TMPPM 2008 > Texas Medicaid Services > Dental > Claims Information

19.24 Claims Information

Note: THSteps providers do not have to bill private insurance; they can bill TMHP directly.

All THSteps and ICF-MR claims must be received by TMHP within 95 days from each date of service and submitted to the following address:

Texas Medicaid & Healthcare Partnership
PO Box 200555
Austin, TX 78720-0555

Dental services must be submitted to TMHP in an approved electronic format or on the ADA Dental Claim Form. Providers may purchase ADA Dental claim forms from the vendor of their choice. TMHP does not supply the forms.

When completing an ADA Dental claim form, all required information must be included on the claim, as information is not keyed from attachments. Superbills, or itemized statements, are not accepted as claim supplements.

Refer to: "TMHP Electronic Data Interchange (EDI)" for information on electronic claims submissions.

"Claims Filing" for general information about claims filing.

"2006 ADA Dental Claim Filing Instructions" . Blocks that are not referenced are not required for processing by TMHP and may be left blank.

The ADA website at www.ada.org/prof/resources/topics/claimform.asp for a sample of the ADA Dental Claim form.

Claims for emergency, orthodontic, or routine services must each be filed on separate forms. Mixing codes will cause the claim to be denied.

A claim submitted for either emergency or orthodontic services must be marked at the proper box for processing.

A THSteps and ICF-MR dental provider cannot bill the Texas Medicaid Program under his individual performing provider identifier for the services provided by one or more associate dentists practicing in his office as employees or independent contractors with specific employer-employee or contractual relationships. All dentists providing services to Medicaid clients must enroll as THSteps dental providers regardless of employer relationships. The individual provider billing may be reimbursed into a single accounting office to maintain these described relationships.

Note: A dentist must not use another dentist's provider identifier.

In any case, a dental group must provide evidence that the practice is 100 percent owned by currently licensed dentists.

The Texas Medicaid Program cannot be billed by a provider for appointments missed by clients. A client with Medicaid cannot be billed for failure to keep an appointment. Only claims for actual services rendered are considered for payment.

Providers should bill the Texas Medicaid Program their usual and customary fees.

The Remittance and Status (R&S) reports received from TMHP should be filed in sequential order in a binder in the provider's office. Electronic R&S reports should be copied for storage.

Refer to: "2006 ADA Dental Claim Filing Instructions"

"Billing Clients" .