|
5.7.1 Provider Types and Selection of Claim Forms
5.7.1.1 CMS-1500
Claims for the following provider types or services must be billed on a CMS-1500 claim form or electronic claim format when requesting payment for medical services and supplies under the CSHCN Services Program:
• Advanced practice nurse (APN), such as pediatric nurse practitioner (PNP), clinical nurse specialist (CNS), and family nurse practitioner (FNP).
•Ambulance.
•Augmentative communication devices (ACDs).
•Certified respiratory care practitioner (CRCP).
•Certified registered nurse anesthetists (CRNA).
•Durable medical equipment (DME).
•Freestanding ambulatory surgery center.
•Gastrostomy devices.
•Genetic services.
•Independent laboratory, radiology, and radiation therapy.
•Medical foods.
•Medical nutritional products and services.
•Orthosis and prosthesis.
•Outpatient behavioral health services.
•Outpatient therapy (physical therapy [PT], occupational therapy [OT], and speech-language pathology [SLP]).
•Physician (doctor of medicine [MD] and doctor of osteopathy [DO]).
•Podiatry.
•Total parenteral nutrition (TPN)/hyperalimentation.
•Transportation of deceased clients (providers should contact the CSHCN Services Program for assistance in obtaining and completing forms).
•Vision services.
•Any other authorized provider of medical services and supplies not specifically required to use a different claim form when submitting claims to TMHP.
Providers are responsible for obtaining these forms from a supplier of their choice (refer to Section 5.7.1.3, "CMS-1500 Example," on page 5-24).
|
