TMPPM 2008 > Texas Medicaid Services > Licensed Clinical Social Worker (LCSW) > Claims Information

28.5 Claims Information

Providers must bill Medicare before Medicaid when clients are eligible for services under both programs. Medicaid's responsibility for the coinsurance and/or deductible is determined in accordance with Medicaid benefits and limitations. Providers must check the client's Medicare card for Part B coverage before billing the Texas Medicaid Program. When Medicare is primary, it is inappropriate to bill Medicaid without first billing Medicare. The Texas Medicaid Program is responsible for the coinsurance and deductible of Medicare-allowed services on a crossover basis only.

Refer to: "Part B" .

"Medicare Part B Crossovers" .

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

When completing a 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.

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