TMPPM 2010 > Volume 1, General Information > Section 6: Claims Filing > Claims Information > Claims Filing Instructions


6.1.2 Claims Filing Instructions

This manual references paper claims when explaining filing instructions. HHSC and TMHP encourage providers to submit claims electronically. TMHP offers specifications for electronic claim formats. These specifications are available from the TMHP website and include a cross-reference of the paper claim filing requirements to the electronic format.

Providers can participate in the most efficient and effective method of submitting claims to TMHP by submitting claims through the TMHP Electronic Data Interchange (EDI) claims processing system using TexMedConnect or a third party vendor. The proceeding claim filing instructions in this manual apply to paper and electronic submitters. Although the examples of claims filing instructions refer to their inclusion on the paper claim form, claim data requirements apply to all claim submissions, regardless of the media. Claims must contain the provider's complete name, address, and provider identifier to avoid unnecessary delays in processing and payment.

Note: Information about filing claims for services rendered to STAR Program and STAR+PLUS Program members is available in Section 8, "Managed Care" (Vol. 1, General Information).

Exception: File Primary Care Case Management (PCCM) claims with TMHP.

Refer to: Section 3: TMHP Electronic Data Interchange (EDI) (Vol. 1, General Information) for information on accessing the TMHP website.

Subsection 8.1, "Medicaid Managed Care" in Section 8, "Managed Care" (Vol. 1, General Information).

Texas Medicaid & Healthcare Partnership
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