Index

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


A

Abdominal flat plate (AFP)

Abuse and neglect reporting requirements

Accident resources and refunds

Accident-related claims

Accounts receivables

ACD

see Augmentative communication devices (ACDs)

Acquired immunodeficiency syndrome (AIDS)

Acronyms and Initialisms Dictionary

Acute lymphoblastic leukemia (ALL)

Acute medical episodes

Acute nonlymphoblastic leukemia (ANLL)

Adalimumab

Adaptive feeder seats

commode chair

Adaptive strollers

authorization requirements

Add date

Addresses

administrative review requests 1 2

CLIA applications

CLIA number notification

CSHCN Enrollment

DSHS-CSHCN Provider Relations 1 2

information change requests

TMHP Provider Enrollment

TMHP Publications

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

TMHP-CSHCN TPR

Adjustment to claims

Administrative review

authorizations

prior authorizations

Advanced practice nurse (APN)

authorization requirements

benefits and limitations

claims information

electronic claims submission

enrollment

reimbursement

Advanced practice registered nurse (APRN)

Aerosol treatments

pentamidine

AFP

see Abdominal flat plate (AFP)

AIDS

see Acquired immunodeficiency syndrome (AIDS)

Air transportation (deceased clients)

authorization requirements

benefits and limitations

AIS

see Automated inquiry system (AIS)

ALL

see Acute lymphoblastic leukemia (ALL)

Allergy services

benefits and limitations

Ambulance

billing for ambulance services

claims information

emergency air ambulance

emergency ground ambulance transportation

nonemergency ground ambulance

electronic claims submission

emergency air ambulance transportation

authorization requirements

emergency air ambulance transportation

benefits and limitations

emergency ground transportation

authorization requirements

benefits and limitations

enrollment

nonemergency ground transportation

authorization requirements

benefits and limitations

origin and destination modifiers

reimbursement

Ambulation aids

ambulation belts

canes

crutches

gait

gait trainers

prescription shoes

prone/supine standers

authorization requirements

benefits and limitations

walkers

Ambulation belts

Ambulatory electroencephalogram (EEG)

diagnosis codes

Ambulatory surgery

authorization requirements

Ambulatory surgical center (ASC)

authorization requirements

benefits and limitations

hospital-based

authorization requirements

benefits and limitations

electronic claims submission

freestanding surgical centers

reimbursement

Americans with Disabilities Act

Anesthesia

administered by surgeon

anesthesiology/anesthesiologists

conversion factor

dental

anesthesia provided in a ASC/HASC

dental (general)

modifiers

monitored care

regional

reimbursement

time-based fees

services incidental to anesthesia

services incidental to surgery

services not incidental to anesthesia

services not incidental to surgery

Anesthesiology

medical direction

see Anesthesia

ANLL

see Acute nonlymphoblastic leukemia (ANLL)

Anterior temporal lobectomies 1 2

authorization requirements

Antibiotic desensitization

Apnea monitors 1 2

Appeals

120-day

administrative review 1 2

address 1 2

requirements

AIS appeals

allowed AIS appeals

authorization or prior authorization

claims filed prior to enrollment

clients eligible for Medicaid

disallowed AIS appeals

electronic

advantages of electronic appeal submission

disallowed electronic appeals

electronic submission

rejections

exceptions to claims filing deadlines

address

fair hearing

address

methods for appealing

paper

provider enrollment

submitted incorrectly

telephone appeals

time limits

ASC

see Ambulatory surgical center (ASC)

Assistant surgeons

Audiology evaluation

Audiometry

procedure codes

Audiometry evaluation

Audiometry/hearing services

Augmentative communication devices (ACDs)

authorization requirements

modifications

repairs

benefits and limitations

claims information

electronic claims submission

enrollment criteria

excluded items

modifications

prior authorization requirements

Prior Authorization Request for Augmentative Communication Devices

purchases or rental

replacement

purchases or rentals

reimbursement

repairs

replacement

Authorization/prior authorization 1 2

additional medical nutritional services

nutritional assessment, counseling, and products services

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

address

advanced practice nurse (APN)

ambulance

emergency air ambulance transportation

emergency ground transportation

nonemergency ground transportation

ambulatory surgical center (ASC)

anterior temporal lobectomies

appeals

augmentative communication devices (ACDs)

modifications

purchase and rental

repairs

replacement

authorization deadline calendar for 2009

authorization deadline calendar for 2010

authorization deadline calendar for 2011

Authorization Request for Extension of Outpatient Therapy (TP2)

Authorization Request for Hemophilia Blood Factor Products

authorizations

blood pressure devices and supplies

bone growth stimulators

bone-anchored hearing aid (BAHA)

certified registered nurse anesthetist (CRNA)

certified respiratory care practitioner

certified respiratory care practitioner (CRCP) 1 2

chemotherapy

cleft/craniofacial surgeries

clinician-directed care coordination services

Authorization Request for Non-Face-to-Face Clinician-Directed Care Coordination Services 1 2

cochlear implants

cranial molding orthoses

denials

dental 1 2

diagnostic procedures

orthodontia

preventive services

Prior Authorization Request for Dental or Orthodontia Services

therapeutic services

treatment in ASC/HASC

diabetic equipment and supplies

diagnostic radiology services

diapers, pull-ups, briefs, or liners

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

durable medical equipment (DME) 1 2 3

adaptive strollers

car seats

continuous passive motion device

custom commode chair

enuresis alarms

foot rest

gait trainers

gastrostomy devices

heavy-duty commode chair

hospital beds

hospital cribs and enclosed beds

hygiene equipment

mobile commode chair

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

replacement pail or pan

standers, prone or supine

stationary commode chair

travel chairs

wheelchairs

dynamic splints

electrodiagnostic (EDX) testing

expendable medical supplies

fair hearing

general information

glucose monitors

hearing services

home health (skilled nursing) 1 2

home health aid (HHA) visits

home health services 1 2

hospice

Prior Authorization Request for Hospice Services

hospital

inpatient behavioral health

hospital inpatient/outpatient

hospital, inpatient

Prior Authorization Request for Inpatient Hospital Admission

rehabilitation

initial inpatient

inpatient admission

after hours

inpatient behavioral health

Prior Authorization Request for Inpatient Psychiatric Care

inpatient rehabilitation services

Prior Authorization Request for Inpatient Rehabilitation Admission

insulin pumps

limitations

magnetic resonance imaging (MRI)

medical foods 1 2

medical nutritional counseling services 1 2

medical nutritional products

formulary

medical nutritional services

counseling

medical foods

Prior Authorization Request for Medical Foods

products

neurostimulator devices and supplies

occupational therapy (OT)

Omalizumab

Authorization Request for Omalizumab

oral surgery procedures

orthotic and prosthetic devices

outpatient hospital

outpatient physical therapy and occupational therapy

physical therapy (PT)

physician 1 2

podiatry

prescription shoes

Prior Authorization Request for Chest Physiotherapy Devices

Prior Authorization Request for Inpatient Surgery-For Surgeons Only

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

prior authorizations

radiation therapy services

stereotactic radiosurgery

radiation therapy services

reciprocating gait orthoses

reconstructive and cosmetic procedures

reduction mammoplasty

removable shoe insert

renal (kidney) transplants

renal dialysis 1 2

Prior Authorization Request for Renal Dialysis Treatment

request for codes pending rate hearing

respiratory equipment

Prior Authorization Request for Apnea Monitor

Prior Authorization Request for Pulse Oximeter Devices

Prior Authorization Request for Respiratory Care-CRCP

respiratory equipment and supplies

respiratory syncytial virus

Prior Authorization Request for Palivizumab (Synagis)

rhizotomy

services that require authorization

services that require prior authorization

signature requirements

skilled nursing (SN) services

social work services

specialty team/center 1 2

speech-language pathology (SLP)

speech-language pathology (SLP) services

stem cell transplant

stem cell transplants

submitting a prior authorization request

submitting a request

surgery

Prior Authorization Request for Inpatient Surgery-For Surgeons Only

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

therapeutic apheresis

total parenteral nutrition (TPN)

transportation

deceased client

vision related services 1 2 3 4

Authorizations

see Authorization/prior authorization

Automated inquiry system (AIS)

claim corrections

services provided

User's Guide

verifying client eligibility

Azacitidine (Viadaza)

