Index

Index

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

AAPD periodicity guidelines

Abatacept (Orencia)

Abnormal hearing screening results

DFPS Abuse Hotline

Abuse and fraud

Accessories, durable medical equipment (DME) (home health)

resources and refunds

Accident resources, refunds

documentation requirements

items not covered

prior authorization

Acknowledgement statement

prior authorization

Acronym dictionary

Add date for client eligibility

see Chemical dependency

CPT coding manual

DARS, blind services

DSHS-BHO services 1 2 3

fee-for-service and PCCM

exception requests

Limited Program

Medical and UR Appeals

provider complaints

utilization review (UR)

eligibility services

regional offices

Presumptive Eligibility Program

Provider Enrollment

public health districts

Texas Medical Board registration department 1 2

Inquiry Control Unit

cervical cancer

communicable disease reporting

hyperlipidemia, screening for

Adoption agencies

Advance directives

Advanced practice registered nurse (APRN)

benefits and limitations

Aerosol treatment 1 2 3

Allergy immunotherapy

Allergy injections

Allergy services

benefits and limitations

origin and destination codes

place of service codes

claim form examples 1 2 3

disposable supplies

disposable supplies

extra attendant

Medicaid disposition

Medicare disposition

prior authorization 1 2

prior authorization 1 2 3

retroactive eligibility

types, definitions 1 2

reimbursement 1 2

disposable supplies

subscription plans

air or specialized vehicle 1 2

out-of-state prior authorization

multiple client

nonemergency 1 2

not medically necessary

nursing facility

to or from state institutions

types of transport

Ambulatory blood pressure monitoring

Ambulatory electroencephalogram (A/EEG)

Ambulatory surgical center (ASC)

benefits and limitations

claim form example (hospital-based)

claim form example

claim form example (hospital-based)

claims resources

cochlear implants

colorectal cancer screening

dental services

documentation requirements

fluocinolone acetonide

global services

implantable infusion pump

prior authorization

reimbursement 1 2 3

incomplete procedures

American Society of Anesthesiologists (ASA)

physical status descriptions

administered by surgeon

claim form example

for labor and delivery

multiple procedures 1 2

pain management

physician services

provided by the surgeon

medical direction

monitored anesthesia care

prior authorization requirements

reimbursement methodology

Antibiotics and steroids

Antihemophilic factor

allowed AIS appeals

claim corrections

client eligibility

electronic submission

disallowed electronic appeals

Provider complaint

fee-for-service

other insurance denial

utilization review (UR)

medical necessity denial

submitted incorrectly

Audiological aervices

reimbursement, hearing aid and audiological services

Audiological services

noncovered services

School Health and Related Services (SHARS)

Audiology evaluation and diagnostic services

Audiometry evaluation and diagnostic services

Auditory brainstem implant (ABI)

Authorization for Use and Release of Health Information

Authorization requirements

corneal topography, optometric services for

CT, CTA, MRI, and MRA

electrodiagnostic (EDX) testing

Authorization to Release Confidential Information

Automated Inquiry System

Bacillus Calmette-Guérin (BCG)

for treatment of bladder cancer

Bariatric surgery

prior authorization requirements

Bathroom equipment

bath shower chair tub transfer bench

documentation requirements

hand-held shower wand

payable procedure codes

prior authorization

battery charger

Behavioral health

Blind Children's Vocational Discovery and Development Program

claim form example

claims information

documentation requirements

Medicaid Managed Care enrollment

Case Management for Children and Pregnant Women (CPW)

assistance with claims concerns

assistance with program concerns

benefits, limitations, and prior authorization

claim form example

claims information

documentation requirements

Medicaid Managed Care enrollment

prior authorization

referral process

technical assistance

court-ordered and DFPS-directed serivces

Early Childhood Intervention (ECI)

benefits, limitations, and prior authorization

case management services

claim form example

documentation requirements

ECI referral requirement

Medicaid Managed Care enrollment

electroconvulsive therapy (ECT)

family therapy/counseling services

hospital psychiatric services

prior authorization

psychological and neuropsychological testing services

licensed clinical social worker (LCSW)

benefits, limitations, and prior authorization

claim form example

documentation requirements

prior authorization

court-ordered and DFPS-directed services

more than 30-encounters per year

subsequent prior authorization requests

licensed marriage and family therapist (LMFT)

benefits, limitations, and prior authorization

documentation requirements

prior authorization

court-ordered and DFPS-directed services

more than 30-encounters per year

subsequent prior authorization requests

licensed professional counselor (LPC)

benefits, limitations, and prior authorization

claim form example

documentation requirements

prior authorization

court-ordered and DFPS-directed services

more than 30-encounters per year

subsequent prior authorization requests

licensed psychological associate (LPA)

benefits, limitations, and prior authorization

12-hour system limitation

formula applied

procedure codes to which it applies

retrospective review

mental health (MH) mental retardation (MR)

benefits, limitations, and prior authorization

documentation requirements

Medicaid Managed Care enrollment

mental health rehabilitation

rehabilitative services limitations

service coordination contact codes

mental health case management

claim form example

non-covered services

outpatient services

annual encounter/visit limitations

prior authorziation after limitations met

pharmacological regimen oversight and pharmacological management services

documentation requirements

indications for

prior authorization

benefits, limitations, and prior authorization

12-hour system limitation

formula applied

procedure codes to which it applies

retrospective review

psychiatric diagnostic interviews

documentation requirements 1 2

domains of a clinical evaluation

prior authorization 1 2

reimbursement 1 2

psychological and neuropsychological testing

benefits, limitations, and prior authorization

12-hour system limitation

formula applied

procedure codes to which it applies

retrospective review

claim form example

psychotherapy/counseling

documentation requirements

initial outpatient

insight oriented behavior modification

prior authorization

subsequent outpatient

supportive outpatient

screening, brief intervention, and referral to treatment (SBIRT)

brief intervention

brief treatment

documentation requirements

referral to treatment

reimbursement and limitations

Benefit and taxonomy codes

prior authorization

Benefits and limitations

ambulatory surgical center (ASC)

federally qualified health center (FQHC)

home health services (DME)

hospital ambulatory surgical center (HASC)

portable X-ray supplier

radiological and physiological laboratory

renal dialysis facility

rural health clinic (RHC)

tuberculosis clinic

Benefits for Medicare/Medicaid Clients

Bilevel positive airway pressure system

prior authorization

prior authorization

with backup (such as BiPAP ST)

without backup (such as BiPAP S)

Billing clients

Blepharoplasty procedures

Blind Children's Vocational Discovery and Development Program

Blood glucose monitors (DME)

prior authorization

Blood pressure devices 1 2

prior authorization

hemoglobin type

Blood transfusions

Bone marrow aspiration

Bone-anchored hearing aid (BAHA)

Botulinum toxin type A

Brachytherapy, radiation therapy

benefits and limitations

Breast cancer screening

prognostic breast cancer studies

Breast imaging studies

Breast reconstruction

prior authorization

bladder cancer, Bacillus Calmette-Guérin (BCG) for treatment

breast cancer screening

colorectal cancer screening

sigmoidoscopies

hereditary nonpolyposis colorectal cancer (HNPCC)

Prognostic breast and gynecological cancer studies

Cancer screening and testing

physician services

Canes, crutches, walkers

Cardiac blood pool imaging 1 2 3 4

Cardiopulmonary resuscitaiton (CPR)

Case Management for Children and Pregnant Women (CPW)

Catheters, impantation

see Comprehensive Care Program

Centers for Medicare & Medicaid Services (CMS)

Certificate of Authority

Certificate of Filing/Certificate of Incorporation

Certificate of Formation

Certificate of Good Standing

Certificate of Incorporation

Certification Statement

prior authorizations

Certified nurse-midwife (CNM)

benefits and limitations

newborn services

antepartum and postpartum

birthing center

hearing screening

prior authorization

claim form example

Documentation requirements

reimbursement 1 2

Certified registered nurse anesthetist (CRNA)

benefits and limitations

claims filing 1 2

claim form example

epidurals, blood patch

interpreting the R&S report

reimbursement 1 2

Certified respiratory care practitioner (CRCP)

benefits and limitations

claim form example

documentation requirements

prior authorization

procedure codes

reimbursement 1 2 3

Cervical cancer screening

change of address telephone number

Checklist for HHSC Monitoring

Chelating agents

deferoxamine mesylate (Desferal)

edetate calcium disodium

edetate disodium

Chemical dependency

behavioral health services

reimbursement 1 2

Chemical dependency treatment facility (CDTF)

benefits, limitations, and prior authorization

claims filing 1 2

documentation requirements

outpatient counseling

prior authorization

Chemistry tests

procedure codes

Chest physiotherapy devices

Child Abuse Reporting Guidelines 1 2

Children with Special Health Care Needs (CSHCN) Services Program

Children's hospitals

CHIP perinatal program 1 2

newborn transfer

client eligibility verification

program benefits

Chiropractic services

benefits and limitations

claim form example

reimbursement 1 2

Claim Status Inquiry Form

Claims filing 1 2 3 4

ambulatory surgical center (ASC) 1 2

appeal time limits

banner message R&S example

CHIP perinatal newborn transfer

claim form example

office visit with lab and radiology

claim form examples

Ambulatory surgical center (ASC)

