodontic services

emergency dental referrals

ICF-MR services

prior authorization

cone beam imaging

general anesthesia

billing after loss of eligibility

routine dental referrals

treatment facilities

dental guidelines

AAPD Periodicity Guidelines

documentation requirements

early hearing detection and intervention

exception-to-periodicity checkups

follow-up medical checkup

Child Health History

Child Health Record

13 Months-2 Years

Hearing Checklist for Parents

Hearing Checklist for Parents (Spanish)

How to Determine Tuberculosis Risk

Mental Health Interview Tool/Referral Form

Ages 10-12 Years

Ages 13-20 Years

Mental Health Parent (Spanish)

Mental Health Parent Questionnaire (Ages 13-20 Years)

Mental Health Parent Questionnaire (Ages 3-9 Years)

Mental Health Parent Questionnaire (Ages Birth-2 Years)

PPD Agreement for Texas Health Steps Providers

Tuberculosis Questionnaire

Tuberculosis Questionnaire (Spanish)

TVFC Patient Eligibility Screening Record

TVFC Patient Eligibility Screening Record (Spanish)

TVFC Provider Enrollment

TVFC Questions and Answers

hearing monitoring

exemption for schools and child-care facilities

general recommendations

recommended childhood schedule

immunizations overview

JCIH 2007 position statement

laboratory services

laboratory submission

laboratory supplies

lead screening 1 2

prevention education and forms

medical checkup

medical home concept

newborn blood screening

newborn hearing screening 1 2

newborn screening supplies

parental accompaniment

periodicity schedules

provider enrollment

Quick Reference Guide 1 2

registered nurse

additional education requirements

newborn examination

reporting abuse and neglect

required laboratory screening procedures

STAR Program enrollment

state legislative requirements

statutory requirements

statutory state requirements

screening and education tool

tuberculosis skin testing

TVFC versus non-TVFC vaccines/toxoids

Texas immunization registry

Texas Kidney Health Care Program

Texas Medicaid Refund Information Form

Texas Medical Assistance Program (Medicaid)

Texas Vaccines for Children (TVFC) Program

Therapeutic apheresis

Therapeutic phlebotomy 1 2

Third party liability (TPL)

Third Party Liability (TPL)

see Third Party Resources (TPR)

Third Party Resources (TPR)

accident-related claims

converting informational claims to claims for payment

filing deadlines

forwarded other insurance claims

health maintenance organization (HMO) copayments

informational claims

other insurance credits

provider liens for reimbursement

submission of informational claims

Third Party Liability (TPL)

THSteps requirements

Workers' Compensation

TMHP Provider Relations

Tooth identification (TID) number

Total Parenteral Nutrition (TPN) Solutions

see Third party liability (TPL)

documentation requirements

prior authorization

see Third Party Resources (TPR) 1 2

Tracheostomy tubes

prior authorization

Tracheostomy Tubes

Transfers of client

Transportation services

School Health and Related Services (SHARS)

Travel restraints

Trigger point injections

How to Determine Tuberculosis Risk

screening and education tool

Tuberculosis clinic

ancillary services

benefits and limitations

claim form example

documentation requirements

provider responsibilities

Tuberculosis skin testing

Texas Health Steps (THSteps)

see Texas Vaccines for Children

TVFC requirements

TVFC versus non-TVFC vaccines/toxoids

Ultraviolet (U-V) Protection

Undocumented aliens

emergency-only eligibility

Utilization review

see Immunizations

Vaccine Adverse Event Reporting System (VAERS) 1 2

Vagal nerve stimulators

prior authorization

Vendor Drug Program (VDP)

Ventilator service agreement

documentation requirements

prior authorization

prior authorization

Vertical stander

Vestibuloplasty

Vision services

benefits and limitations

claim form example

prior authorization

corneal bandage

corneal topography

documentation requirements

federally qualified healthcare centers (FQHC)

Physician's Examination Report

Vision Care Eyeglass Patient Certification Form

long-term care facilities

medically necessary exams

non-prosthetic eyewear

dispensing requirements

eyeglass lenses and frames

Medicare coverage

polycarbonate lens

undeliverable eyeglasses

ophthalmic ultrasound

ophthalmological exam with general anesthesia

orthoptic and pleoptic training

circulatory system

complications of pregnancy, childbirth, and puerperium

conditions in the perinatal period

congenital anomalies

endocrine, nutritional and metabolic, immunity

infectious and parasitic diseases

injury and poisoning

metabolic disorders

musculoskeletal system and connective tissue

nervous system and sense organs

skin and subcutaneous tissue

prosthetic eyewear

artificial eyes

contact lens fitting

intraocular lens (IOL)

provider responsibilities

reimbursement 1 2

routine vision testing

sensorimotor examination

THSteps checkup vision screening

vision screening outside THSteps checkup

Volume ventilators

prior authorization

Waste, abuse, and fraud

administrative actions

administrative sanctions

employee education requirements

Medicaid limited program

sanctionable providers

suspected cases

types of violations

claims and Billing

delivery of health-care services

improper collection and misuse of funds

kickbacks and referrals

licensure actions

managed care organizations

program compliance

program-related convictions

provider eligibility

records and documentation

Wearable cardiac defibrillator

Wheelchair batteries

battery charger

prior authorization

Wheelchair ramp (portable and threshold)

prior authorization

see Women's Health Program (WHP)

Women's Health Program (WHP)

FQHC reimbursement

benefits and limitations

client eligibility 1 2

documentation requirements

drugs and supplies

family planning guidelines

natural family planning

outpatient services

FQHC reimbursement

radiology services

third party liability (TPL)

wrap-around services

Workers' Compensation

Third Party Resources (TPR)

noncovered services

prior authorization

procedures and limitations

documentation requirements

prior authorization

documentation requirements

prior authorization

pulsatile jet irrigation

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