B

Banner messages

Banner pages

Bi-level positive airway pressure (BiPAP) systems 1 2

Bilateral procedures

Billing clients

BiPAP

see Bi-level positive airway pressure (BiPAP) systems

Blood factor products 1 2

inpatient/outpatient

benefits and limitations

procedure codes

Blood pressure devices and supplies

authorization requirements

benefits and limitations

claims information

diagnosis codes

documentation of receipt

enrollment

reimbursement

Blue Cross Blue Shield

nonparticipating physicians

Bone growth stimulators

internal

noninvasive

ultrasound

prior authorization requirements

Bone-anchored hearing aid (BAHA)

prior authorization requirements

reimbursement

Botulinum toxin, types A and B

type A diagnosis codes

type B diagnosis code

Breast reconstruction

Bus transportation (deceased clients)

authorization requirements

benefits and limitations

C

Calendars

authorization and filing deadline calendar for 2009

authorization and filing deadline calendar for 2010 1 2

authorization and filing deadline calendar for 2011 1 2

fair hearing and administrative review 1 2 3

Cancer screening

benefits and limitations

colorectal diagnosis codes

Canes

CAPD

see Continuous ambulatory peritoneal dialysis (CAPD)

Car seats

prior authorization requirements

Cardiac blood pool imaging

Cardiorespiratory (apnea) monitors

Casting

CBC

see Complete blood count (CBC)

CCPD

see Continuous cycling peritoneal dialysis (CCPD)

Cerebrovascular accident (CVA) 1 2 3

Certificate

independent laboratory waiver

physician-performed microscopy procedure

Certified registered nurse anesthetist (CRNA)

authorization requirements

benefits and limitations

claims information

electronic claims submission

enrollment

reimbursement

Certified respiratory care practitioner (CRCP)

authorization requirements 1 2 3

claims information

electronic claims submission

enrollment criteria

reimbursement

Certolizumab pegol

CHAMPUS/CHAMPVA

Chemistry tests

Chemotherapy

authorization requirements

benefits and limitations

inpatient/outpatient

benefits and limitations

procedure codes

Child support

Children's Health Insurance Program of Texas (CHIP)

eligibility

CHIP

see Children's Health Insurance Program of Texas (CHIP)

Cidofovir

Circumcision

Claim number, explanation

Claim refunds

Claim reissues

Claim status inquiry (CSI)

Claim voids

Claims

accidents

third-party liability

processed by the Vendor Drug Program

Claims filing

adjustments

billing 1 2

CMS-1450

dates on claims

deadlines

exceptions

extensions

fiscal agent payment

dental emergency claims

dental paper billing

electronic claims submission 1 2

exception requests

exceptions, holiday or weekend

hospital

inpatient claims

interim claims

outpatient claims

hospital-based ambulatory surgical center (HASC) claims

incomplete information

inpatient claims

laboratory tests

outpatient claims

paper ADA Dental Claim Form

processed by date of service

refunds

span dates

TMHP processing procedures

when a service is a benefit of Medicare

Claims filing forms

Institutional UB-04 CMS-1450

Professional (CMA-1500)

Claims filing instructions

CMS-1450

CMS-1500

deadlines

dental

DSHS

modifier requirements

multipage claim forms

Institutional UB-04 CMS-1450

Professional (CMS-1500

paper ADA Dental Claim Form

processed by date of service

provider types and selection of claim forms

TMHP

TPR

Claims in process

Claims information

advanced practice nurse (APN)

ambulance emergency air transportation

ambulance emergency ground transportation

ambulance nonemergency ground transportation

augmentative communication devices (ACDs)

blood pressure devices and supplies

certified registered nurse anesthetist (CRNA)

certified respiratory care practitioner (CRCP)

dental 1 2

diabetic equipment and supplies

diagnostic radiology services

durable medical equipment (DME)

expendable medical supplies

hearing services

home health (skilled nursing)

home health services

hospice

hospital

laboratory services

medical foods

medical nutritional counseling services

medical nutritional products

neurostimulator devices and supplies

occupational therapy

orthodontics

orthotic and prosthetic devices

outpatient

behavioral health

physical therapy

physician

group billing procedure

radiation therapy services

reimbursement

national drug codes (NDC)

renal dialysis

respiratory equipment

speech-language pathology (SLP) services

total parenteral nutrition (TPN)

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

authorization requirements

benefits and limitations

physician

surgical procedures

CLIA

see Clinical Laboratory Improvement Amendments (CLIA) of 1988

Client benefits

claims processed by the Vendor Drug Program

Medical Transportation Program

program limitations and exclusions 1 2

services provided outside Texas

Client eligibility 1 2

CHIP/CSHCN benefits

financial eligibility criteria

Medicaid/CSHCN benefits

Medically Needy Program (MNP)

claims filing

provider assistance to clients

spend down processing

renal dialysis

telephone appeals

verifying

Clients eligible for Medicaid

Medically Needy Program (MNP)

Clinical brachytherapy (radiation therapy)

procedure codes

Clinical brachytherapy (surgery)

procedure codes

Clinical Laboratory Improvement Amendments (CLIA) of 1988

regulations

requirements 1 2

Clinical laboratory services

outpatient services

Clinical nurse specialist (CNS)

enrollment

Clinical pathology services

Clinical treatment

planning

Clinician-directed care coordination services

authorization requirements

benefits and limitations

face-to-face

non-face-to-face

Clofarabine (Clorar)

CML

see Chronic myelogenous leukemia (CML)

CMS-1500

paper claim form example

paper claim form instructions

Cochlear implant

postsurgery rehabilitation

authorization requirements

Cochlear implants 1 2

authorization requirements

benefits and limitations 1 2

sound processor replacement

Codes

coding

diagnosis coding

procedure coding

CPT

HCPCS

ICD-9-CM

Colorectal cancer screening

Commode chair

heavy duty

authorization requirements

level 1 stationary

prior authorization requirements

level 2 mobile

prior authorization requirements

level 3 custom

prior authorization requirements

replacement pail or pan

authorization requirements

seat lift mechanism

with integrated seat lifts

Complaints

Complete blood count (CBC) 1 2

Computed tomography (CT) scan 1 2

Cone-beam imaging

Confidential information

release of

Consultations

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) systems 1 2

Controlled dose inhalation drug delivery system

Corrections and resubmissions (appeals)

time limits

Cosurgery

Cough stimulating devices

Counseling

CPAP

see Continuous positive airway pressure (CPAP) systems

CPT codes

see Codes

Cranial molding orthoses

Craniofacial anomaly

CRCP

see Certified respiratory care practitioner (CRCP)

Critical care 1 2

intensive (noncritical) low birth weight services

newborn resuscitation critical care services

pediatric services

CRNA

see Certified registered nurse anesthetist (CRNA)

Crutches

CSHCN

central and regional offices

Eligibility Form

program history

Provider Manual

regional offices

Region 1

Region 11

Region 2

Region 3

Region 4

Region 5 North

Region 5 South and 6

Region 7

Region 8

Region 9 and 10

CSI

see Claim status inquiry (CSI)

CT

see Computed tomography (CT) scan

Custom DME

car seats

travel restraints

see Durable medical equipment (DME)

CVA

see Cerebrovascular accident (CVA)