Chemical dependency treatment facility (CDTF)

Comprehensive Outpatient Rehabilitation Facility (CORF) (CCP Only)

Diagnosis and Treatment (Referral from THSteps Checkup)

Durable Medical Equipment (CCP Only)

Early Childhood Intervention (CCP Only)

Family Planning Services for Hospitals, FQHCs

FQHC Encounter (T1015)

Hospital Outpatient

Hospital-Based ASC

Independent Laboratory

Inpatient Psyciatric Hospital/Facility (CCP Only)

Inpatient Rehabilitation Hospital (CCP Only)

medical nutritional counseling (CCP only)

Orthotic and Prosthetic Serives (CCP Only)

Physical Therapists (CCP Only)

Private Duty Nurses (CCP Only)

Radiation Therapy

Radiological/Physiological Laboratory and Portable X-Ray Supplier

Renal Dialysis CMS-1500 Example

Renal Dialysis Facility CAPD Training

Renal Dialysis Facility CAPD/CCPD

Rural Health Clinic Freestanding

Rural Health Clinic Freestanding (Immunization

Rural Health Clinic Hospital-Based

School Health and Related Services (SHARS)

Speech-Language Pathologists (CCP Only)

THSteps Established Patient and Referral, TB Skin Test, and Physical Examination by a Physician

THSteps New Patient/Immunization, Physical Examination by a Nurse Practitioner, and FQHC Billing (medical checkup)

claims filing instructions

diagnosis coding

procedure coding

type of service

Crossover Type 30 claim form (MRAN)

Crossover Type 31 and 50 claim form

deadline exceptions

appeal time limits

exceptions to the 95-day filing deadline

incomplete information

zero paid claims

electronic billing

provider check amounts

electronic claim acceptance

electronic rejections

newborn claim hints

electronic submission

federally qualified health center (FQHC) 1 2

filing a Medicare-adjusted claim

filing a Medicare-denied claim

hearing aid and audiological services

HHSC payment deadline

home health services 1 2

hospice clients

medical services

hospital ambulatory surgical center (HASC) 1 2

independent laboratory

attachments to claims

claim form requirements

clients with a designated or primary care provider

CMS-1500 claim form (blank)

CMS-1500 claim form (paper) billing

CMS-1500 electronic billing

CMS-1500 instruction table

Crossover Type 30 (MRAN)

Crossover Type 31 and 50

dental claim form

instruction table

dental filing instructions

claim form (paper) billing

electronic billing

Family Planning 2017 Claim Form (blank)

Family Planning 2017 Claim Form instruction table

group providers

multipage claim forms

newborn clients without Medicaid numbers

patient status codes

filing tips for outpatient claims

prior authorization numbers on claims

provider signature on claims

claim form (blank)

claim form (paper) billing

electronic billing

instruction table

occurrence codes

vision claim form

managed care 1 2

medical services

Medically Needy Program (MNP)

Medicare primary paper

Medicare/Medicaid deadlines

modifier requirements for TOS assignment

assistant surgery

interpretations

technical components

other insurance filing

claims forward to other insurance carriers

portable X-ray supplier

Preferred Provider Organization

processing procedures

payment error rate measurement (PERM)

radiological and physiological laboratory

Remittance and Status (R&S) Report

delivery options

account receivables

backup withholding penalty information

claims in process

paid or denied claims (hospital)

paid or denied claims (physician)

refunds for Managed Care

refunds for Medicaid

sub-owner recoupments

void and stop pay

field explanation

section explanation

status of claims

renal dialysis facility 1 2

resubmission of TMHP EDI rejections

rural health clinic (RHC)

specialist services

STAR Health Program

tuberculosis clinic 1 2

vision services

Claims filing and reimbursement 1 2 3

Claims Filing for OT Services

Claims Filing for PT Services

Claims filing information

Claims filing instructions

ambulance transfers

dental claim form

instruction table

home health services 1 2

Hysterectomy Acknowledgment Statement

Claims Resources 1 2

Vision Services

Client billing 1 2

Client eligibility

CHIP perinatal program

deceased individuals

hospital services

Medicaid identification

restricted Medicaid coverage

selection of provider/pharmacy

Medicaid Buy-In Program

Medicaid eligibility verification

Medicaid for breast and cervical cancer

Medicare Part B Crossovers

Medicare/Medicaid

clients without QMB, MQMB status

contract with outside parties

THSteps medical checkup

Women's Health Program (WHP)

Client enrollment

Clients with Medicare/Medicaid

prior authorizations

Clinical Laboratory Improvement Amendments (CLIA)

Clinical nurse specialist

benefits and limitations

reimbursement 1 2

Clinical pathology consultations

Clinical records

Clinician-directed care coordination services

Comprehensive Care Program (CCP)

Closing a prior authorization

claim form (blank)

electronic billing

instruction table

see Clinical nurse specialist

Cochlear implants 1 2 3 4

prior authorization

Cochlear Implants 1 2

independent laboratories, pathologists, radiologists

place of service (POS) 1 2

precoding paper claims

procedure coding

type of service (TOS)

Colony stimulating factors

Colorectal cancer screening 1 2

genetic testing

sigmoidoscopies

Commodity supplemental food program

Communicable disease reporting 1 2

Community health centers (CHC)

Complaints and fair hearings

Complete blood count (CBC) 1 2

Complete eye examinations

Compliance with federal legislation

Comprehensive Care Program (CCP) 1 2

benefits and limitations

client eligibility

clinician-directed care coordination services

claims information

documentation requirements

medical home clinician telephone consult with specialist

specialist/subspecialist telephone consult with medical home clinician

face-to-face services

medically complex health care

multidisciplinary health care

non-face-to-face services

care plan oversight

clinician supervision of a home health client

clinician supervision of a hospice client

general requirements

medical conferences

medical team conference

other supervision

prolonged services

supervision of a nursing facility client

telephone consultation

prior authorization

clinician-directed care coordination services (CCP)

benefits and limitations

comprehensive outpatient rehabilitation facility (CORF)

benefits and limitations

claims information

documentation requirements

prior authorization

diagnosis coding

documenation requirements

drug and medical device approval

durable medical equipment (DME)

benefits and limitations

cardiorespiratory apnea monitor

benefits and limitations

documentation requirements

prior authorization

claims information

benefits and limitations

documentation requirements

prior authorization

DME certification and receipt form

documentation requirements

donor human milk

benefits and limitations

documentation requirements

prior authorization

electronic blood pressure monitoring device

benefits and limitations

documentation requirements

prior authorization

benefits and limitations

documentation requirements

prior authorization

equipment adjustments

equipment modification

equipment repairs

incontinence supplies

benefits and limitations

documentation requirements

prior authorization

medical nutritional products

benefits and limitations 1 2

documentation requirements

enteral nutritional products

prior authorization

benefits and limitations

documentation requirements

portable lifts for outside the home

prior authorization

prior authorization

documentation requirements

prior authorization

documentation requirements

prior authorization

pediatric hospital cribs

benefits and limitations

documentation requirements

prior authorization

phototherapy devices

benefits and limitations

documentation requirements

prior authorization

retroactive eligibility

policies specific to CCP

prior authorization

benefits and limitations

documentation requirements

prior authorization

purchase vs. rental

reflux wedges and slings

benefits and limitations

documentation requirements

prior authorization

special needs car seats

benefits and limitations

documentation requirements

prior authorization

travel restraints

benefits and limitations

documentation requirements

prior authorization

Early Childhood Intervention (ECI) (CCP)

inpatient psychiatric hospital (freestanding)

benefits and limitations

claims information

clinical criteria for inpatient psychiatric care

continued stays

court-ordered services

documentation requirements

continuity of eligibility through change of ownership

prior authorization

prior authorizations

retrospective utilization review

utilization review

inpatient rehabilitation hospital (freestanding)

