Index

Index

A - B - C - D - E - F - G - H - I - J - K - L - M - N - O - P - R - S - T - U - V - W - X

Abdominal flat plate (AFP)

Abuse and neglect reporting requirements

Accident resources and refunds

Accident-related claims

Accounts receivables

see Augmentative communication devices

Acquired immunodeficiency syndrome (AIDS)

Acronyms and Initialisms Dictionary

Acute lymphoblastic leukemia (ALL) 1 2

Acute medical episodes

Acute nonlymphoblastic leukemia (ANLL)

Adaptive feeder seats

Adaptive strollers

administrative review requests 1 2

authorization requests

change of address request

CLIA applications

CLIA number notification

DSHS-CSHCN Enrollment

DSHS-CSHCN Provider Relations 1 2

fair hearing requests 1 2

Provider Information Change Form 1 2

TMHP Provider Enrollment

TMHP Publications

TMHP-CSHCN Appeals

TMHP-CSHCN Appeals and Adjustments

TMHP-CSHCN Claims

TMHP-CSHCN electronic claims and rejected reports

TMHP-CSHCN Enrollment

TMHP-CSHCN other correspondence

TMHP-CSHCN Prior Authorization and Authorization

Adenoidectomies

Adjustment to claims

Administration procedure codes for vaccines/toxoids

Advanced practice nurse (APN)

authorization requirements

benefits and limitations

claim information

electronic claims submission

Aerosol treatments

benefits and limitations

see Abdominal flat plate

see Acquired immunodeficiency syndrome

Air ambulance transport

Air transportation (deceased clients)

benefits and limitations

see Automated inquiry system

see Acute lymphoblastic leukemia

Allergy services

benefits and limitations

air ambulance transport

benefits and limitations

billing for ambulance services

claims information

electronic claims submission

emergency air ambulance transportation

emergency ground transport 1 2

nonemergency ground transport 1 2

Ambulation aids

gait/ambulation belts

prescription shoes

prone/supine standers

Ambulatory electroencephalogram

diagnosis codes

Ambulatory surgery authorizations

Ambulatory surgical center (ASC)

benefits and limitations

claims information

electronic claims submission

Americans with Disabilities Act

Anatomical pathology services

administered by surgeon

anesthesiology/anesthesiologists

benefits and limitations

anesthesia provided in a ASC/HASC

anesthesia provided in an office setting

services incidental to anesthesia

services incidental to surgery

see Acute nonlymphoblastic leukemia

Anterior temporal lobectomies

for complex partial seizures

Antibiotic desensitization 1 2

see Advanced practice nurse

Apnea monitors 1 2

administrative claim appeals

administrative review 1 2

AIS appeals 1 2

allowed AIS appeals

claims filed prior to enrollment

clients eligible for Medicaid

corrections and resubmissions

disallowed AIS appeals

advantages of electronic appeal submission

disallowed electronic appeals

electronic submission

exceptions to claims filing deadlines

medical necessity denials

submitted incorrectly

telephone appeals

TMHP administrative claim

see Ambulatory surgical center 1 2

Assistant surgeons

Audiometry/hearing services

benefits and limitations

procedure codes 1 2 3 4 5

Augmentative communication devices (ACDs)

authorization requirements for ACD purchases or rental

authorization requirements for ACD repairs

authorization requirements for ACDs modifications

benefits and limitations

purchases or rentals

claims information

electronic claims submission

enrollment criteria

noncovered ACD system items

prior authorization requirements

Prior Authorization Request for Augmentative Communication Devices

prior authorization requirements replacement

trial period requirements

Authorization/prior authorization

advanced practic nurse (APN)

ambulatory surgical centers

anterior temporal lobectomies

augmentative communication devices 1 2

Prior Authorization Request for Augmentative Communication Devices

augmentative communication devices purchase and rental

authorization deadline calendar for 2007 1 2

authorization deadline calendar for 2008 1 2

bone marrow/stem cell transplants 1 2

Prior Authorization Request for Bone Marrow/Stem Cell or Renal Transplant

car seats, documentation of

certified registered nurse anesthetist

certified respiratory care practitioner

cleft/craniofacial surgeries

clinician directed care coordination services

Authorization Request for Non-Face-to-Face Clinician-Directed Coordinated Care Service

cochlear implants

cranial molding devices

definition of authorization

definition of prior authorization

diagnostic procedures

preventive procedures

Prior Authorization Request for Dental or Orthodontia Services

therapeutic procedures

diapers, pull-ups, underpads, briefs, or liners 1 2

Prior Authorization and Authorization Request for Durable Medical Equipment (DME)

expendable medical supplies

freestanding surgical centers

home health (skilled nursing)