Cytogenetics testing for leukemia and lymphoma

Cytopathology

sites other than vaginal, cervical, and uterine

studies

vaginal, cervical, and uterine sites

D

Dalteparin sodium

Darbepoietin

diagnosis codes 1 2

Dates on claims

Day surgery

inpatient stays

Denials

authorization/prior authorization

verbal 1 2

Denileukin diftitox

Dental

adjunctive general services

procedure codes

anesthesia (general)

anesthesia provided in an ASC/HASC

Criteria for Dental Therapy Under General Anesthesia

anesthesia provided in an office setting

procedure codes

benefits and limitations

claims filing information 1 2

electronic billing

emergency claims

instructions

paper billing

cone-beam imaging

dental treatment in ASC/HASC

anesthesia

dental rehabilitation or restoration services

diagnostic procedures

clinical oral evaluation

first dental home

prior authorization requirements

radiographs or diagnostic imaging

tests and oral pathology procedures

diagnostic services

doctor of dentistry services as a limited physician

anesthesia

cleft/craniofacial surgery

evaluation and management

laboratory

radiology

surgery

surgical procedure codes

enrollment

implants

procedure codes

maxillofacial prosthetics

procedure codes

noncovered counseling services

dental nutrition counseling

tobacco counseling

oral and maxillofacial surgery

procedure codes

orthodontia services

local codes

prior authorization requirements

Prior Authorization Request for Dental or Orthodontia Services

required documentation

periodontic services

procedure codes

preventive services

authorization requirements

benefits and limitations

dental prophylaxis and topical fluoride treatment

noncovered counseling services

oral hygiene instruction

sealants

space maintainers

prior authorization requirements 1 2

prophylaxis and topical fluoride treatment

procedure codes

prosthetic services, fixed

procedure codes

prosthodontic services, fixed

procedure codes

prosthodontics (removable) and maxillofacial prosthetics

procedure codes

reimbursement

tooth identification and surface identification systems

restorations

procedure codes

root canals

procedure codes

screening

supernumerary tooth identification

therapeutic services

adjunctive general services

anesthesia

authorization requirements

interrupted treatment plan

dental behavior management

endodontics

pulp caps

root canals

implants

internal bleaching of tooth

maxillofacial prosthetics

oral and maxillofacial surgery

periodontics

prior authorization requirements

prosthodontics (removable) and maxillofacial prosthetics

prosthodontics, fixed

restorations

treatment in ASC/HASC

authorization requirements

treatment in hospitals

Diabetic equipment and supplies

authorization requirements

benefits and limitations

claims information

enrollment

glucose monitors

insulin pumps

reimbursement

Diabetic supplies and equipment

documentation of receipt

Diagnosis codes

allogenic transplants

ambulatory electroencephalogram (EEG)

autologous transplants

blood pressure devices and supplies

botulinum toxin type A

botulinum toxin type B

cancer screening, colorectal

clubfoot casting

darbepoietin 1 2

dorsal column neurostimulation (DCN)

electroencephalogram (EEG) (ambulatory)

electromyography (EMG)

erythropoietin alfa (EPO) 1 2

extracorporeal shock wave lithotripsy

gamma globulin

glucose monitors

growth hormone 1 2

high frequency chest wall compression system (HFCWCS)

intracranial neurostimulation (ICN)

intraoperative echography

multiple latency test

orthodontia

pediatric pneumogram

polysomnography

positron emission tomography

renal dialysis

rhizotomy

septoplasty 1 2

stem cell transplants

Strontium 89

therapeutic apheresis

total parenteral nutrition (TPN)

vision examinations 1 2

vision related services

Diagnosis coding

Diagnostic dental procedures

clinical oral evaluation

first dental home

prior authorization requirements

radiographs or diagnostic imaging

tests and oral pathology procedures

Diagnostic dental services

Diagnostic radiology services

authorization requirements

benefits and limitations

cardiac blood pool imaging

claims filing

computed tomography (CT) scan

contrast material

enrollment

hospital

magnetic resonance angiography (MRA)

magnetic resonance imaging (MRI) 1 2

mammography certification

noncovered

positron emission tomography (PET)

provided by hospitals

provided by physician or at physician offices or clinics

abdominal flat plates

provided by physician, APRN, physician groups, and clinics

reimbursement

radiologist

provided by or at an ASC/HSCS

X-rays and ultrasounds

Diapers

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

Diapers, briefs, pull-ups, or liners

Direct supervision

DME

see Durable medical equipment (DME)

DO

see Doctor of osteopathy

Doctor of dentistry services as a limited physician

anesthesia

cleft/craniofacial surgery

procedure codes

evaluation and management

laboratory procedures

radiology procedures

Doctor of osteopathy

Documentation of receipt

blood pressure devices and supplies

diabetic supplies and equipment

orthotic and prosthetic devices

Documentation requirements

medical records

Dorsal column neurostimulation (DCN)

diagnosis codes

procedure codes

DSHS Health Region map

Durable medical equipment (DME)

adaptive feeder seats

commode chair

adaptive strollers

authorization requirements

ambulation aids

ambulation belts

authorization

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

authorization requirements

benefits and limitations

canes

car seats

prior authorization requirements

car seats and travel restraints

claims filing

claims information

cochlear implant

authorization requirements

cochlear implants 1 2

commode chair

prior authorization requirements

seat lift mechanism

with integrated seat lifts

continuous passive motion device

authorization requirements

crutches

custom commode chair

authorization requirements

custom DME

documentation of receipt

Documentation of Receipt form

Documentation of Receipt form (Spanish)

enrollment

custom DME

Enuresis alarms

prior authorization requirements

foot rest

authorization requirements

gait

gait trainers

authorization requirements

gastrostomy devices

authorization requirements

nonobturated

obturated

heavy-duty commode chair

authorization requirements

hospital beds

authorization requirements

hospital beds (manual and electric)

hospital cribs and enclosed beds

prior authorization requirements

hygiene equipment

authorization requirements

infusion pumps

mobile commode chair

authorization requirements

modifier requirements

noncovered rehabilitative and therapeutic DME

portable hydrocollator units

portable paraffin units

portable wheelchair ramps

pressure reducing pads

program overview and guidelines 1 2

prone/supine standers

authorization requirements

reimbursement

rental

repairs and modifications

replacement pail or pan

authorization requirements

respiratory equipment

enrollment

standard DME

standard wheelchairs

standers, prone and supine

authorization requirements

TENS units

transfer boards

travel chairs

prior authorization requirements

walkers

wheelchair

battery

power elevating leg lifts

power seat elevation system

wheelchairs

authorization requirements

custom manual wheelchairs

manual wheelchairs

positioning equipment

power wheelchairs

approval criteria

ramps

Wheelchair Seating Evaluation Form

Dynamic splints

Dysphagia (swallowing disorder)

E

E/M

see Evaluation and management (E/M) services

ECG

see Electrocardiogram (ECG)

Echoencephalography

EDI

see Electronic Data Interchange (EDI)

EEG

see Electoencephalogram (EEG)

EFT

see Electronic funds transfer (EFT)

Electrocardiogram (ECG)

Electrodiagnostic (EDX) testing

authorization requirements

benefits and limitations

inpatient/outpatient

benefits and limitations

Electroencephalogram (EEG) (ambulatory)

benefits and limitations

diagnosis codes

procedure codes

Electromyography (EMG)

diagnosis codes

procedure codes 1 2

Electronic analysis for implantable neurostimulators

procedure codes

Electronic claim submission

Electronic Data Interchange (EDI)

electronic submitters

automated maintenance process

electronic transmission reports

forms

gaining access

getting help

overview

services available

submitting claims

supported file types

TexMedConnect

third-party billing agents

third-party vendor implementation

TMHP website

training

vendor software

Electronic funds transfer (EFT) 1 2 3 4

advantages

enrollment procedures

Electronic Remittance and Status (ER&S) report

Electronic Remittance and Status (ER&S) Agreement

Electronic Remittance and Status (ER&S) reports

general information

Electronic transmission reports

Eligibility Form sample

Eligibility verification (EV)

client

Medicaid

Embalming

authorization requirements

benefits and limitations

Emergency air ambulance transportation

Emergency ground ambulance transportation

Emergency Medical Transportation and Labor Act (EMTALA)

Emergency services

benefits and limitations

defined 1 2

emergency room

hospital emergency room

hospital-based emergency department

observation room

prolonged physician services

EMG

see Electromyography (EMG)

