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2012 Texas Medicaid Provider Procedures Manual

Volume 1, General Information : Section 6: Claims Filing : 6.5 CMS‑1500 Paper Claim Filing Instructions : 6.5.2 CMS‑1500 Claim Form (Paper) Billing

CMS‑1500 Claim Form (Paper) Billing
Claims must contain the billing provider’s complete name, address, and a provider identifier. Claims without a provider name, address, and provider identifier cannot be processed. Each claim form must have the appropriate signatory evidence in the signature certification block.
When completing a CMS‑1500 paper claim form, all required information must be included on the claim in the appropriate block. Information is not keyed from attachments. Superbills or itemized statements are not accepted as claim supplements.

Texas Medicaid & Healthcare Partnership
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