Prior Authorization Request for Hospice Services

hospital admissions

hospital, inpatient

Prior Authorization Request for Inpatient Hospital Admission

inpatient behavioral health

Prior Authorization Request for Inpatient Psychiatric Care

inpatient rehabilitation services

Prior Authorization Request for Inpatient Rehabilitation Admission

medical nutrition services

Prior Authorization Request for Medical Foods

medical nutrition products

medical nutritional counseling services

nutritional assessment, counseling, and products (additional) services

Prior Authorization Request for Nutritional Assessment, Counseling, and Products (Additional)

medical nutritional products

Authorization Request for omalizumab

oral surgery procedures

Prior Authorization Request for Dental or Orthodontia Services

orthotics and prosthetics

outpatient behavioral health

outpatient physical therapy and occupational therapy

Authorization Request for Outpatient Therapy (TP1), Initial

Authorization Request for Outpatient Therapy (TP2), Extension

physician services requiring authorization

physician services requiring prior authorization

prescription shoes

radiology services

reduction mammoplasty

Prior Authorization Request for Renal Dialysis Treatment

renal transplants

Prior Authorization Request for Bone Marrow/Stem Cell or Renal Transplant

respiratory equipment

Authorization Request for Apnea Monitor Rental

Authorization Request for Chest Physiotherapy Devices

Authorization Request for Pulse Oximeter Devices

Prior Authorization Request for Respiratory Care-CRCP

respiratory syncytial virus

Prior Authorization Request for Palivizumab (Synagis)

services requiring authorization by TMHP

specialty team/center 1 2

speech-language pathology services

stem cell transplants

Prior Authorization and Authorization Request for Outpatient Surgery-For Outpatient Facilities and Surgeons

Prior Authorization Request for Inpatient Surgery-For Surgeons Only

telemedicine services

therapeutic apheresis

total parenteral nutrition (TPN)/hyperalimentation

vision related services

see Authorization/prior authorization

Automated inquiry system (AIS)

claim corrections

services provided

verifying client eligibility

Bacille Calmette-Guérin (BCG)

Banner messages

see Bacille Calmette-Guérin

Bi-level positive airway pressure 1 2

Bilateral procedures

Billing clients

see Bi-level positive airway pressure 1 2

Blood factor products 1 2 3

benefits and limitations

procedure codes

Blood pressure devices

Blue Cross Blue Shield

nonparticipating physicians

Bone growth stimulators

Bone marrow/stem cell transplants 1 2

benefits and limitations 1 2

facility reimbursement

physician reimbursement

prior authorization

Botulinum toxin, types A and B

type A diagnosis codes

type B diagnosis code

Bus transportation (deceased clients)

benefits and limitations

authorization and filing deadline calendar for 2007 1 2

authorization and filing deadline calendar for 2008 1 2

fair hearing and administrative review

Cancer screening

benefits and limitations

colorectal diagnosis codes

procedure codes

see Continuous ambulatory peritoneal dialysis

Cardiac blood pool imaging

see Complete blood count 1 2

see Continuous cycling peritoneal dialysis

Cerebrovascular accident (CVA) 1 2 3

independent laboratory waiver

physician-performed microscopy procedure

Certification and IRS W-9 form

Certified registered nurse anesthetist (CRNA)

authorization requirements

benefits and limitations

claims information

electronic claims submission

Certified respiratory care practitioner (CRCP)

benefits and limitations

claims information

electronic claims submission

enrollment criteria

prior authorization requirements

CHAMPUS/CHAMPVA

Change of address request

Provider Information Change Form 1 2

Chemistry tests

benefits and limitations

noncovered procedure

procedure codes

Children's Health Insurance Program of Texas (CHIP)

see Children's Health Insurance Program of Texas

Chronic myelogenous leukemia (CML)