EMTALA

see Emergency Medical Transportation and Labor Act

Enoxaparin sodium

Enrollment

advanced practice nurse (APN)

ambulance

augmentative communication devices (ACDs)

blood pressure devices and supplies

certified registered nurse anesthetist (CRNA)

certified respiratory care practitioner (CRCP)

dental/orthodontia

diabetic equipment and supplies

diagnostic radiology services

durable medical equipment (DME) 1 2

custom DME

electronic funds transfer (EFT)

expendable medical supplies

family support services

hearing services

home health (skilled nursing)

home health services

hospice

hospital

laboratory services

medical foods

medical nutritional services

counseling

neurostimulator devices and supplies

occupational therapy

orthotic and prosthetic devices

outpatient behavioral health

outpatient physical therapy

physician

independent practices

specialty team/center

substitute

radiation therapy

renal dialysis

respiratory equipment

specialty team/center

speech-language pathology (SLP) services

substitute physician

TMHP-CSHCN address

total parenteral nutrition (TPN)

vision related services

Enuresis alarms

prior authorization requirements

EOB

see Explanation of benefits 1 2

see Explanation of benefits (EOB)

EOPS

see also Explanation of pending status (EOPS) 1 2

see Explanation of pending status (EOPS)

Epirubicin hydrochloride

EPO

see Erthropoietin Alfa (EPO)

Epoprostenol

ER&S

see Electronic Remittance and Status (ER&S) Report

Erythropoietin alfa (EPO)

diagnosis codes 1 2

ESWL

see Extracorporeal shock wave lithotripsy (ESWL)

EV

see Eligibility verification (EV)

Evaluation and management (E/M) services

benefits and limitations

consultations

emergency services

initial and subsequent hospital care

inpatient professional services

new or established patient visits

observation room services

office and outpatient services

prolonged physician services

Excluded orthoses

Expendable medical supplies

authorization requirements

benefits and limitations

claims information

diapers, pull-ups, and liners

enrollment

examples of covered supplies

gastrostomy devices

reimbursement

Explanation of benefits (EOB) 1 2 3 4

codes appendix

Explanation of pending status (EOPS) 1 2

Extracorporeal shock wave lithotripsy (ESWL)

Eye prostheses

F

Fair hearing

Fair hearing requests

authorizations

prior authorizations

Family support services

Fees

global

lab handling

Ferritin and iron studies

Filing deadlines

120-day

90-day

95-day 1 2

calendars 1 2 3 4 5

exceptions

fair hearing and administrative review calendars 1 2 3

third-party resources

Financial transactions

void and stop

Fiscal agent payment deadline

Fluocinolone acetonide intravitreal implant (Retisert)

inpatient/outpatient

benefits and limitations

Fondaparinux sodium

Foot rest

authorization requirements

Form instructions

Authorization and Prior Authorization Request

Authorization Request for Extension of Outpatient Therapy (TP2)

Authorization Request for Hemophilia Blood Factor Products

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

Authorization Request for Outpatient Therapy (TP1), Initial

Home Health (Skilled Nursing) Referral and Treatment Plan

Instructions for Completing the Provider Information Change Form

Physician/Dentist Assessment Form (PAF) Instructions

Physician/Dentist Assessment Form (PAF) Instructions (Spanish)

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

Prior Authorization Request for Apnea Monitor Rental

Prior Authorization Request for Augmentative Communication Devices (ACDs)

Prior Authorization Request for Chest Physiotherapy Devices

Prior Authorization Request for Dental or Orthodontia Services

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

Prior Authorization Request for Durable Medical Equipment (DME)

Prior Authorization Request for External Insulin Pump

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 Omalizumab

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

Prior Authorization Request for Palivizumab (Synagis) 1 2

Prior Authorization Request for Pulse Oximeter Devices

Prior Authorization Request for Renal Dialysis Treatment

Prior Authorization Request for Respiratory Care-CRCP

Prior Authorization Request for Stem Cell or Renal Transplant

Wheelchair Seating Evaluation Form

Forms

Authorization and Prior Authorization Request

Authorization Request for Apnea Monitor Rental

Authorization Request for Extension of Outpatient Therapy (TP2)

Authorization Request for Hemophilia Blood Factor Products

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

Specialist or Subspecialist Telephone Consultation Form

Authorization Request for Omalizumab

Authorization Request for Outpatient Therapy (TP1), Initial

Claim Status Inquiry (CSI) Authorization

Criteria for Dental Therapy Under General Anesthesia

Criteria for Dental Therapy Under General Anesthesia, Attachment 1

Department of State Health Services Form to Release CSHCN Services Program Claims History

Department of State Health Services Form to Release CSHCN Services Program Claims History (Spanish)

Documentation of Receipt

Documentation of Receipt (Spanish)

Electronic Funds Transfer (EFT) Notification

Electronic Remittance and Status (ER&S) Agreement

Home Health (Skilled Nursing) Referral and Treatment Plan

Physician/Dentist Assessment Form (PAF)

Prior Authorization and Authorization Request for Durable Medical Equipment (DME) 1 2

Prior Authorization Request for Additional Nutritional Assessment, Counseling, and Products 1 2

Prior Authorization Request for Augmentative Communication Devices

Prior Authorization Request for Augmentative Communication Devices (ACDs)

Prior Authorization Request for Chest Physiotherapy Devices

Prior Authorization Request for Dental or Orthodontia Services

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

Prior Authorization Request for External Insulin Pump

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 Medical Foods

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

Prior Authorization Request for Palivizumab (Synagis)

Prior Authorization Request for Pulse Oximeter Devices

Prior Authorization Request for Renal Dialysis Treatment

Prior Authorization Request for Respiratory Care-CRCP

Prior Authorization Request for Stem Cell or Renal Transplant

Provider Information Change Form

Refund Information Form

Reimbursement Request for Transportation of the Remains of Deceased Clients

Tort Response Form

Vision Care Eyeglass Client Certification Form

Vision Care Eyeglass Client Certification Form (Spanish)

Wheelchair Seating Evaluation Form

Formula

Freestanding ambulatory surgical centers

electronic claims submission

G

Gait

Gait trainers

authorization requirements

Gamma globulin

diagnosis codes

Gastrostomy devices 1 2

authorization requirements

benefits and limitations

electronic claims submission

Genetic services

electronic claims submission

Global fees

anesthesiologists

surgeons

Glucose monitors

diagnosis codes

prior authorization requirements

Granisetron hydrochloride

Group

billing procedure

practices

practices enrollment

Growth hormone

Gynecological

cytopathology studies

Pap smears

H

HASC

see Hospital-based ambulatory surgical center (HASC)

HBOT

see Hyperbaric oxygen therapy (HBOT)

HCPCS

see Healthcare common procedure coding system (HCPCS)

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

Health maintenance organization (HMO)

Healthcare common procedure coding system (HCPCS)

Level I codes

Level II codes

modifiers

place of service coding

Hearing aid

accessories

binaural procedure codes

devices

devices and accessories

modifications

monaural procedure codes

repairs

supplies

warranty

Hearing aids

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

Hearing services

audiology evaluation

audiometry evaluation

authorization requirements

benefits and limitations

claims information

enrollment

fitting and dispensing

required documentation

reimbursement

see Audiometry

Helicobacter pylori (H. pylori)

physician

HFCWCS

see High frequency chest wall compression systems (HFCWCS)

HHA

see Home health aid (HHA) visits

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

Hip orthoses (HO) 1 2

Hip-knee-ankle-foot orthoses (HKAFO)

HIPAA

see Health Insurance Portability and Accountability Act (HIPAA)

HIV

see Human immunodeficiency virus (HIV)

HKAFO

see Hip-knee-ankle-foot orthoses (HKAFO)

HLA

see Human leukocyte antigen (HLA)

HO

see Hip orthoses (HO)

Home health (skilled nursing)

authorization requirements 1 2

Home Health (Skilled Nursing) Referral and Treatment Plan

benefits and limitations

claims filing

claims information

enrollment

reimbursement

Home health aid (HHA)

supervision

Home health aid (HHA) visits

medical nutritional counseling

occupational therapy (OT)

limitations

physical therapy (PT)

limitations

prior authorization requirements

skilled nursing (SN) services

limitations

social work services

speech-language pathology (SLP)

