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2012 Texas Medicaid Provider Procedures Manual

Volume 1, General Information : Section 6: Claims Filing : 6.4 Claims Filing Instructions

This section contains instructions for completion of Medicaid-required claim forms. When filing a claim, providers should review the instructions carefully and complete all requested information. A correctly completed claim form is processed faster.
This section provides a sample claim form and its corresponding instruction table for each acceptable Texas Medicaid claim form.
All providers, except those on prepayment review, should submit paper claims to TMHP to the following address:
Texas Medicaid & Healthcare Partnership
PO Box 200555
Austin, TX 78720‑0555
Providers on prepayment review must submit all paper claims and supporting medical record documentation to the following address:
Texas Medicaid & Healthcare Partnership
Attention: Prepayment Review MC–A11 SURS
P.O. Box 203638
Austin, TX 78720‑3638

Texas Medicaid & Healthcare Partnership
CPT only copyright 2011 American Medical Association. All rights reserved.