benefits and limitations

claims information

comprehensive treatment

documentation requirements

continuity of eligibility through change of ownership

prior authorization

client transfers

medical nutrition counseling services

benefits and limitations

claims information

documentation requirements

prior authorization

occupational therapy (OT)

benefits and limitations

claims information

documentation requirements

prior authorization

orthotics and prosthetics

benefits and limitations

corrective shoes

benefits and limitations

prior authorization

cranial molding orthotics

benefits and limitations

documentation requirements

prior authorization

benefits and limitations

documentation requirements

prior authorization

general documentation requirements

prior authorization

protective helmets

benefits and limitations

documentation requirements

prior authorization

reciprocating gait orthoses (RGO)

benefits and limitations

documentation requirements

prior authorization

removable shoe insert

benefits and limitations

documentation requirements

prior authorization

thoracic-hip-knee-ankle orthoses (THKAO)

benefits and limitations

claims information

documentation requirements

benefits and limitations

prior authorization

standing frame/brace

benefits and limitations

vertical stander

benefits and limitations

wedges and lifts

benefits and limitations

documentation requirements

prior authorization

outpatient rehabilitation facility (ORF)

benefits and limitations

claims information

documentation requirements

prior authorization

personal care services (PCS)

benefits and limitations

claims information

client eligibility

accessing the PCS benefit

primary practioner's role

documentation requirements

place of service

prior authorization

provided in group settings

provider responsibilities

retrospective review

physical therapy (PT)

benefits and limitations

claims information

documentation requirements

prior authorization

physician signature

prior authorization

private duty nursing

authorization appeals

authorization for revision of current services

benefits and limitations

CCP Prior Authorization Request Form

claims information

client/provider notification

amount and duration of PDN

client eligibility

medical necessity

place of service

retroactive client eligibility

documentation requirements

home health plan of care

Nursing Addendum to Plan of Care (CCP) Form

prior authorization

initial requests

recertifications of authorizations

responsible adult or identified contingency plan requirement

retrospective review

skilled nursing visit

TPN administration education

start of care (SOC)

termination of authorization

School Health and Related Services (SHARS)

appealing denied claims

benefits, limitations, and prior authorization

billing units based on 15 minutes

billing units based on an hour

counseling services

documentation requirements

eligibility verification

Medicaid Managed Care enrollment

nonschool SHARS enrollment

nursing services

occupational therapy (OT)

personal care services (PCS)

physical therapy (PT)

physician services

prior authorization

private school enrollment

psychological services

psychological testing

record retention

speech therapy (ST)

description of services

provider and supervision requirements

transportation services

speech therapy (ST)

benefits and limitations

claims information

documentation requirements

prior authorization

therapy services

Comprehensive health center (CHC)

physician services

Comprehensive outpatient rehabilitation facility (CORF)

Computed tomography angiography (CTA)

benefits and limitations

Computed tomography imaging (CT)

benefits and limitations

Computer-aided detection (CAD)

Confidential information

prosthetic eyewear

Contact TMHP 1 2 3

Continuous glucose monitoring (CGM)

prior authorization requirements

continuous passive motion device DME

prior authorization

Continuous positive airway pressure (CPAP)

Contrast materials

benefits and limitations

prior authorization

Corneal bandage

Corneal topography

Corneal transplants

Corporate Board of Directors Resolution

Corrective shoes

federally qualified health center (FQHC)

prior authorization

prior authorization renewal

pior authorization

see Case Management for Children and Pregnant Women

Crime Victims' Compensation Program

Crossover Reimbursement

Custom commode chair

Custom manual wheelchair

prior authorization

Cytogenetics testing for leukemia and lymphoma

Cytopathology studies other than gynecological

Darbepoetin alfa

DARS, blind services

contact information

Date of service (DOS)

Deferoxamine mesylate (Desferal)

instruction table

adjunctive general services

claim form (paper) billing

client eligibility

diagnostic services

doctor of dentistry practicing as a limited physician

electronic claim billing

emergency services

clients over 21 1 2

first dental home

general information

handicapping labiolingual deviation (HLD)

HLD score sheet 1 2

hospitalization

ICF-MR dental services

implant services

informed consent

mandatory prior authorization

Medicaid Managed Care enrollment

oral/maxillofacial surgery

orthodontic procedure codes

orthodontic services

comprehensive treatment

mandatory prior authorization

special orthodontic appliances

transfer of services

treatment plans

periodontal services

preventive services

prosthodontics, removable

provider enrollment

reimbursement 1 2

space maintenance (passive appliance)

supernumerary tooth identification

tests and examinations

therapeutic services

third-party resources

THSteps dental services 1 2 3 4

THSteps guidelines

TMHP information and assistance

tooth identification (TID) and surface identification (SID)

treatment plans

utilization review

Dentist (Doctor of Dentistry)

Department of Assistive and Rehabilitative Services (DARS), Blind Services

Diabetic supplies

procedure codes

Diagnosis coding

Diagnosis requirements

portable X-ray supplier

radiological and physiological laboratory

Diagnostic tests

claim form example

Direct supervision

DME benefits for Medicare/Medicaid clients

DME home health services

augmentative communication device (ACD) system

benefits limitations prior authorization

prior authorization

supply procedure codes

DME medical supplier

Doctor of dentistry

claim form example

limited physician

diagnosis codes

mandatory prior authorization

Medicaid Managed Care enrollment

Document requirements and retention

prior authorization

Donor human milk

Doppler studies

Drugs and supplies

outpatient services

contact information

public health regions

contact information

Dual eligibility, Medicare and Medicaid

Durable medical equipment (DME)

accessories (home health)

bath and bathroom equipment

blood pressure devices 1 2

claim form example (CCP)

cochlear implants

continuous passive motion device

modifications (home health)

Early Childhood Intervention (ECI)

claim form example (CCP only)

Comprehensive Care Program (CCP)

statutory requirements

Echoencephalography

Edetate calcium disodium

Edetate disodium

see electrodiagnostic (EDX) testing

EFT Authorization

Electrical percussor

prior authorization

Electrocardiogram (EKG)

Electrodiagnostic (EDX) testing 1 2

authorization requirements

electromyography (EMG)

maximum number of studies

nerve conduction studies (NCS)

Electromyography (EMG)

electrodiagnostic (EDX) testing

Electronic blood pressure monitoring device

Electronic claims submission

Electronic Data Interchange

see EDI and TMHP EDI

Electronic data interchange (EDI)

advantages of electronic services

automated maintenance process

electronic billing

electronic services

electronic transmission reports

provider check amounts

supported file types

third party billing agents

third party vendor implementation

Electronic eligibility transactions

Electronic funds transfer

enrollment procedures

medical transportation

refer to type of provider

see also client eligibility

emergency care restrictions

restricted coverage

Endodontics 1 2

cystourethroscopy

endoscopic retrograde cholangiopancreatography (ERCP)

lower gastrointestinal endoscopy

sinus endoscopy

upper gastrointestinal endoscopy

advanced practice registered nurse (APRN)

ambulatory surgical center (ASC)

certified registered nurse anesthetist (CRNA)

certified respiratory care practitioner (CRCP)

chiropractic services

clinical nurse specialist (CNS)

criteria for out-of-state providers

DME home health services

electronic funds transfer

federally qualified health center (FQHC)

hospital ambulatory surgical center (HASC)

independent laboratory

nurse practitioner (NP)

physical therapist

physician assistant (PA)

portable X-ray supplier

radiological and physiological laboratory

rural health clinic (RHC)

tuberculosis clinic

managed care program

Enteral nutritional products 1 2

limitations procedure codes

Enteral supplies

Epidural, implantable infusion pumps

Epoetin alfa (EPO)

see also Texas Health Steps (THSteps)

Esophageal pH probe monitoring

Exceptions-to-periodicity checkup, Texas Health Steps (THSteps)

External insulin pumps

documentation requirement

prior authorization

Extracorporeal membrane oxygenation (ECMO)

eye examinations for the purpose of prescribing eyewear

False claims recovery

employee education

Familial adenomatous polyposis

Family Planning 2017 Claim Form

Family planning services

claims information

laboratory handling fees

physician services

Sterilization Consent Form 1 2

Federal financial participation (FFP)