Home health services

authorization requirements

benefits and limitations

claims information

enrollment

prior authorization requirements

reimbursement

Hospice

authorization requirements

benefits and limitations

claims filing

enrollment

prior authorization requirements

Prior Authorization Request for Hospice Services

reimbursement

Hospital

ambulatory surgical center (ASC)

authorization requirements

benefits and limitations

freestanding surgical center

authorization requirements

inpatient

outpatient

beds (manual and electric)

billing 1 2

blood factor products

change of ownership

chemotherapy

claims information

cribs and enclosed beds

prior authorization requirements

dental treatment in hospital/ambulatory surgical centers

authorization requirements

dental treatment in hospital/ambulatory surgical centers (HASCs)

diagnostic radiology services

eligibility

emergency inpatient hospital admissions

enrollment

initial inpatient prior authorization requests

inpatient

claims filing

hospital extensions

rehabilitation services

renal (kidney) transplants

stem cell transplants

inpatient behavioral health

authorization requirements

Prior Authorization Request for Inpatient Psychiatric Care

benefits and limitations

inpatient rehabilitation

authorization requirements

benefits and limitations

inpatient services

authorization requirements

benefits and limitations

inpatient/outpatient

authorization requirements

benefits and limitaitons

laboratory services 1 2

magnetic resonance angiography (MRA)

magnetic resonance imaging (MRI)

outpatient behavioral health services

outpatient services

authorization requirements

benefits and limitations

claims filing

hospital-based emergency services

observation

positron emission tomography (PET)

radiation treatment delivery/port films

rehabilitation services

Prior Authorization Request for Inpatient Rehabilitation Admission

reimbursement

hospital-based emergency services

inpatient services

outpatient services

renal (kidney) transplants

specialty team/center

stem cell transplants 1 2

Strontium-89

Technetium TC 99M

Hospital beds

authorization requirements

Hospital-based ambulatory surgical center (HASC)

claims filing

Hospital-based emergency department professional services

Human immunodeficiency virus (HIV) 1 2 3

Human leukocyte antigen (HLA) 1 2 3

Hygiene equipment

authorization requirements

Hyperbaric oxygen therapy (HBOT)

benefits and limitations

I

Ibutilide fumarate

ICN

see Internal control number (ICN)

Immune globulin

Immunizations

assessment

benefits and limitations

reporting

Texas Vaccines for Children (TVFC) Program 1 2

vaccine information statement (VIS)

Incomplete claims

appeal deadlines

Independent laboratory

electronic claims submission

physician-performed microscopy procedure certificates

reimbursement

services

waiver certificate

Independent practices

Infliximab

Information change requests

Infusion pumps

Inhalation therapy

see Aerosol treatments

Initial and subsequent hospital care

benefits and limitations

Initial inpatient prior authorization requests

Injectable medications

adalimumab

azacitidine (Viadaza)

benefits and limitations

botulinum toxin

certolizumab pegol

cidofovir

clofarabine (Clorar)

dalteparin sodium

darbepoietin

denileukin diftitox

enoxaparin sodium

epirubicin hydrochloride

epoprostenol

erythropoietin alfa (EPO)

fondaparinux sodium

granisetron hydrochloride

growth hormone

ibutilide fumarate

immune globulin

immunizations

infliximab

leuprolide acetate

lioresal

natalizumab

porfimer sodium

reclast

rituximab

sumatriptan succinate

topotecan HCL

trastuzumab

valrubicin

Injection administration

benefits and limitations

Injections

billed by physician

modifiers

procedure codes

Inpatient

claims filing

hospital extensions

professional services

benefits and limitations

critical care

emergency services

hospital-based emergency department

initial and subsequent hospital care (nonintensive)

observation room services

rehabilitation services

Inpatient behavioral health

authorization requirements

benefits and limitations

Inpatient hospital services

Inpatient rehabilitation

authorization requirements

benefits and limitations

Inpatient stays

scheduled day surgery

Inpatient/outpatient

benefits and limitations

blood factor products

chemotherapy

electrodiagnostic (EDX) testing

fluocinolone acetonide intravitreal implant (Retisert)

Inpatient/outpatient benefits and limitations

laboratory services

Insulin pumps

Insulin Pumps

prior authorization requirements

Insurance Premium Payment Assistance Program (IPPA)

Intensity modulated radiation therapy (IMRT)

Intermittent peritoneal dialysis (IPD)

Intermittent positive pressure breathing (IPPB)

Internal control number (ICN)

Intracranial neurostimulation (ICN)

diagnosis codes

procedure codes

Intracranial pressure monitoring

Intraocular lenses (IOL)

Intraoperative echography

diagnosis codes

IOL

see Intraocular lenses (IOL)

IPD

see Intermittent peritoneal dialysis (IPD)

IPPA

see Insurance Premium Payment Assistance Program (IPPA)

IPPB

see Intermittent positive pressure breathing (IPPB)

IRS levies

J

Juvenile rheumatoid arthritis (JRA) 1 2 3

K

Kidneys, ureters, and bladder (KUB)

Knee orthoses (KO)

Knee-ankle-foot orthoses (KAFO)

L

Laboratory panel tests

complete blood count (CBC)

organ or disease

panel tests

Laboratory services

authorization requirements

benefits and limitations 1 2 3

chemistry tests

claims filing for lab tests

claims information

CLIA

clinical pathology

cytogenetics testing for leukemia and lymphoma

cytopathology of sites other than vaginal, cervical, and uterine

cytopathology of vaginal, cervical, and uterine sites

cytopathology studies

enrollment

ferritin and iron studies

handling fee

handling fees

Helicobacter pylori (H. pylori)

hospital

reimbursement

hospital laboratory services

independent laboratory

inpatient/outpatient benefits and limitations

organ or disease panels

other procedures

panel tests

pathology consultation

physician

physician-owned laboratory services 1 2

receiving labs

reimbursement 1 2

urinalysis

Laboratory tests

claims filing

Land transportation (deceased clients)

authorization requirements

benefits and limitations

LBW

see Low birth weight (LBW)

LDL

see Low density lipoprotein (LDL)

Leuprolide acetate

Limitations 1 2 3

Limitations and exclusions 1 2

Lioresal

Low birth weight (LBW)

Low density lipoprotein (LDL)

M

Magnetic resonance angiography (MRA) 1 2

abdomen

chest

head and/or neck

lower extremities

pelvis

Magnetic resonance imaging (MRI)

Magnetic resonance imaging (MRI)

authorization requirements

benefits and limitaitons

Mammography certification

Manual pricing

reimbursement

Manufacturer's suggested retail price (MSRP) 1 2

Maximum allowable fee schedule

reimbursement

Medicaid

eligibility

spend down claims filing

Medical foods

authorization requirements 1 2

Prior Authorization Request for Medical Foods

benefits and limitations

electronic claims submission

enrollment 1 2

Medical nutritional counseling services

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

Prior Authorization Request for Nutritional Assessment, Counseling, and Products (Additional) 1 2

prior authorization requirements

Medical nutritional products

authorization requirements

benefits and limitations

claims information

enrollment

Medical nutritional products and services

electronic claims submission

Medical nutritional services

authorization requirements

medical nutritional products formulary

enrollment

medical foods

medical foods

authorization requirements

benefits and limitations

claims information

enrollment

reimbursement

medical nutritional counseling services

authorization requirements 1 2

benefits and limitations

claims information

enrollment

reimbursement

medical nutritional products

authorization requirements 1 2

benefits and limitations

enrollment

reimbursement

medical nutritional products and services

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

Medical record documentation requirements

Medical Transportation Program (MTP) 1 2

Medically Needy Program (MNP) 1 2

Medications

injectable

oral

Methylmalonic acidemia and maple syrup urine disease (MSUD) 1 2 3 4

MNP

see Medically Needy Program (MNP)

Modifier requirements for DME

Modifiers

ambulance

assistant surgeons

injections and oral medications

MRA

see Magnetic resonance angiography (MRA)

