Automated Inquiry System (AIS)

vii

TMHP Electronic Data Interchange (EDI)

3-1

CMS-1500 Claim Filing Instructions

5-22

Example of CMS-1500 claim form

5-24

TMHP Electronic Claims Submission

5-13

State and Federal Offices Communication Guide

A-1

Abortion Certification Statements Form

B-3

Hysterectomy Acknowledgment Form

B-50

Request for Extended Outpatient Psychotherapy/Counseling Form

B-83

Sterilization Consent Form (English)

B-94

Sterilization Consent Form (Spanish)

B-96

Sterilization Consent Form Instructions

B-97

Anesthesia Claim Example

D-5

Dialysis Training Claim Example

D-11

Office Visit with Lab and Radiology Claim Example

D-24

Radiation Therapy Claim Example

D-28

Surgery Claim Example

D-34

Acronym Dictionary

F-1