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July 2014 Texas Medicaid Provider Procedures Manual

Children’s Services Handbook : 2. Medicaid Children’s Services Comprehensive Care Program (CCP) : 2.11 Private Duty Nursing (PDN)(CCP) : 2.11.4 Claims Information

2.11.4
Claims Information
PDN providers must submit claims for services in an approved electronic claims format or on the appropriate claim form based on their provider type. Home health agencies must submit claims on the UB‑04 CMS‑1450 paper claim form. Independently enrolled nurses must submit claims on the CMS‑1500 paper claim form. TMHP does not supply the forms.
Refer to:
Section 3: TMHP Electronic Data Interchange (EDI) (Vol. 1, General Information) for information on electronic claims submissions.
Section 6: Claims Filing (Vol. 1, General Information) for general information about claims filing.
Subsection 6.5, “CMS‑1500 Paper Claim Filing Instructions” in Section 6, “Claims Filing” (Vol. 1, General Information) for instructions on completing paper claims.
Subsection 6.6, “UB-04 CMS-1450 Paper Claim Filing Instructions” in Section 6, “Claims Filing” (Vol. 1, General Information) for paper claims completion instructions.

Texas Medicaid & Healthcare Partnership
CPT only copyright 2013 American Medical Association. All rights reserved.