MRI

see Magnetic resonance imaging (MRI)

MSRP

see Manufacturer's suggested retail price (MSRP)

Mucus clearance valve

Multiple sleep latency test

Multiple surgeries

N

Natalizumab

National correct coding initiative (NCCI)

National drug codes (NDC)

claims information

reimbursement

National provider identifier (NPI) 1 2

NCS

see Nerve conduction studies (NCS)

NDC

see National drug codes (NDC)

Nebulizers

Neonatal critical care services

Nerve conduction studies (NCS)

procedure codes 1 2

Neuromuscular electrical stimulation (NMES)

clients with spinal cord injuries (SCI)

muscle atrophy

procedure codes

Neuropsychological testing

Neurostimulator devices and supplies

authorization requirements

benefits and limitations

claims information

dorsal column neurostimulation (DCN)

enrollment

intracranial neurostimulation (ICN)

noncovered services

percutaneous electrical nerve stimulation (PENS)

reimbursement

sacral nerve stimulation (SNS)

supplies

transcutaneous electrical nerve stimulation (TENS

vagal nerve stimulation (VNS)

Neurostimulators

devices and supplies

neuromuscular electrical stimulation (NMES)

Neutron-beam delivery

New or established patient visits

Noncovered

benefits and limitations 1 2

rehabilitative and therapeutic DME

Noncovered devices

shoes or shoe inserts

Noncovered services

outpatient behavioral health

reconstructive and cosmetic procedures

Nonemergency ground transportation

Nonobturated gastrostomy devices

Nurse practitioner (NP)

enrollment

O

Observation room services

benefits and limitations

Obturated gastrostomy devices

occupational therapy (OT)

Occupational therapy (OT) 1 2 3 4 5 6

authorization requirements

benefits and limitations

limitations

prior authorization requirements

Omalizumab

Authorization Request for Omalizumab

OMT

see Osteopathic manipulative treatment (OMT)

Online provider check amounts

Ophthalmology

benefits and limitations

intraocular lenses (IOL)

Vitrasert ganciclovir implant

Oral medications

benefits and limitations

modifiers

Oral surgery procedures

authorization requirements

Orthodontia

claims filing

diagnosis codes

local codes

prior authorization requirements

required documentation

Orthoses

Orthotic and prosthetic devices

authorization requirements

benefits and limitations

claims information 1 2

cranial molding orthoses

documentation of receipt

dynamic splints

enrollment

excluded orthoses

eye prostheses

noncovered shoes or shoe inserts

orthoses

prescription shoes and lifts

prostheses

reimbursement

Osteopathic manipulative treatment (OMT) 1 2

benefits and limitations

OT

see Occupational therapy (OT) 1 2

Out-of-office services

benefits and limitations

physician

Out-of-state providers 1 2

Outpatient

claims filing

Outpatient (hospital)

authorization requirements

benefits and limitations

Outpatient behavioral health services

authorization requirements 1 2

benefits and limitations

claims information

documentation requirements

electronic claims submission

enrollment

noncovered services

pharmacological management documentation 1 2

pharmacological regimen oversight documentation 1 2

reimbursement 1 2

Outpatient hospital services

Outpatient observation

Outpatient physical therapy and occupational therapy

authorization requirements

Authorization Request for Outpatient Therapy (TP2), Extension

benefits and limitations

claims information

coordination with the public school system

enrollment

reimbursement

Outpatient services

Outpatient speech-language pathology (SLP) services

authorization requirements

benefits and limitations

claims information

coordination with the public school system

enrollment

reimbursement

Outpatient therapy

electronic claims submission

Oxygen concentrators

P

PACT

see Program for Amplification for Children of Texas (PACT)

PAF

see Physician/Dentist Assessment Form

Paid or denied claims

Pap smears

Pathology services

Payouts

Pediatric pneumogram

Pentamidine aerosol

Percutaneous electrical nerve stimulation (PENS)

Personal supervision

PET

see Positron emission tomography

Pharmacological management documentation requirements 1 2

Pharmacological regimen oversight documentation requirements 1 2

Phenylketonura (PKU) 1 2 3

Physical medicine 1 2

physical therapy (PT)

Physical therapy (PT)

benefits and limitations 1 2

limitations

prior authorization requirements

Physician

after-hours services

allergy services

anesthesia

administered by surgeon

anterior temporal lobectomy

assistant surgeons

audiometry/hearing services

augmentative communication devices (ACDs)

authorization requirements

benefits and limitations

bilateral procedures

bone growth stimulators

casting

chemotherapy

authorization requirements

circumcision

claims information

group billing procedure

cleft/craniofacial procedures

CLIA requirements

clinician-directed care coordination services

benefits and limitations

face-to-face

non-face-to-face

clinician-directed care coordinaton services

authorization for nonface-to-face

cochlear implants

benefits and limitations

colorectal cancer screening

consultations

cosurgery

critical care services

intensive (noncritical) low birth weight

neonatal

newborn resuscitation

pediatric

cytogentics testing

documentation requirements

echoencephalography

electroencephalogram (EEG) (ambulatory)

electronic claims submission

emergency services

enrollment 1 2

independent practices

specialty team/center

substitute

evaluation and management (E/M) services

evaluation and management (E/M) services

emergency

emergency room

initial and subsequent hosptial care (nonintensive)

inpatient

new or established patients

observation room services

office and outpatient services

preventive care services

teaching physicians

extracorporeal shock wave lithotripsy

genetics

global fees

group practices

helicobacter pylori (H. pylori)

hyperbaric oxygen therapy (HBOT)

immunizations

injections and oral medications

adalimumab

administration billed by a physician

azacitidine (Viadaza)

botulinum toxin (type A and B)

certolizumab pegol

cidofovir

clofarabine

dalteparin sodium

denileukin diftitox

enoxaparin sodium

epirubicin hydrochloride

epoprostenol

erythropoietin alfa (EPO) and darbepoietin

fondaparinux sodium

granisetron hydrochloride

growth hormone

ibutilide fumarate

immune globulins

infliximab

leuprolide acetate

lioresal

natalizumab

omalizumab

porfimer sodium

procedure codes

reclast

rituximab

sumatriptan succinate

topotecan HCL

trastuzumab

valrubicin

internal bone growth stimulators

intracranial pressure monitoring

intraoperative echography

laboratory services 1 2 3

cytopathology studies (gynecological, Pap smears)

handling fee

multiple surgeries

noncovered reconstructive and cosmetic procedures

noninvasive bone growth stimulators 1 2

ophthalmological services

intraocular lenses (IOL)

vitrasert ganciclovir implant

ostepathic manipulative treatment (OMT)

outpatient hospital setting

physical medicine

physical therapy

podiatry

primary surgeons

prolonged services

psychological testing

reconstructive and cosmetic procedures

medical review requirements

reduction mammoplasty

referrals to other providers

reimbursement

renal (kidney) transplants

rhizotomy

second opinions

septoplasty

services incidental to surgery or anesthesia

sign language interpreting services

stem cell transplant 1 2

allogenic

autologous

stem cell transplants

substitute

supervision

surgery

telemedicine

telemedicine services

distant site

patient site

therapeutic apheresis

transplants

unlisted surgical procedures

physician services

Physician/Dentist Assessment Form

PKU

see Phenylketonura

Place of service (POS)

see Place of service

Podiatry

authorization requirements

benefits and limitations

electronic claims submission

reimbursement

Polysomnography

Porfimer sodium

Portable hydrocollator units

Portable paraffin units

Positron emission tomography (PET) 1 2

Prescription shoes and lifts

Preventive care checkups

preventive health/medicine services

Preventive services

authorization requirements

benefits and limitations

dental prophylaxis and topical fluoride treatment

noncovered counseling services

dental nutrition counseling

tobacco counseling

noncovered dental counseling services

oral hygiene instruction

sealants

space maintainers

Primary surgeons

Prior authorization number (PAN)

