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2012 Texas Medicaid Provider Procedures Manual

Volume 1, General Information : Section 6: Claims Filing : 6.13 Medicare Claims : 6.13.4 Electronic Crossover Claims : Requirement for Group Billing Providers – Professional Claims
The performing provider NPI must be billed on the professional electronic claim if the billing provider is a group. Claims will be processed using the performing provider NPI that is submitted on the Medicare claim.
The claim will be denied if the performing provider NPI is missing, invalid, or is not a member of the billing provider’s group. Denied claims may be appealed on paper with the appropriate performing provider information.
The performing provider who is identified on the claim must be a member of the billing provider’s group. If the performing provider is not a member of the billing provider group, the detail line item will be denied.

Texas Medicaid & Healthcare Partnership
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