TMPPM 2008 > Provider Information > Claims Filing > Claims Information

5.1.3 Claims Filing Instructions

This manual references paper claims when explaining filing instructions. HHSC and TMHP encourage providers to submit claims electronically. TMHP offers specifications for electronic claim formats. These specifications are available from the TMHP website and include a cross-reference of the paper claim filed requirements to the electronic format.

Providers can participate in the most efficient and effective method of submitting claims to TMHP by submitting claims through the TMHP Electronic Data Interchange (EDI) claims processing system using TexMedConnect, TDHconnect, or a third party vendor. The proceeding claim filing instructions in this manual apply to paper and electronic submitters. Although the examples of claims filing instructions refer to their inclusion on the paper claim form, claim data requirements apply to all claim submissions, regardless of the media. Claims must contain the provider's complete name, address, and provider identifier to avoid unnecessary delays in processing and payment.

Note: Providers rendering services to State of Texas Access Reform (STAR) and STAR+PLUS Program members must file claims and encounters with the appropriate health plan using the health plan's guidelines.

Exception: File Primary Care Case Management (PCCM) claims with TMHP.

Refer to: "TMHP Electronic Data Interchange (EDI)" for instructions on accessing the TMHP website and filing electronically and "Medicaid Managed Care" .