Federally qualified health center (FQHC)

benefits and limitations 1 2

after-hours care

migrant farm workers

claims filing 1 2

claim form example 1 2 3

claims resources

cost reporting 1 2

documentation requirements

Medicare-Medicaid crossover claims pricing

prior authorization 1 2

reimbursement 1 2

Filing deadlines

TPR 110-day rule

Fluocinolone acetonide 1 2

1120 Medical Bills Transmittal

Abortion Certification Statements Form

Abortion Certification-Statements

American Dental Association (ADA) claim form

instruction table

behavioral health

Extended Outpatient Psychotherapy/Counseling Request Form

Psychological/Neuropsychological Testing Request Form

Birthing Center

Birthing Center Report (Form 7484)

ECI Request for Outpatient Therapy

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

Prior Authorization Request Form

Private Duty Nursing 6 Month Authorization

Family Planning

Maternity Clinic

Nurse Practitioner/Clinical Nurse Specialist

Client Eligibility

Crossover Type 30 claim form (MRAN)

Crossover Type 30 claims

Crossover Type 31 and 50

DME Certification and Receipt Form 1 2 3

Donor Human Milk Request Form

Extended Outpatient Psychotherapy/Counseling Request Form

External Insulin Pump 1 2

Federally Qualified Health Center Report (Form 7484)

Form Pb-109 Physician Reference on Follow-up Testing and Case Management

Hearing Evaluation, Fitting, and Dispensing Report (Form 3503)

Addendum to Home Health Services (Title XIX) DME/Medical Supplies Physician Order Form

Home Health Services (Title XIX) DME/Medical Supplies Physician Order Form

Home Health Services (Title XIX) DME/Medical Supplies Physician Order Form Instructions

Home Health Services Plan of Care (POC) 1 2 3

Plan of Care 1 2

Prior Authorization Checklist 1 2

Home Health Plan of Care

Hospital Report (Form 7484) 1 2

Hysterectomy Acknowledgement

Hysterectomy Acknowledgment Form 1 2

Medicaid Certificate of Medical Necessity for Chest Physiotherapy Devices

Extended Request

Initial Request

Medicaid Certificate of Medical Necessity for CPAP/BiPAP or Oxygen Therapy

Medicaid Certificate of Medical Necessity for Reduction Mammaplasty

Medicaid Identification

Medicaid Identification (Form H3087) 1 2 3

Medicaid verification letter (Form H1027-A)

Medicaid verification letter (Form H1027-B)

Medicaid verification letter (Form H1027-C) 1 2

Nonemergency Ambulance Prior Authorization Request 1 2

Nursing Addendum to Plan of Care

Physician's Examination Report

Psychiatric Hospital Inpatient Initial Admission Request Form

Psychiatric Inpatient Extended Stay Request Form

Pulse Oximeter Form 1 2

Radiology Prior Authorization Request Form 1 2

Request for Extension of Outpatient Therapy (Form TP-2)

Request for Initial Outpatient Therapy (Form TP-1)

Special Medical Prior Authorization (SMPA) Request

Specimen submission

Statement for Initial Wound Therapy System In-Home Use

Sterilization Consent Form 1 2

Texas Health Steps

Child Health Clinical Records

Child Health History

Child Health Record

13 Months-2 Years

Dental Criteria for Dental Therapy Under General Anesthesia 1 2

Dental Mandatory Prior Authorization Request 1 2 3

Hearing Checklist for Parents

Hearing Checklist for Parents (Spanish

Mental Health Interview Tool/Referral Form

Ages 10-12 Years

Ages 13-20 Years

Mental Health Parent Questionnaire

Ages 10-12 Years

Ages 10-12 Years (Spanish)

Ages 13-20 Years

Ages 13-20 Years (Spanish

Ages 3-9 Years (Spanish)

Ages Birth-2 Years

Ages Birth-2 Years (Spanish)

PPD Agreement for Texas Health Steps Providers

Referral Form Instructions

Risk Assessment for Lead Exposure Parent Questionnaire, Form Pb-110 1 2

Specialist or Subspecialist Telephone Consultation Form for Non-Face-to-Face Clinician-Directed Care Coordination Services-Comprehensive Care Program (CCP)

Tuberculosis Questionnaire

Tuberculosis Questionnaire (Spanish)

TVFC Patient Eligibility Screening Record

TVFC Patient Eligibility Screening Record (Spanish)

TVFC Provider Enrollment

TVFC Questions and Answers

Dental Mandatory Prior Authorization Request

Ventilator Service Agreement

Vision Care Eyeglass Patient Certification Form

Wheelchair Seating Assessment Form 1 2

Wound Therapy System In-Home Use

Recertification

Fraud and abuse

suspected cases

Fraud and abuse policy

Functional MRI (fMRI)

Gamma globulin/immune globulin

Genetic testing

colorectal cancer screening

benefit schedule

claim form example

genetic evaluation and counseling

reimbursement 1 2

Global services

ambulatory surgical center (ASC)

hospital ambulatory surgical center (HASC)

Group clinical visits

Guidelines for procedures awaiting rate hearing

Gynecological services

prior authorization

assays for vaginitis

masculinized females

see Healthcare Common Procedure Coding System (HCPCS)

Health Insurance Premium Payment (HIPP) Program

Health maintenance organization (HMO)

Healthcare Common Procedure Coding System (HCPCS)

Hearing aid and audiological services claims

Hearing aid devices

30-day trial period

facility visits and home visits

fitting and dispensing visits and revisits

limitations and required forms

medical necessity

non-implantable 1 2

noncovered services

supplies and accessories

warranty repairs and modifications

Hearing aid devices and accessories

Hearing aids and audiometric evaluations

claim form example

Hearing devices

services/benefits, limitations and prior authorization

Hearing diagnostic services

Hearing screening

early hearing detection and intervention

Hearing screenings

Hearing services

documentation requirements

Medicaid HMO claims

physician diagnostic

Heart disease classifications

Heart transplants

Heavy duty commode chair

Heavy duty wheelchair

prior authorization

Helicobacter pylori (H. pylori)

Hematopoietic agents

Hematopoietic injections

Hemoglobin type

Hepatitis B immunizations

Hereditary nonpolyposis colorectal cancer (HNPCC)

documentation requirements

payment deadline

DSHS-BHO services

complaints and fair hearings

complaints to HHSC fee-for-service

fee-for-service and PCCM

administrative claim appeals

exception requests

exception to the 120-day appeal deadline

exception to the 95-day filing deadline

exceptions to the 24-month payment deadline

Provider complaints

utilization review

medical necessity appeals

utilization review (UR)

continued stay denials

technical denials

contact information

High-volume providers

CDC recommendations for testing

testing procedure codes

where to go for help

workplace guidelines

abililty to work

confidentiality and privacy

coworker concerns

employee education

employment rights

performance standards

Home health (DME)

manual wheelchairs

Home health agency

pending agency certification

Home health servcies

Home health services

blood glucose monitors

canceling an prior authorization

change of address/telephone number

claim form example

DME/medical supplies

skilled nursing visit and physical therapy

skilled nursing visits

claims information 1 2

client evaluation

criteria for grouping levels

decubitus care accessories

documentation requirements

durable medical equipment (DME)

enteral feeding pumps

external insulin pump and supplies

group 1 support surfaces

group 2 support surfaces

group 3 support surfaces

home health aide services

home health aide visits

hospital beds and equipment

hospital beds and equipment procedure code

incontinence equipment

incontinence supplies and equipment

insulin and insulin syringes

intravenous (IV) therapy equipment and supplies

manual wheelchairs

heavy duty and extra heavy duty

standard, standard hemi, standard reclining, tilt-in-space

medical supplies

medication administration limitations

mobility aids that are not a benefit

nursing and therapy

nursing services

nutritional (enteral) products, supplies, and equipment

nutritional supplies and equipment procedure codes and limitations

occupational therapy

prior authorization procedures

physical therapy services

possible Medicare clients 1 2

pressure reducing support services

prior authorization 1 2 3

prior authorization external insulin pump and supplies

professional nursing

prohibition of Medicaid payment 1 2

pulsatile jet irrigation wound care system

respiratory equipment and supplies

procedure codes and limitations

retroactive eligibility 1 2

sealed suction wound care system

services, benefits, limitations, and prior authorization

skilled nursing and home health aid services provider responsibilities

skilled nursing and home health aide services assessments and reassessments

skilled nursing and home health aide services not prior authorizated

skilled nursing and home health aide services prior authorization requirements

skilled nursing care

skilled nursing visits

supervision of home health aides

supplies submitted with a plan of care

vocational nursing

written plan of care

Home health services (DME)

incontinence supplies

Home health services POC

physician supervision

Home Health SN and Home Health Aide (HHA) Services

Home mechanical ventilation equipment

Home oxygen therapy

documentation requirements

Hormone injections

Hospice Medicaid Identification

Hospice Program

ambulance services

change of ownership 1 2

client transfer

day surgery services

emergency department services

general information

inpatient claim form example

inpatient reimbursement

newborn services

observation to inpatient admission

claim form example

outpatient claims information

outpatient reimbursement

outpatient services

revenue codes (outpatient)

aerosol treatment

cochlear implants

colorectal cancer screening

contraction stress testing

fetal nonstress testing

Helicobacter pylori

hyperbaric oxygen therapy

hysterectomy services

laboratory services

pentamidine aerosol

pulmonary function studies

radiation therapy

radiology services

tetanus injections, acute care

teaching hospitals

third party liability reporting

Hospital ambulatory surgical center (HASC)

benefits and limitations

claims resources

cochlear implants

colorectal cancer screening

documentation requirements

fluocinolone acetonide

global services

implantable infusion pump

prior authorization

reimbursement 1 2

incomplete procedures

documentation requirements

prior authorization

Hospital beds and equipment

home health services

Hospital visits

physician services

Human donor milk

Human rabies immune globulin (HRIG)

