TMPPM 2008 > Texas Medicaid Services > Military Hospital > Claims Information

33.5 Claims Information

If type of bill (TOB) 110 is used to submit a claim, all charges must be noncovered and the claim will finalize with Explanation of Benefit (EOB) 217, "Payment reduced through hospital action."

It is appropriate to submit information only claims using TOB 110.

Military hospitals may submit total charges in one line with appropriate accommodation revenue codes. Emergency hospital services must be submitted to TMHP in an approved electronic format or on the UB-04 CMS-1450 claim form. Providers may purchase claim forms from the vendor of their choice. TMHP does not supply the forms.

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

"Claims Filing" for general information about claims filing.

When completing a UB-04 CMS-1450 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 claims supplements.

Instructions for completing paper claims are provided in "UB-04 CMS-1450 Claim Filing Instructions" . Blocks that are not referenced are not required for processing by TMHP and may be left blank.

Refer to: "Military Hospital (Emergency Inpatient)".