Claim number, explanation

Claim refunds 1 2

Claim reissues 1 2

Claim status inquiry (CSI)

Claim voids 1 2

processed by the Vendor Drug Program

ADA Dental Claim Form

dates on claims

dental emergency claims

dental paper billing

electronic claims submission 1 2

exception requests

exceptions, holiday or weekend

inpatient claims

outpatient claims

incomplete information

other insurance resources

third-party resources

TMHP processing procedures

when a service is a benefit of Medicare

Claims filing instructions

ADA Dental Claim Form

modifier requirements

multipage claim forms

provider types and selection of claim forms

Claims in process

Claims information

advanced practice nurse

ambulatory surgical centers

augmentative communication devices

certified registered nurse anesthetist

certified respiratory care practitioner

durable medical equipment Durable medical equipment (DME)

claims information

expendable medical supplies

freestanding surgical centers

home health (skilled nursing)

inpatient behavioral health

hospital-based surgical center claims

laboratory services

medical nutrition services

medical nutritional counseling services

medical nutritional products

occupational therapy

orthotics and prosthetics

outpatient behavioral health

outpatient physical therapy

radiation therapy services

radiology services

respiratory equipment

speech-language pathology services

total parenteral nutrition (TPN)/hyperalimentation

transportation of remains of deceased clients

vision related services

Claims payment summary

claims - paid or denied

claims in process

EOB codes appendix

Cleft lip/palate

Cleft/craniofacial center team approval requirements

Cleft/craniofacial surgery

prior authorization

surgical procedures

see Clinical Laboratory Improvement Amendments of 1988

Client benefits

claims processed by the Vendor Drug Program

Medical Transportation Program

program limitations and exclusions

services provided outside Texas

Client eligibility 1 2

CHIP/CSHCN benefits

Medicaid/CSHCN benefits

Medically Needy Program

spend down processing

telephone appeals

Clients eligible for Medicaid

Medically Needy Program (MNP)

Clinical Laboratory Improvement Amendments (CLIA) of 1988

regulations 1 2

requirements 1 2

Clinical laboratory services outpatient services

Clinical treatment

Clinician directed care coordination services

see Chronic myelogenous leukemia

claim form example

claim form instructions

Cochlear implant

authorization requirements

benefits and limitations 1 2

claims filing and reimbursement

sound processor replacement guidelines

diagnosis coding

procedure coding

Complete blood count (CBCs) 1 2

Computed tomography (CT) scan 1 2 3

Contact information

CSHCN regional offices

CSHCN telephone and fax communication

TMHP Contact Center

TMHP-CSHCN regional representatives

TMHP-CSHCN Services Program Contact Center

Continuous ambulatory peritoneal dialysis (CAPD) 1 2 3 4 5 6

Continuous cycling peritoneal dialysis (CCPD) 1 2 3 4 5

Continuous positive airway pressure (CPAP) 1 2

Corrections and resubmissions (appeals)

automated inquiry system (AIS)

