41.6 Claims InformationFreestanding and hospital-based RHC services must be submitted to TMHP in an approved electronic format or on a UB-04 CMS-1450 claim form. Providers may purchase UB-04 CMS-1450 claim forms from the vendor of their choice. TMHP does not supply the forms. 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 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" . Blocks that are not referenced are not required for processing by TMHP and may be left blank |
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Texas Medicaid & Healthcare Partnership CPT only copyright 2007 American Medical Association. All rights reserved. |
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