13.5.6 Dental Claim Form InstructionsDental services must be submitted to TMHP in an approved electronic format or on the ADA Dental Claim Form. Providers may purchase ADA Dental Claim Forms from the vendor of their choice. TMHP does not supply the forms. When completing an ADA Dental 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: Chapter 33, "TMHP Electronic Data Interchange (EDI)" on page 33-1, for information on electronic claims submissions. Chapter 5, "Reimbursement and Claims Filing" on page 5-1, for general information about claims filing. Chapter 5, "Instructions for Completing the ADA Dental Claim Form" on page 5-37, for instructions on completing paper claims. 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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