Human rabies vaccine

Humidification Units

Hyperbaric oxygen therapy (HBOT), physician services

Acknowledgment Statement

claims filing instructions

Ilizarov device, physician services

how to report records

Immune globulin (Cytogam)

administrations and immunizations

general recommendations

how to report records

human rabies immune globulin (HRIG)

physician services

recommended childhood schedule

requirements for TVFC

Texas Health Steps

TVFC requirements

Vaccine Adverse Event Reporting System (VAERS)

Immunosuppressive drugs

Implantable hearing aid devices

Implantable hearing devices

sound processor replacement

Implantable infusion pumps 1 2

cochlear implants

fluocinolone acetonide intravitreal

In-home total parenteral nutrition

procedure codes with limitations

documentation requirements

prior authorization

Independent laboratory

benefits and limitations

chemistry tests

claim form example

electronic filing

clinical laboratory improvement amendments (CLIA)

Physician-performed microscopy procedure (PPMP) certificates

waiver certificates

complete blood count (CBC)

documentation requirements

lab handling fees

laboratory paneling

prior authorization

Prior authorization

independed laboratory

reimbursement 1 2

repeated procedures

Texas Health Steps

outpatient services

Independent practitioners

Indian Health Services

Indian Self-Determination and Education Assistance Act

Informational claims 1 2

Injectable contraceptives

prior authorization

abatacept (Orencia)

antibiotics and steroids

antihemophilic factor

botulinum toxin type A

chelating agents

edeferoxamine mesylate (Desferal)

edetate calcium disodium

edetate disodium

gamma globulin/immune globulin

growth hormone 1 2

hematopoietic agents 1 2

darbepoetin alfa

epoetin alfa (EPO)

immunosuppressive drugs

implantable infusion pumps

joint and trigger point

leuprolide acetate (Lupron Depot)

maternal serum alpha-fetoprotein

Integrated Care Management (ICM)

Intermittent positive-pressure breathing (IPPB) treatment

Internal control number (ICN)

Intestinal transplants

Intraocular lenses 1 2

Intraoperative MRI (iMRI)

Intrathecal infusion, implantable infusion

Intravitreal drug delivery system

prior authorization

Iridectomy/iridotomy/trabeculectomy

Iron injections

Iron sucrose (Venofer)

prior authorization

documentation requirements

JCIH 2007 position statement

Joint injections

Lab handling fees

follow-up care guidelines

required tests for medical checkups

newborn screening 1 2

see also Independent laboratory

THSteps services

Laboratory forms

Laboratory handling fees

family planning services

Laboratory paneling

Laboratory services 1 2

clinical lab panel implementation

clinical pathology consultations

see Licensed clinical social worker (LCSW)

measuring blood lead levels

prevention materials

symptoms of lead poisoning

Leuprolide acetate (Lupron Depot)

Levels for custom manual wheelchairs

Licensed clinical social worker (LCSW)

behavioral health services

see Behavioral health

Licensed marriage and family therapist (LMFT)

behavioral health services

see Behavioral health

Licensed professional counselor (LPC)

behavioral health services

see Behavioral health

Licensed psychological associate (LPA)

behavioral health services

see Behavioral health

Licensure renewal

Limitations, Medicaid Program

noncovered procedures

Limited status claims payment

Liver transplants

see Licensed marriage and family therapist (LMFT)

Local health departments

contact information

see Licensed professional counselor (LPC)

Lung transplants

Lung volume reduction surgery (LVRS)

Magnetic resonance angiography (MRA)

benefits and limitations

Magnetic resonance imaging (MRI)

benefits and limitations

Maintenance of provider information

advance directives

after-hours guidelines

automatic reenrollment

behavioral health

client eligibility

client enrollment

client responsibilities

clients rights and responsibilities

advance directives

responsibilities

complaints and fair hearings

continuous coverage

cultural competency

Health Insurance Premium Payment (HIPP) Program

health plan changes

HMO plan changes

administrator-initiated

client-initiated

limited English proficiency

primary care provider

eligible provider types

primary care provider changes

prior authorization

provider requirements and information

provider-to-client ratio

STAR Program 1 2

STAR+PLUS Program

third party resources

unacceptable telephone arrangements

Manual wheelchair

prior authorization

Manual wheelchairs

seating assessment

Maternal and child health

services block grant program

Maternal serum alpha-fetoprotein

Maternity clinics

provider enrollment

high-risk individuals

physician responsibility

services, limitations, prior authorization

initial antepartum care

laboratory tests

postpartum care

prior authorization

subsequent antepartum care

Medicaid for breast and cervical cancer, client eligibility

Medicaid HMO prior authorizations

Medicaid Identification

Medicaid Program Administration

Medicaid Qualified Medicare Beneficiary (MQMB)

Medicaid relationship to Medicare 1 2

Medicaid verification letter

Medicaid, Texas Program

client eligibility

fraud and abuse policy

medical necessity, definition

requirements for participation

restricted coverage

services provided outside Texas

verification documents

Medical checkup (THSteps)

birth through 20 years of age

procedures and tests 1 2

Medical nutrition counseling

Medical nutritional counseling

CCP claim form example

Medical nutritional products

Medical supplies

prior authorization

Medical supplies and wound care system

prior authorization

Medical transportation

Form H3113 Health Care Provider Statement of Medical Need

program limitations 1 2

program services

verification of service

Medically Needy Program (MNP)

closing MNP case

spend down processing 1 2

claims deadlines

crossover reimbursement

fraud and abuse policy

Medicare and Medicaid DME prior authorization

Medicare and Medicaid Prior Authorization 1 2

Medicare Part C

Medicare/Medicaid

renal dialysis facility

Mental health claims

Migrant health centers

Military hospital

benefits and limitations

claim form example (emergency inpatient)

claims information

inpatient services

Mobile commode chair

prior authorization

procedure codes and limitations

Modifications to durable medical equipment (DME) home health

Modifier 76 1 2

Modifier 91 1 2

See Medical transportation

Mucous clearance valve

Muscular Dystrophy Association

Myocardial perfusion imaging

Myocardial perfusion pool imaging

National Drug Code (NDC) 1 2 3

outpatient services

National Provider Identifier

prior authorization

Negative pressure ventilators

prior authorization

Nerve conduction studies (NCS)

electrodiagnostic (EDX) testing

Neurostimulators 1 2

blood screening

hearing screening

1-3-6 Month Practitioner's Guide

outpatient rescreen

screening, statutory requirements

THSteps examination

Newborn Eligibility

Non-implantable hearing aid devices

Non-prosthetic contact lenses

Non-prosthetic eyeglass lenses

Non-prosthetic eyewear

frames, lenses, and contact lenses

Medicare coverage

vision services

Noncovered Services

Nonemergency Ambulance Prior Authorization Request Form

NorthSTAR Program

behavioral health billing

client eligibility

client enrollment

complaints and appeals

enrollment broker

guidelines for working with NorthSTAR clients

hospital billing

prior authorization requirements

provider requirements

quality improvement monitoring

see nurse practitioner

NPI Verification

see certified nurse midwife, nurse practitioner, clinical nurse specialist, or certified registered nurse anesthetist

Nurse practitioner

benefits and limitations

reimbursement 1 2

Nursing facility

Nursing services

Nutritional products

documentation requirements

prior authorization

less than 24 hours

Observation services 1 2

Obstetrics/prenatal care

Occupational therapy

School Health and Related Services (SHARS)