Cough stimulating devices

see Continuous positive airway pressure 1 2

Cranial molding devices

Craniofacial anomaly

see Certified respiratory care practitioner

see Certified registered nurse anesthetist

Eligibility Form

program history

Provider Manual

regional offices

Region 5 South and 6

Region 9 and 10

see Claim status inquiry

see Computed tomography (CT) scan

documentation for authorization of car seats

travel restraints

see Durable medical equipment

see Cerebrovascular accident

Cytogenetics testing for leukemia and lymphoma

sites other than vaginal/cervical/uterine

vaginal, cervical, and uterine sites

diagnosis codes 1 2

Dates on claims

Denileukin diftitox

anesthesia provided in an ASC/HASC

Criteria for Dental Therapy Under General Anesthesia

authorization requirements

benefits and limitations

claim filing instructions

electronic billing

emergency claims

claims information

dental treatment in ASC/HASC

dental rehabilitation or restoration services

diagnostic procedures

benefits and limitations

clinical oral evaluation

prior authorization

radiographs or diagnostic imaging

tests and oral pathology procedures

doctor of dentistry services as a limited physician

cleft/craniofacial surgery

evaluation and management

surgical procedure codes

orthodontia services

benefits and limitations

prior authorization requirements

Prior Authorization Request for Dental or Orthodontia Services 1 2

required documentation

preventive procedures

authorization requirements

benefits and limitations

dental nutrition counseling

oral hygiene instruction

dental prophylaxis and topical fluoride treatment

space maintainers

tobacco counseling

supernumerary tooth identification

tooth identification and surface identification systems

therapeutic procedures

adjunctive general services

authorization requirements

interrupted treatment plan

benefits and limitations

dental anesthesia provided in an office setting

dental behavior management

dental hospital call

internal bleaching of tooth

maxillofacial prosthetics

oral and maxillofacial surgery

prosthodontics (removable) and maxillofacial prosthetics

prosthodontics, fixed

therapeutic drug injection

treatment in hospitals

Diagnosis codes

allogenic transplants 1 2

ambulatory electroencephalogram

autologous and allogenic transplants 1 2

blood pressure devices

bone growth stimulation

botulinum toxin type A

botulinum toxin type B

cancer screening, colorectal

clubfoot casting

darbepoietin 1 2

electroencephalogram (ambulatory)

epirubicin hydrochloride

erythropoietin alfa (EPO) 1 2

hyperbaric oxygen therapy

ibutilide fumarate

intraoperative echography

magnetic resonance imaging (MRI)

lower extremities

orbit/face/neck 1 2

upper extremities

porfimer sodium

positron emission tomography

proton beam therapy

radiation treatment delivery/port films

septoplasty 1 2

therapeutic apheresis

total parenteral nutrition (TPN)/hyperalimentation

Diagnosis coding

Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV)

Diagnostic dental procedures

benefits and limitations

clinical oral evaluations

prior authorization

radiographs or diagnostic imaging

tests and oral pathology procedures

Authorization Request for Diapers, Pull-ups, Underpads, Briefs, or Liners

Direct supervision

see Durable medical equipment

diagnosis codes

Doctor of dentistry services as a limited physician

cleft/craniofacial surgery

evaluation and management

X-ray procedures

Documentation requirements

medical records

DSHS Health Region map

see Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision

Durable medical equipment (DME)

adaptive feeder seats

adaptive strollers

ambulation aids

Prior Authorization and Authorization Request for Durable Medical Equipment (DME)

benefits and limitations

blood pressure devices

car seats/travel restraints

cochlear implants 1 2 3

Documentation of Receipt

Documentation of Receipt (Spanish)

gait trainers 1 2

gait/ambulation belts

gastrostomy devices

glucose monitors

hospital beds (manual and electric)

hygiene equipment

modifier requirements

noncovered rehabilitative and therapeutic DME

portable hydrocollator units

portable paraffinn units

portable wheelchair ramps

pressure reducing pads

prone/supine standers

reimbursement 1 2

respiratory equipment

standers, prone and supine

transfer boards

manual wheelchairs

positioning equipment

power wheelchairs

Wheelchair Seating Evaluation Form

Dysphagia/swallowing disorder

see Evaluation and management services 1 2

see Electrocardiogram

Echoencephalography

see Electronic Data Interchange

see Electroencephalogram (ambulatory)

see Electronic funds transfer

Electro-oculogram (EOG)

Electrocardiogram (ECG) 1 2

Electroencephalogram (EEG) (ambulatory)

benefits and limitations

diagnosis codes

procedure codes

Electromyogram (EMG)

