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20.5.2.1 Medicaid Managed Care Claims
Providers must use the CMS-1500 (physician, nonfacility) or UB-04 CMS-1450 (hospital) claim forms and submit claims directly to Medicaid health maintenance organizations (HMOs) for Title XIX family planning services. Title V, X, or XX claims must always be submitted to TMHP directly using the Family Planning 2017 (Revised January 2007) claims form/format.
Providers submitting claims for family planning services to TMHP for Primary Care Case Management (PCCM) may use the Family Planning 2017 claim form.
Hospitals must use the UB-04 CMS-1450 claim form when billing family planning services.
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