Occurrence codes for UB-04 CMS-1450

Office visit with lab and radiology

claim form examples

Online enrollment

Online Fee Lookup (OFL)

Online prior authorizations

Online Provider Lookup (OPL) 1 2

Ophthalmic ultrasound, sonography, and echography services

Ophthalmological services

Ophthalmology 1 2

Optometric services

diagnosis limitations

see Abatacept (Orencia)

Organ procurement

Organ transplant

Orthodontic services

mandatory prior authorization

procedure codes

special orthodontic appliances

Orthotic and prosthetic services

claim form example

Osteogenic stimulation 1 2

documentation requirements

invasive electrical osteogenic stimulator

noninvasive electrical osteogenic stimulator

prior authorization

professional services

ultrasound osteogenic stimulator

Osteopathic manipulation treatment (OMT)

OT procedure codes

documentation requirements

Other Ophthalmological Services

Vision Services

Other/Special Provisions

Out-of-state Medicaid providers 1 2

physician services in an outpatient hospital setting

Outpatient facilities

Outpatient rehabilitation facility (ORF)

Outpatient services

claims resources

drugs and supplies

global services

cochlear implants

fluocinolone acetonide intravitreal

National Drug Code (NDC)

neurostimulators

prior authorization

incomplete procedures

home delivery system types

prior authorization

recertification

Parental accompaniment 1 2

statutory requirements

Patient Acknowledgment Statement

Payment error rate measurement (PERM) 1 2

Payment Information

access and availability standards

denials and appeals (inpatient)

facility services

professional services (inpatient)

behavioral health services

case management fee

specialist services

client eligibility

client enrollment

client responsibilities

community health services

complaints and appeals

authorization appeals

conflict resolution

provider complaints

contact numbers

covered services

behavioral health services

family planning services

OB/GYN services

Texas Health Steps

vision services

credentialing committee

frequency and logistics

grievance committee

facility/hospital services

reporting medical staff changes to TMHP

linguistic services

monthly member panel report

notification of admission 1 2

scheduled admissions

observation services

office and medical record standards

confidentiality of medical records

content of medical record

medical records audit

provider site requirements

office and medical records standards

out-of-network inpatient services

primary care provider

primary care provider selection

responsibilities

services to be provided

verifying assignment

primary care providers

additional criteria

prior authorization

procedures requiring

prior authorizations

provider enrollment

provider responsibilities

client self-referred services

referral network

specialist-to-specialist

emergency outpatient services

network hospitals

non-emergency outpatient clinic services

out-of-network hospitals

PCCM claims details

specialists responsibilities

support services

client support and education

transportation services

client rights and responsibilities

plan of care (POC)

services offered

PE Medicaid Identification

Pediatric hospital cribs

Pediatric nurse practitioner

see nurse practitioner

Pediatric pneumogram

Pentamadine, aerosol

Percutaneous transluminal coronary intervention

Performing provider

Periodicity schedule (THSteps)

birth through 20 years of age

medical checkup

Personal care services 1 2 3

School Health and Related Services (SHARS)

Personal supervision

Phototherapy devices

Comprehensive Care Program (CCP)

see Comprehensive Care Program (CCP)

Physical examinations, sports

Physical status descriptions

Physical therapists 1 2

claim form example

reimbursement 1 2

Physical therapy

claim form examples (CCP only)

behavioral health services

see Behavioral health

comprehensive health centers (CHC)

dentistry, doctor of

domiciliary, rest home, or custodial care

emergency department services

evaluation and management services

group clinical visits

inpatient hospital services

concurrent care

hospital admissions, initial visits, and subsequent visits

hospital discharge

nursing facility services

intermittent positive-pressure breathing (IPPB)

kidney transplant

office or other outpatient hospital services

consultation services

new and established patient services

observation services

preventive care visits

services outside of business hours

outpatient hospital reimbursement

prior authorization

procedures and services

see also PCCM, referrals

reimbursement 1 2

aerosol treatment 1 2

allergy immunotherapy

allergy testing

direct nasal mucous membrane test

inhalation bronchial challenge testing

ophthalmic mucous membrane test

patch or application tests

percutaneous and intracutaneous skin test

photo or photo patch skin test

RAST/MAST tests

for labor and delivery

for THSteps dental

multiple procedures 1 2

pain management

provided by the surgeon

Bacillus Calmette-Guérin (BCG) for treatment of bladder cancer

bariatric surgery

prior authorization requirements

breast cancer screening

cancer screening and testing

cardiopulmonary resuscitaiton (CPR)

procedure codes

cochlear implants

colorectal cancer screening

sigmoidoscopies

colorectal screening

genetic testing

continuous glucose monitoring (CGM)

prior authorization

corneal transplants

diagnostic tests

ambulatory blood pressure monitoring

ambulatory electroencephalogram (A/EEG)

bone marrow aspiration

cytopathology studies other than gynecological

echoencephalography

electrocardiogram (EKG)

electrodiagnostic (EDX) testing

esophageal pH probe monitoring

Helicobacter pylori (H. pylori)

myocardial perfusion imaging

pediatric pneumogram

doppler studies

cystourethroscopy

endoscopic retrograde cholangiopancreatography (ERCP)

lower gastrointestinal endoscopy

sinus endoscopy

upper gastrointestinal endoscopy

extracorporeal membrane oxygenation (ECMO)

family planning

Helicobacter pylori

hospital visits

hyperbaric oxygen therapy (HBOT)

Ilizarov device

human rabies immune globulin (HRIG)

human rabies vaccine

abatacept (Orencia)

antibiotics and steroids

antihemophilic factor

botulinum toxin type A

chelating agents

deferoxamine mesylate (Desferal)

edetate calcium disodium

edetate disodium

gamma globulin/immune globulin

hematopoietic agents

darbepoetin alfa

epoetin alfa (EPO)

immunosuppressive drugs

implantable infusion pumps

joint and trigger point

leuprolide acetate (Lupron Depot)

intraocular lenses

clinical lab panel implementation

clinical pathology consultations

long term care nursing facility

magnetic resonance angiography (MRA)

magnetic resonance imaging (MRI)

mastectomy and breast reconstruction

neuromuscular electrical stimulation (NMES)

neurostimulators

doral column neurostimulator (DCN)

intracranial neurostimulators (ICN)

NMES and TENS supplies

NMES/TENS garments

percutaneous electrical nerve stimulators (PENS)

prior authorization

sacral nerve stimulators (SNS)

transcutaneous electrical nerve stimulators (TENS)

noninvasive diagnostic studies

nuclear medicine

obstetrics/prenatal care

occupational therapy

ophthalmology 1 2

orthognathic surgery

physical therapy

radiation therapy

reduction mammoplasties

speech-language therapy

stereotactic radiosurgery

transplant prior authorization

vaccinationsee Immunizations

vagal nerve stimulators (VNS)

ventilation assist and management

sign language interpreting services

substitute physician

teaching attending physician and resident physician

supplies, trays, and drugs

wearable cardiac defibrillator

Physician assistant (PA)

benefits and limitations

reimbursement 1 2

Physician oversight services

Physician services

School Health and Related Services (SHARS)

Physician-performed microscopy procedure (PPMP) certificates

Physiological laboratory

Podiatrist services

clubfoot casting

flat foot treatment

routine foot care

Portable X-ray supplier 1 2

benefits and limitations

contrast materials

prior authorization

radiology procedures

cardiac blood pool imaging

myocardial perfusion imaging

radiation therapy

radiopharmaceuticals

reimbursement 1 2

Positive airway pressure system devices

Positron-emission tomography (PET) scans

prior authorization

Power elevating leg lifts

documentation requirements

Power seat elevation system

documentation requirements

Power wheelchairs

documentation requirements

Preferred Provider Organization (PPO)

Premature infants

Prescription pads

Pressure-reducing support surface

documentation requirements

Presumptive eligibliity process

Primary Care Case Management

Primary care provider

see Managed care

Prior authorization

ambulance 1 2 3

emergency out-of-state transport

retroactive eligibility

ambulatory surgical center (ASC)

certified respiratory care practitioner

Comprehensive Care Program (CCP)

continuous glucose monitoring (CGM)

contrast materials

federally qualified health center (FQHC) 1 2

Addendum to Home Health Services (Title XIX) DME/Medical Supplies Physician Order Form