Electronic claim submission

Electronic Data Interchange (EDI)

electronic transmission reports

services available

setting up access

submitting claims

supported file types

vendor implementation

vendor software

Electronic funds transfer (EFT) 1 2 3 4

enrollment procedures

Information and Authorization Agreement

Electronic Remittance and Status (ER&S) report

Electronic Remittance and Status (ER&S) Agreement

Electronic transmission reports

Eligibility Form sample

Eligibility verification (EV)

benefits and limitations

Emergency air ambulance transportation

Emergency ground ambulance transportation

Emergency ground transportation

Emergency Medical Transportation and Labor Act (EMTALA) 1 2

Emergency services

benefits and limitations

hospital emergency room

hospital-based emergency department services

observation room

prolonged physician services

see Electromyogram

see Emergency Medical Transportation and Labor Act 1 2

advanced practice nurse (APN)

augmentative communication devices

certified registered nurse anesthetist (CRNA)

certified respiratory care practitioner (CRCP)

dental/orthodontia

durable medical equipment (DME) 1 2

electronic funds transfer

expendable medical supplies

home health (skilled nursing)

hospital-based and freestanding ambulatory surgical center

inpatient behavioral health

laboratory services

medical nutrition services 1 2

medical nutritional counseling

occupational therapy

orthotics and prosthetics

outpatient behavioral health

outpatient physical therapy

group billing procedure

independent practices

personal supervision versus direct supervision

specialty team/center

radiation therapy

radiology services

respiratory equipment

specialty team/center

speech-language pathology services

TMHP-CSHCN address

total parenteral nutrition (TPN)/hyperalimentation

vision related services

see Explanation of benefits 1 2 3

see Electro-oculogram

see Explanation of pending status 1 2

Epidural, anesthesia 1 2

Epirubicin hydrochloride

see Erthropoietin Alfa

see Electronic Remittance and Status (ER&S) report

Erythropoietin alfa (EPO)

diagnosis codes 1 2

see Extracorporeal shock wave lithotripsy

see Eligibility verification

Evaluation and management (E/M) services

benefits and limitations

emergency services

initial and subsequent hospital care

inpatient professional services

new patient visits

observation room services

procedure codes

prolonged physician services

Expendable medical supplies

authorization requirements

benefits and limitations

claims information

examples of covered supplies

Explanation of benefits (EOB) 1 2 3 4

Explanation of pending status (EOPS) 1 2

Extracorporeal shock wave lithotripsy (ESWL)

Family nurse practitioner (FNP)

Ferritin and iron studies

Filing deadlines

calendar 1 2 3 4 5

fair hearing and administrative review calendar

third-party resources

Financial transactions

Authorization Request for Apnea Monitor Rental

Authorization Request for Chest Physiotherapy Devices

Authorization Request for Diapers, Pull-ups, Underpads, Briefs, or Liners

Authorization Request for Non-Face-to-Face Clinician-Directed Coordinated Care Services

Authorization Request for Omalizumab

Authorization Request for Outpatient Therapy (TP1), Initial 1 2

Authorization Request for Outpatient Therapy (TP2), Extension

Authorization Request for Pulse Oximeter Devices

Claim Status Inquiry (CSI) Authorization

Criteria for Dental Therapy Under General Anesthesia

Documentation of Receipt

Documentation of Receipt (Spanish)

Electronic Funds Transfer (EFT) Information and Authorization Agreement

Electronic Remittance and Status (ER&S) Agreement 1 2

Home Health (Skilled Nursing) Referral and Treatment Plan

Instructions for Completing the Provider Information Change Form

Physician/Dentist Assessment Form (PAF)

Physician/Dentist Assessment Form (PAF) Instructions

Prior Authorization and Authorization Request for Durable Medical Equipment (DME)

Prior Authorization and Authorization Request for Outpatient Surgery-For Outpatient Facilities and Surgeons

Prior Authorization Request for Augmentative Communication Devices

Prior Authorization Request for Bone Marrow/Stem Cell or Renal Transplant

Prior Authorization Request for Dental or Orthodontia Services

Prior Authorization Request for Hospice Services

Prior Authorization Request for Inpatient Hospital Admission

Prior Authorization Request for Inpatient Psychiatric Care

Prior Authorization Request for Inpatient Rehabilitation Admission

Prior Authorization Request for Inpatient Surgery-For Surgeons Only

Prior Authorization Request for Medical Foods

Prior Authorization Request for Nutritional Assessment, Counseling, and Products (Additional)

Prior Authorization Request for Palivizumab (Synagis)