Prior authorizations

Procedure codes

adjunctive general services

anesthesia

incidental services

nonincidental services

audiometric testing

augmentative communication devices (ACDs)

behavioral health services

12-hour system limitation 1 2

blood factor products

body and upper extremity

casts

splints

strapping

botulinum toxin type A

breast reconstruction

cardiac blood pool imaging 1 2

cast removal or repair

chemotherapy

cleft and craniofacial procedures

clinical brachytherapy (radiation therapy)

clinical brachytherapy (surgery)

clinical treatment planning

critical care services

cytopathology, vaginal, cervical, and uterine sites 1 2

dental

anesthesia provided in an office setting

dental implants

dental restorations

dental surgery

dentist-physician

anesthesia

cleft/craniofacial surgery

evaluation and management

laboratory

radiology

dorsal column neurostimulation (DCN)

dosimetry

electroencephalogram (EEG) (ambulatory)

electromyography (EMG) 1 2

electronic analysis for implantable neurostimulators

end stage renal disease (ESRD)

eye examinations and ophthalmoscopy or ophthalmological services

eye prostheses

gastrostomy devices

genetics

helicobacter pylori (H. pylori)

hospital beds (manual and electric)

immune globulins 1 2

injectable medications

injections

injections and oral medications

intracranial neurostimulation (ICN)

lenses

bifocal

contact

high-power

single vision

trifocal

lower extremity

casts

splints

strapping

magnetic resonance angiography (MRA)

abdomen

chest

lower extremities

pelvis

maxillofacial prosthetics

medical radiation physics

neonatal critical care

nerve conduction studies (NCS) 1 2

neuromuscular electrical stimulation (NMES)

noncovered reconstructive and cosmetic services

oral and maxillofacial surgery

oral surgery procedures

other vision services

outpatient physical therapy

periodontic services

physical medicine

positron emission tomography (PET)

pressure reducing pads

preventive care

prolonged physician services

prophylaxis and topical fluoride treatment

prosthetic services, fixed

prosthodontic services, fixed

prosthodontics (removable) and maxillofacial prosthetics

proton-beam delivery

radiation treatment delivery/port films

radiation treatment devices

radiation treatment management

reconstructive and cosmetic services requiring medical review

renal dialysis

supplies

renal transplant

rhizotomy 1 2 3

root canals

sacral nerve stimulation (SNS)

special lenses

special radiation services

special vision services

stem cell transplants

stereotactic radiosurgery

surgery

incidental services

nonincidental services

telemedicine services

total parenteral nutrition (TPN)

transcutaneous electrical nerve stimulation (TENS)

vagal nerve stimulation (VNS)

vision examination 1 2

waiver certificate

Procedure coding

CPT

modifiers

place of service (POS)

type of service (TOS)

Program for Amplification for Children of Texas (PACT)

hearing aids

Program limitations and exclusions 1 2

Prolonged services

benefits and limitations

physician

Prone/supine standers

authorization requirements

benefits and limitations

Protective helmets

Proton- and neutron-beam delivery

Provider Agreement

Provider and principal information forms

Provider certification/assignment

Provider check amounts

online

Provider complaints process

Provider enrollment

appeals

changes in enrollment

cleft/craniofacial specialty teams

determinations

FQHCs and RHCs

general information

information change requests

out-of-state providers

Provider Agreement

provider and principal information forms

Provider Enrollment Application

provider's license

providers paid by DSHS

request for taxpayer identification number

requirements for cleft/craniofacial center team approval

transplant specialty centers

types of providers

Provider responsibilities

billing clients

general requirements

provider certification/assignment

release of confidential information

retention of records

utilization review

waste, abuse, and fraud

Provider types and selection of claim forms

Provider's license

Psychological testing 1 2

Psychotherapy

PT

see Physical therapy (PT) 1 2

Public school system

coordination with outpatient physical and occupational therapy

coordination with speech-language pathology (SLP) services

Pulse oximeters 1 2

R

R&S

see Remittance and Status (R&S) Reports

Radiation therapy services

authorization requirements

benefits and limitations

claims filing 1 2

clinical treatment management

proton- and neutron-beam delivery

clinical treatment planning

enrollment

intensity modulated radiation therapy (IMRT)

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

noncovered services

procedure code limitations

radiation treatment management and delivery

radioisotope therapy

reimbursement

stereotactic radiosurgery

authorization requirements

Strontium-89

Technetium TC 99M

Radiation treatment delivery/port films

Radioallergosorbent (RAST) 1 2 3

Radioisotope therapy

Radiologist

reimbursement

Radiology services

claims filing 1 2

see Diagnostic radiology services

Rail transportation (deceased clients)

benefits and limitations

RAST

see Radioallergosorbent (RAST)

Receiving labs and handling fees

Reciprocating gait orthoses (RGOs) 1 2

Reclast

Reconstructive and cosmetic procedures

authorization requirements

benefits and limitations

medical review requirements

noncovered

Record retention

Reduction mammoplasty

authorization requirements

benefits and limitations

Referrals to other providers

Refunds

accident resources

other insurance

Refund Information Form

Regional anesthesia

Regional offices

DSHS

TMHP

Rehabilitation

inpatient claims filing

Reimbursement

advanced practice nurse (APN)

ambulance

anesthesia

time-based fees

anesthesiology

augmentative communication devices (ACDs)

blood pressure devices and supplies

bone-anchored hearing aid (BAHA)

certified registered nurse anesthetist (CRNA)

certified respiratory care practitioner (CRCP)

claims information

national drug codes (NDC)

clinical laboratory services

outpatient services

dental/orthodontia

diabetic equipment and supplies

diagnostic radiology services

durable medical equipment (DME)

expendable medical supplies

home health (skilled nursing)

home health services

hospice

hospital

hospital-based emergency services

inpatient services

laboratory

outpatient services

laboratory services

manual pricing

maximum allowable fee schedule

medical nutritional services

medical foods

medical nutritional counseling services

medical nutritional products

medical services provided outside of Texas 1 2

neurostimulator devices and supplies

orthotic and prosthetic devices

out-of-state providers

outpatient behavioral health

outpatient physical therapy and occupational therapy

physician

podiatrists

radiation therapy services

renal dialysis

respiratory equipment

speech-language pathology (SLP) services

stem cell transplants 1 2

Texas Medicaid Reimbursement Methodology (TMRM)

total parenteral nutrition (TPN)

transportation of remains of deceased clients

vision related services

Release of confidential information

Remittance and Status (R&S) reports

examples

accounts receivable

adjustments

backup withholding penalty information

banner page

claims - paid or denied

explanation of EOB messages

explanation of EOPS messages

IRS levy information

manual payouts

refunds

summary

system payouts

explanation of benefits (EOB) codes

explanation of row headings

explanation of section headings

financial transactions

void and stop

general formatting guidelines

general information

incomplete claims

IRS levies

payouts

stale-dated checks

voids and stops

Remittance and Status (R&S) Reports

accounts receivables

adjustments to claims

banner pages

claim refunds

claim reissues

claim voids

claims - paid or denied, incomplete claims

claims in process

claims payment summary

electronic

see Electronic Remittance and Status (ER&S) Report

Removable shoe insert

Renal (kidney) transplants

authorization requirements

benefits and limitations

hospital

Renal dialysis

authorization requirements

benefits and limitations

claims filing

claims information

client eligibility

dialysis services

dialysis training

enrollment

evaluation and management

maintenance hemodialysis

method II (dealing direct)

prior authorization requirements

Prior Authorization Request for Renal Dialysis Treatment

reimbursement

ultrafiltration

Rentals

transcutaneous electrical nerve stimulation (TENS) device

Respiratory equipment

apnea monitors

Prior Authorization Request for Apnea Monitor

benefits and limitations

rental or purchase

cardio respiratory (apnea) monitors

claims information

enrollment

high frequency chest wall compression systems (HFCWCS) 1 2

nebulizers

other unspecified equipment

oxygen concentrators

prior authorization requirements

Prior Authorization Request for Respiratory Care-CRCP

pulse oximeters 1 2

Prior Authorization Request for Pulse Oximeter Devices

reimbursement

suction equipment

tracheostomy tubes 1 2

Respiratory equipment and supplies

authorization requirements

benefits and limitations

bi-level positive airway pressure (BiPAP) systems

continuous positive airway pressure (CPAP) systems

controlled dose inhalation drug delivery system

mucus clearance valve

Respiratory syncytial virus (RSV)

prior authorization requirements

Prior Authorization Request for Palivizumab (Synagis)