CCP ECI Request for Outpatient Therapy

CCP Prior Authorization Private Duty Nursing 6 Month Authorization

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

CCP Prior Authorization Request Form

Donor Human Milk Request Form

Extended Outpatient Psychotherapy/Counseling Request Form 1 2

External Insulin Pump 1 2

Home Health Services (Title XIX) DME/Medical Supplies Physician Order Form

Home Health Services (Title XIX) DME/Medical Supplies Physician Order Form Instructions

Home Health Services Plan of Care (POC) 1 2 3

Home Health Services Plan of Care (POC) Instructions 1 2

Home Health Services Prior Authorization Checklist 1 2

Medicaid Certificate of Medical Necessity for Chest Physiotherapy Devices

Extended Request

Initial Request

Medicaid Certificate of Medical Necessity for CPAP/BiPAP or Oxygen Therapy

Medicaid Certificate of Medical Necessity for Reduction Mammaplasty

Nonemergency Ambulance Prior Authorization Request

Psychiatric Hospital Inpatient Initial Admission Request Form

Psychiatric Inpatient Extended Stay Request Form

Pulse Oximeter Form 1 2

Radiology Prior Authorization Request Form

Request for Extension of Outpatient Therapy (Form TP-2)

Request for Initial Outpatient Therapy (Form TP-1)

THSteps Dental Mandatory Prior Authorization Request Form 1 2 3 4

home health services (DME)

hospital ambulatory surgical center (HASC)

independed laboratory

mandatory prior authorization (dental)

MRI/fMRI/MRAPrior authorization

neurostimulators

NorthSTAR Program

orthodontic services

outpatient services

PCCM outpatient prior authorization

portable X-ray supplier

programmable pumps

radiological and physiological laboratory

radiopharmaceuticals 1 2

renal dialysis facility

rural health clinic (RHC) 1 2

THSteps and ICF-MR dental prior authorization

tissue transplant services

tuberculosis clinic 1 2

Prior Authorization of Retroactive Eligibility

Prior authorizations

denials appeals process

requests by FAX, telephone, or mail

requests by mail

requests for clients with private insurance

requests for clients with retroactive eligibility

requests for newly enrolled providers

requests through the TMHP website

requirements for hearing aid devices

retroactive eligibility

terms and condition

Private duty nursing

claim form examples (CCP only)

Private Pay Agreemen

Procedure codes

HCPCS codes (level II)

levels of codes

THSteps dental 1 2 3

DOT/DOPT examination

initial examination

Professional providers

Prognostic breast and gynecological cancer studies

Programmable pumps, prior authorization

Prosthetic contact lenses

Prosthetic eyewear 1 2

dispensing requirements

Medicare coverage

replacement and repair

Protective helmets

professional organizations

resolution of problems

Provider enrollment

application 1 2

Disclosure of Ownership and Control of Interest Statement

group information changes

group practices

Medicaid Audit Information Form

miscellaneous provisions

termination/disenrollment

provider agreement

provider responsibilities

STAR and STAR+PLUS Programs

Medicaid Managed Care Programs

Texas Health Steps (THSteps)

Provider Information Change (PIC) Form

Provider reenrollment

Provider responsibilities

billing requirements

compliance with

Americans with Disabilities Act of 1990

Civil Rights Act of 1964

Rehabilitation Act of 1973

confidential information

incidental services

medical record documentation requirements

patient acknowledgment statement

procedures for reporting

abuse or neglect

suspected sexual abuse

retention of records

tuberculosis clinic

utilization control

Provider-specific visits

Providers Liens for Third Party Reimbursement

Psychiatric Hospital/Facility

claim form example (Inpatient - CCP only)

behavioral health services

see Behavioral health

procedure codes

Public health districts

contact information

prior authorization

Pulse oximetry 1 2

Pumps, implantation

Qualified Medicare Beneficiary (QMB) 1 2 3 4

Qualified provider enrollment

presumptive eligibility

Quick Reference Guide

Texas Health Steps

Rabies post-exposure prophylaxis (PEP)

Radiation services

Radiation therapy

benefits and limitations

claim form example

claim form examples

procedure code limitations

Radiological and physiological laboratory

benefits and limitations

contrast materials

prior authorization

radiology procedures

cardiac blood pool imaging

myocardial perfusion imaging

radiation therapy

radiopharmaceuticals

Radiological and physiological laboratory and portable X-ray supplier

claim form examples

Radiological laboratory

Radiology and laboratory services

general information

Radiology prior authorizations

Radiology services 1 2 3

benefits and limitations

diagnosis requirements

physician-performed services

therapeutic radiopharmaceuticals

Radiopharmaceuticals

benefits and limitations

prior authorization

RAST/MAST tests

Rate hearings, guidelines for procedures awaiting

Reciprocating gait orthoses (RGO)

Record retention

rural health clinic (RHC)

Reduction mammoplasties

Case Management for Children and Pregnant Women (CPW)

family planning

genetic services

Reflux, slings, and wedges 1 2

prior authorization

Other insurance payments

Registered nurse

additional THSteps educational requirements

Texas Health Steps (THSteps)

Rehabilitation hospital

claim form example (inpatient - CCP only)

Rehabilitation hospital (freestanding) (CCP)

Rehabilitative services

Reimbursement 1 2

ambulatory surgical center (ASC) 1 2 3

case management

for children and pregnant women

for children who are blind and visually impaired

for early childhood intervention

certified nurse-midwife

certified registered nurse anesthetist

certified respiratory care practitioner

chemical dependency treatment facility

chiropractic services

clinical nurse specialist

cost reimbursement

drugs/biologicals

durable medical equipment

family planning services

federal financial participation (FFP)

federally qualified health center (FQHC) 1 2

genetic services

hearing aid and audiometric evaluations

Hearing Services

high-volume providers

home health services

hospital ambulatory surgical center (HASC) 1 2

in-home total parenteral nutrition

independent laboratory 1 2

independent practitioners

Indian Health Services

licensed clinical social worker

licensed marriage and family therapist

licensed professional counselors

maternity service clinic

Medicare crossover

nurse practitioner

out-of-state medicaid providers

outpatient facilities

personal care services

physical therapists 1 2

physician assistant 1 2

physician services in outpatient hospital setting

physiological laboratory

portable X-ray supplier 1 2

professional providers

provider-specific visits

radiological and physiological laboratory

radiological laboratory

reasonable cost/interim rates

renal dialysis facility 1 2 3

rural health clinic (RHC) 1 2

School Health and Related Services (SHARS) 1 2

certification of funds

cost reconciliation and cost settlement

random moment time study (RMTS)

static fee schedules

tuberculosis clinic 1 2

tuberculosis clinics

vision services

Reimbursement methodology

Remittance and Status (R&S) Report

adjustments to claims

claims being processed

claims payment summary

delivery options

accounts receivables

backup withholding penalty information

claims in process

paid or denied claims

sub-owner recoupments

void and stop pay

explanation of benefit codes

explanation of columns

explanation of pending status codes

field explanation

financial items

internal control number (ICN)

paid or denied claims

section explanation

status of claims

see banner pages

documentation requirements

prior authorization

Renal dialysis facility

benefits and limitations

claim form example (CAPD/CCPD) 1 2

claim form example CMS-1500

claims filing 1 2

claims resources

dealing direct-support services

in-facility dialysis

nonroutine laboratory

routine laboratory

laboratory services

Medicare/Medicaid

prior authorization

radiology services

reimbursement 1 2 3

Repairs to client-owned equipment

Repeated procedures

Replacement of equipment/accessories

Reporting abuse and neglect, statutory requirements for

Reporting waste, abuse, and fraud

Reservoirs, impantation

Respiratory care

Respiratory equipment

prior authorization

Respiratory equipment and supplies

Retroactive eligibility

see Client eligibility

renal dialysis facility

Root canal therapy

Routine hearing screenings

Rural health clinic (RHC)

after-hours care

benefits and limitations

claim form example, freestanding 1 2

claim form example, hospital-based

claims information

claims resources

cost reporting 1 2

documentation requirements

freestanding 1 2

hospital-based 1 2

prior authorization 1 2

record retention

reimbursement 1 2

School Health and Related Services (SHARS)

claim form examples

personal care services

documentation requirements

prior authorization

Screening services

Screening, brief intervention, and referral to treatment (SBIRT)

Seat lift mechanisms

documentation requirements

Seating assessment

documentation requirements

prior authorization

Seating assessments

manual wheelchairs

Second opinions

Secretion clearance devices

Presumptive Eligibility

Services/Benefits, Limitations and Prior Authorization

SHARS Audiology Services

Sign language interpreting services, physician

Signature authority

Silver nitrate applicators

Sodium ferric gluconate complex in sucrose (Ferrlecit)

