CSHCN 2008 > Radiology Services > Claims Information

26.5 Claims Information

Claims for radiology services must include the referring provider. Radiologists are required to identify the referring provider by full name and address or CSHCN Services Program provider identifier in Block 17 of the CMS-1500 claim form. As with all procedures billed to the CSHCN Services Program, baseline screening and comparison studies are not benefits.

Radiology services must be submitted to TMHP in an approved electronic format or on the CMS-1500 claim form or the UB-04 CMS-1450 claim form. Providers may purchase CMS-1500 claim forms and UB-04 CMS-1450 claim forms from the vendor of their choice. TMHP does not supply the forms.

When completing a CMS-1500 claim form or 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: Chapter 33, "TMHP Electronic Data Interchange (EDI)" on page 33-1, for information about electronic claims submissions.

Chapter 5, "Reimbursement and Claims Filing"on page 5-1, for general information about claims filing.

Chapter 5, "CMS-1500 Claim Form Instructions"on page 5-19, and "Instructions for Completing the UB-04 CMS-1450 Claim Form" , for instructions on completing paper claims. Blocks that are not referenced are not required for processing by TMHP and may be left blank.