RGO

see Reciprocating gait orthoses (RGOs)

Rhizotomy

authorization requirements

Rituximab

S

Sacral nerve stimulation (SNS)

procedure codes

Seat lift mechanism

Durable medical equipment (DME)

seat lift mechanism

Second opinions

see Acquired immunodeficiency syndrome (AIDS)

Septoplasty

Services incidental to surgery or anesthesia

benefits and limitations

Services not incidental to surgery or anesthesia

benefits and limitations

Services outside of business hours

benefits and limitations

physician

Services provided outside of Texas

50 or fewer miles from Texas border

50 or more miles from Texas border

benefits and limitations

Sign language interpreting services

Skilled nursing

see Home health (skilled nursing)

skilled nursing (SN) services

Skilled nursing (SN) services

prior authorization requirements

Skilled Nursing (SN) services

limitations

Sleep studies

multiple sleep latency test

pediatric pneumogram

polysomnography

SLP

see Speech-language pathology (SLP)

see Speech-language pathology (SLP) services

SN

see Skilled nursing (SN) services

SO

see Spinal orthoses (SO)

Social work services

prior authorization requirements

Span dates

Specialty team/center

authorization requirements

enrollment

procedures

services

Speech-language pathology (SLP)

prior authorization requirements

Speech-language pathology (SLP) services 1 2

authorization requirements

benefits and limitations

claims information

cochlear implants surgery

coordination with the public school system

dysphagia (swallowing disorder)

enrollment

reimbursement

Spend down processing

Medically Needy Program (MNP)

Spinal orthoses (SO)

Stale-dated checks

Standard DME

Standers, prone or supine

authorization requirements

Stem cell transplant

authorization requirements

Stem cell transplants 1 2

authorization requirements

physician reimbursement

Stereotactic radiosurgery

authorization requirements

Strontium-89

Substitute physician

Suction equipment

Sumatriptan succinate

Supernumerary tooth identification

Surgery

anesthesia administered by surgeon

assistant surgeons

authorization requirements

Prior Authorization Request for Inpatient Surgery-For Surgeons Only

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

benefits and limitations

bilateral procedures

bone growth stimulators

casting

circumcision

cleft/craniofacial by dentist physician

cochlear implants

cosurgery

extracorporeal shock wave lithotripsy

global fees

incidental services

internal bone growth stimulators

multiple surgeries

noninvasive bone growth stimulators 1 2

primary surgeons

second opinions

septoplasty

services not incidental to surgery

unlisted surgical codes

Vitrasert ganciclovir implant

T

Team/center requirements

Technetium TC 99M tetrofosmin

Telemedicine services

distant site

patient site

procedure codes

Telephone numbers

CSHCN regional offices

TMHP-CSHCN regional representatives

TMHP-CSHCN Services Program Contact Center 1 2

TENS

see Transcutaneous electric nerve stimulator (TENS)

Texas Family Code compliance

abuse and neglect reporting requirements

child support

Texas Health Steps (THSteps)

client eligibility

Comprehensive Care Program (THSteps-CCP)

Texas Medicaid & Healthcare Partnership (TMHP)

Contact Center 1 2 3 4

Electronic Data Interchange (EDI)

appeal submission

provider enrollment

regional representatives

website

banner messages

file libraries

publications

online searches

Texas Medicaid Reimbursement Methodology (TMRM)

Texas State Board of Dental Examiners (TSBDE) 1 2

Texas Vaccines for Children (TVFC) Program 1 2

TexMedConnect

orthodontia claims

overview

Therapeutic apheresis

authorization requirements

Therapeutic services

adjunctive general services

procedure codes

anesthesia provided in an office setting

procedure codes

dental

anesthesia

behavior management

restorations

dental restorations

procedure codes

endodontics

procedure codes

pulp caps

root canals

implants

procedure codes

internal bleaching of tooth

interrupted treatment plan

maxillofacial prosthetics

procedure codes

oral and maxillofacial surgery

procedure codes

periodontics

procedure codes

prior authorization requirements

prosthetics, fixed

procedure codes

prosthodontics (removable) and maxillofacial prosthetics

procedure codes

prosthodontics, fixed

procedure codes

Therapy

hyperbaric oxygen (HBOT)

occupational

physical

speech-language pathology (SLP) services

Third-party liability

claims involving accidents

Third-party resources (TPR) 1 2

accident resources

accident-related claims

address 1 2

Blue Cross Blue Shield nonparticipating providers

claims filing

filing deadlines

health maintenance organization (HMO)

payment sources

refunds involving claims for accidents

refunds to TMHP resulting from other insurance

verbal denials

Third-party vendor implementation for TMHP EDI services

THKAO

see Thoracic hip-knee-ankle orthoses (THKAO)

Thoracic hip, knee, and ankle orthoses (THKAO)

THSteps

see Texas Health Steps (THSteps)

THSteps-CCP

see THSteps-Comprehensive Care Program (THSteps-CCP)

TID

see Tooth identification (TID)

TMHP

see Texas Medicaid & Healthcare Partnership (TMHP)

TMRM

see Texas Medicaid Reimbursement Methodology (TMRM)

Tooth identification (TID) 1 2 3

surface identification

Topotecan HCL

Total parenteral nutrition (TPN) 1 2 3

authorization requirements

benefits and limitations

claims information

electronic claims submission

enrollment

reimbursement 1 2

TPN

see Total parenteral nutrition (TPN)

Tracheostomy tubes 1 2

Transcutaneous electric nerve stimulator (TENS)

Transcutaneous electrical nerve stimulation (TENS)

procedure codes

purchase

rental

Transfer boards

Transplant specialty centers

Transplants

allogenic transplants

autologous

renal (kidney) 1 2

authorization requirements

stem cell 1 2 3

authorization requirements

Transportation

ambulance

deceased client

air transportation

authorization requirements

benefits and limitations

bus transportation

claims information

embalming

land transportation

rail transportation

reimbursement

emergency air ambulance

authorization requirements

benefits and limitations

emergency ground ambulance

authorization requirements

benefits and limitations

nonemergency ground ambulance

authorization requirements

benefits and limitations

Trastuzumab

Travel chairs

prior authorization requirements

Travel restraints 1 2

TriCare (formerly CHAMPUS/CHAMPVA)

TSBDE

see Texas State Board of Dental Examiners (TSBDE)

TVFC

see Texas Vaccines for Children (TVFC) Program

U

UB04 (CMS 1450)

paper claim form example

paper claim form instructions

UB04 (CMS-1450)

Unlisted surgical procedures

Urinalysis

Utilization review

V

Vaccine information statement (VIS)

Vagal nerve stimulation (VNS)

procedure codes

Valrubicin

Vendor Drug Program (VDP)

Verifying client eligibility

Very low birth weight (VLBW)

Vision related services

authorization requirements 1 2 3 4

benefits and limitations

bifocal lenses

contact lenses

electronic claims submission

enrollment

examinations

frames, lenses, and contact lenses

high-power lenses

ophthalmology

other services

reimbursement

single vision lenses

specialized lenses

trifocal lenses

Vision Care Eyeglass Client Certification Form

Vision Care Eyeglass Client Certification Form (Spanish)

Vitrasert ganciclovir implant

Vision-related services

claims information

Vitrasert ganciclovir implant

VLBW

see Very low birth weight (VLBW)

W

Waiting list information

Walkers

Waste, Abuse, and Fraud

Wheelchair

battery

power elevating leg lifts

power seat elevation system

Wheelchairs

authorization requirements

custom manual wheelchairs

manual wheelchairs

portable ramps

positioning equipment

power wheelchairs

approval criteria

ramps

standard

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