Special Medicaid Prior Authorization (SMPA) Request Form

Special needs car seats 1 2

Special needs travel restraints

Special ophthalmological services

School Health and Related Services (SHARS)

Speech-language pathology

claim form examples (CCP only)

Speech-language therapy

Spend down, Medically Needy Program

Sports physical examinations

ST and Aural Rehabilitation Services

Stale-dated checks

Standard manual wheelchair

prior authorization

Standard power wheelchair

documentation requirements

documentation requirements

Standing frame/brace

STAR Health Program

claims submissions

mental health rehabilitation

client eligibility

STAR Health model

adult well check

prescription drugs

spell of illness

newborn claims submission

client enrollment

assignment of Medicaid ID

STAR+PLUS Program

client eligibility

dual eligible clients

ineligible clients

enrollment of newborns

mental health claims

spell of illness limitation

State Legalization Impact Assistance Grant (SLIAG)

State requirements

early childhood intervention (ECI)

parental accompaniment

reporting abuse and neglect

Texas Health Steps

newborn blood screening

State Supported Living Centers

Stationary commode chair

Statutory requirements

communicable disease reporting

Early Childhood Intervention (ECI)

newborn screening

parental accompaniment

reporting abuse and neglect

teen confidentiality issues

Texas Health Steps (THSteps)

Stem cell transplants

Stereotactic knife radiosurgery

consent form 1 2 3

attachment to claims

subcutaneous injection port

documentation requirements

Subcutaneous injection port

prior authorization

Subcutaneous injection ports

Submission of birth information

Submission of informational claims

third party reimbursement

Submitting claims for services that require prior authorizations

Supplemental Security Income (SSI)

anesthesia administered by surgeon

assistant surgeons

prior authorization requirements

bilateral procedures

global surgery concurrent care

incomplete procedures

lung volume reduction

office procedures

orthopedic hardware

second opinions

Syphilis testing

Tamper-resistant prescription pads

Tax Equity and Fiscal Responsibility Act (TEFRA)

physician reimbursement

Taxonomy codes 1 2

see Tuberculosis

Teen confidentiality issues, statutory requirements

see Tax Equity and Fiscal Responsibility Act (TEFRA)

Telephone numbers

DARS, blind services 1 2

federal and state

client communication

community health services

inpatient/outpatient prior authorization line

member helpline

provider helpline

Temporary license/certification

Terminal illness, Medicaid services unrelated to

Texas Band of Kickapoo Equity Health Program

Texas Board of Nursing (BON)

Texas early hearing detection and intervention (TEHDI)

Texas Family Code

Texas Health Steps

communicable disease reporting

dental guidelines

AAPD Periodicity Guidelines

early hearing detection and intervention

Child Health History

Child Health Record

13 Months-2 Years

Form Pb-109 Physician Reference on Follow-up Testing and Case Management

Hearing Checklist for Parents

Hearing Checklist for Parents (Spanish)

How to Determine Tuberculosis Risk

Mental Health Interview Tool/Referral Form

Ages 10-12 Years

Ages 13-20 Years

Mental Health Parent (Spanish)

Mental Health Parent Questionnaire

Ages 10-12 Years

Ages 10-12 Years (Spanish)

Ages 13-20 Years

Ages 3-9 Years (Spanish)

Ages Birth-2 Years

Ages Birth-2 Years (Spanish)

PPD Agreement for Texas Health Steps Providers

Tuberculosis Questionnaire

Tuberculosis Questionnaire (Spanish)

TVFC Patient Eligibility Screening Record

TVFC Patient Eligibility Screening Record (Spanish)

TVFC Provider Enrollment

TVFC Questions and Answers

hearing monitoring

exemption for schools and child-care facilities

exemption for schools and child-care facilities

general recommendations

recommended childhood schedule

immunizations overview

JCIH 2007 position statement

lead screening 1 2

prevention education and forms

newborn blood screening

newborn hearing screening 1 2

outpatient laboratory services

parental accompaniment

Quick Reference Guide 1 2

reporting abuse and neglect

state legislative requirements

screening and education tool

tuberculosis skin testing

TVFC versus non-TVFC vaccines/toxoids

Texas Health Steps (THSteps)

administrative information

assistance contacts

cervical cancer screening

claim form examples

THSteps medical checkup

diagnosis and treatment claim form example

client eligibility

Comprehensive Care Program (CCP)

claim filing resources

emergency dental referrals

routine dental referrals

exceptions-to-periodicity checkup

laboratory services

laboratory supplies

medical checkup

periodicity schedule, birth-20 years of age

medical home concept

required components of examination

periodicity schedules

provider enrollment

registered nurse

additional education requirements

newborn examination

required laboratory screening procedures

STAR Program enrollment

statutory requirements

statutory state requirements

Texas immunization registry

Texas Kidney Health Care Program

Texas Medicaid & Healthcare Partnership (TMHP)

Texas Medical Assistance Program (Medicaid)

Texas Medical Review Program (TMRP)

Texas Vaccines for Children (TVFC) Program

TexMedConnect 1 2

electronic billing

The Stewart McKinney Act

Therapeutic apheresis

Therapeutic phlebotomy 1 2

Therapists, independent practitioners and physicians

services benefits limitations and prior authorization

Therapy in a Nursing Facility

Third party reimbursement

Third Party Liability

Third party reimbursement

Third Party Resources (TPR)

110-day rule 1 2

accident-related claims

other insurance

claims forward to other insurance carriers

other insurance credits

filing deadlines 1 2

hearing services

third party billing agents

THSteps requirements

vendor implementation

Workers' Compensation

Title XIX Family Planning

Billing for non-family planning services during family planning visit

National Drug Code

services, limitations, prior authorization

intrauterine device

occlusive sterilization

drugs and supplies

reference labratory

specimen handling

medical counseling

outpatient visits

undocumented and legalized aliens

Titles V, X, XX

National Drug Code

Third-party resource

Title X Encounter

Provider enrollment

Services, Limitations, Prior Authorization

Intrauterine Device

Medroxyprogesterone Acetate/Estradiol Cypionate

Drugs and supplies

Natural family planning

Nutritional Therapy

Prior Authorization

Incomplete sterilization

resubmitting rejections

TMHP Provider Relations

Tooth identification (TID) number

Tort Response Form

Total Parenteral Nutrition (TPN) Solutions 1 2

documentation requirements

prior authorization

see Third party resources

Tracheostomy tubes

prior authorization

Tracheostomy Tubes

Transfers of client

Transportation services

School Health and Related Services (SHARS)

Travel restraints

Trigger point injections

How to Determine Tuberculosis Risk

screening and education tool

Tuberculosis clinic

ancillary services

benefits and limitations 1 2

claims filing 1 2

claim form example

claims resources

documentation requirements

prior authorization 1 2

provider responsibilities

reimbursement 1 2

Tuberculosis skin testing

Texas Health Steps

benefits and limitations

see Texas Vaccines for Children

TVFC requirements

TVFC versus non-TVFC vaccines/toxoids

Type of service (TOS) 1 2

claim form (paper) billing

electronic billing

instruction table

Undeliverable eyewear

Undocumented aliens

Utilization review

see Immunizations

Vaccine Adverse Event Reporting System (VAERS) 1 2

Vagal nerve stimulators

prior authorization

Vendor Drug Program (VDP)

72-hour emergency supply

cost avoidance COB

medically necessary drugs and supplies

Palivizumab (Synagis)

participating pharmacies

controlled substances

tamper-resistant prescription pads

Ventilator service agreement

documentation requirements

prior authorization

prior authorization

Verifying Prior Authorization Status

Vertical stander

Vestibuloplasty

claim form example

reimbursement 1 2

services performed in long- term care facilities

Vision services

corneal transplants

documentation requirements

noncovered services and supplies

services not reimbursed separately

Volume ventilators

prior authorization

Waiver Certificates

Waste, abuse, and fraud

Wearable cardiac defibrillator

Wedges and lifts

Wheelchair batteries

battery charger

prior authorization

Wheelchair ramp (portable and threshold)

prior authorization

Women, Infants, and Children (WIC)

Documentation requirements

Provider enrollment

Services, Limitations, Prior Authorization

Drugs and supplies

Natural family planning

Breast and cervical cancer clients

Breast and cervical cancer screenings

National Drug Code

third-party resource

Women's Health Program (WHP)

Workers' Compensation 1 2

prior authorization

procedures and limitations

documentation requirements

Next Index