Prior Authorization Request for Renal Dialysis Treatment

Prior Authorization Request for Respiratory Care-CRCP

Provider Information Change Form

Reimbursement Request for Transportation of the Remains of Deceased Clients

Vision Care Eyeglass Client Certification Form

Vision Care Eyeglass Client Certification Form (Spanish)

Wheelchair Seating Evaluation Form

Fraud and abuse

Freestanding ambulatory surgical centers

claims information

electronic claims submission

Gait trainers 1 2

Gait/ambulation belts

diagnosis codes

Gastrostomy devices

benefits and limitations

electronic claims submission

Genetic services

electronic claims submission

anesthesiologists

Glucose monitors

Granisetron hydrochloride

billing procedure 1 2

practices enrollment

cytopathology studies

see Hyperbaric oxygen therapy

see Healthcare common procedure coding system

Health Insurance Portability and Accountability Act (HIPAA) 1 2 3 4 5

Health maintenance organization (HMO)

Healthcare common procedure coding system (HCPCS)

place of service coding

processed by Program for Amplification for Children of Texas (PACT)

Hearing services

Helicobacter pylori (H. pylori)

see High frequency chest wall compression systems

High frequency chest wall compression systems (HFCWCS) 1 2 3 4 5 6

Hip knee ankle foot orthotics (HKAFO)

Hip orthotics (HO) 1 2

see Health Insurance Portability and Accountability Act

see Human immunodeficiency virus

see Hip knee ankle foot orthotics

see Human leukocyte antigen

see Hip orthotics

Home health (skilled nursing)

authorization requirements

Home Health (Skilled Nursing) Referral and Treatment Plan

benefits and limitations

claims information

benefits and limitations

prior authorization requirements

Prior Authorization Request for Hospice Services

ambulatory surgical center

beds (manual and electric)

benefits and limitations

blood factor products 1 2

change of ownership

claims information

clinical treatment management

dental treatment in hospital/ambulatory surgical centers

emergency inpatient hospital admissions

freestanding surgical center claims

hospital admission prior authorization requirements

Prior Authorization Request for Inpatient Hospital Admission

hospital-based emergency department services

hospital-based surgical center claims

hospital admission prior authorization requirements

hospital extensions

radiology reimbursement

rehabilitation services 1 2

inpatient behavioral health

benefits and limitations

claims information

prior authorization

Prior Authorization Request for Inpatient Psychiatric Care

laboratory services 1 2

magnetic resonance angiography (MRA)

magnetic resonance imaging (MRI)

medical radiation physics, dosimetry, treatment devices, and special services

observation 1 2

radiology reimbursement

positron emission tomography (PET)

radiation therapy services

radiation treatment delivery/port films

radiology services

rehabilitation services

Prior Authorization Request for Inpatient Rehabilitation Admission

reimbursement 1 2 3

renal transplants

Prior Authorization Request for Inpatient Psychiatric Care

specialty team/center

stem cell transplants

Prior Authorization Request for Inpatient Psychiatric Care

Technetium TC 99M

Hospital-based and freestanding ambulatory surgical centers

Hospital-based emergency department professional services

Human immunodeficiency virus (HIV) 1 2 3

Human leukocyte antigen (HLA) 1 2 3

diagnosis codes

Hygiene equipment

Hyperbaric oxygen therapy (HBOT)

benefits and limitations

diagnosis codes

Ibutilide fumarate

see International Classification of Diseases, Ninth Revision, Clinical Modification

see Internal control number

see Individualized education plan

Immune globulin

authorization requirements

benefits and limitations

noncovered vaccines/toxoids

Texas Vaccines for Children (TVFC) Program

vaccines/toxoids

Incomplete claims

appeal deadlines

Independent laboratory

electronic claims submission

physician-performed microscopy procedure certificates

waiver certificate

Independent practices

Individualized education plan (IEP) 1 2

Inhalation therapy

benefits and limitations

see Aerosol treatments

Initial and subsequent hospital care

benefits and limitations

Injectable medications

benefits and limitations

botulinum toxin

denileukin diftitox

epirubicin hydrochloride

erythropoietin alfa (EPO)

granisetron hydrochloride

ibutilide fumarate

immune globulin

porfimer sodium

sumatriptan succinate

Injection administration

benefits and limitations