TMPPM 2008 > Texas Medicaid Services > Federally Qualified Health Center (FQHC) > Claims Information

21.4 Claims Information

FQHC services must be submitted to TMHP in approved electronic format or on a UB-04 CMS-1450 or CMS-1500 claim form. Providers may purchase UB-04 CMS-1450 or CMS-1500 claim forms from the vendor of their choice. TMHP does not supply the forms.

When completing a UB-04 CMS-1450 or CMS-1500 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.

"UB-04 CMS-1450 Claim Filing Instructions" for instructions on completing paper claims.

"CMS-1500 Claim Filing Instructions" for instructions on completing paper claims. Blocks that are not referenced are not required for processing by TMHP and may be left blank.

When filing claims for clients who only have Medicaid, providers may use either a UB-04 CMS-1450 or CMS-1500 claim form. Claims for THSteps services provided by FQHC providers must include the EP modifier.

FQHC providers billing for THSteps must use the CMS-1500 claim form and the EP modifier, not the UB-04 CMS-1450 claim form.

For FQHC providers who also have Titles V, X, and XX funding, family planning claims are filed on the "Family Planning 2017 Claim Form" .

When filing for a client who has Medicare and Medicaid coverage, providers must file on the same claim form that was filed to Medicare. The THSteps Dental (ADA) claim form described under FQHC services, Family Planning, Case Management for CPW, and THSteps services may be submitted electronically or on the "ADA Dental Claim Form" on page 5-38.