Automated Inquiry System (AIS)

xv

TMHP Electronic Data Interchange (EDI)

3-1

CMS-1500 Claim Filing Instructions

5-26

Example of CMS-1500 claim form

5-28

TMHP Electronic Claims Submission

5-15

State and Federal Offices Communication Guide

A-1

Abortion Certification Statements Form

B-3

Hysterectomy Acknowledgment Form

B-56

Request for Extended Outpatient Psychotherapy/Counseling Form

B-89

Sterilization Consent Form (English)

B-100

Sterilization Consent Form (Spanish)

B-101

Sterilization Consent Form Instructions

B-98

Anesthesia Claim Example

D-5

Dialysis Training Claim Example

D-11

Office Visit with Lab and Radiology Claim Example

D-24

Radiation Therapy Claim Example

D-28

Surgery Claim Example

D-34

Acronym Dictionary

F-1