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2012 Texas Medicaid Provider Procedures Manual

Volume 1, General Information : Section 6: Claims Filing : 6.18 Claims for Texas Medicaid and CSHCN Services Program Eligible Clients : 6.18.1 New Claim Submissions

6.18.1
New claims that are submitted for clients who are eligible for both Texas Medicaid and CSHCN Services Program benefits during the same eligibility period will be processed through the appropriate program and may result in a separate claim for each program. The Medicaid claim number and disposition will be listed under the “Claims – Paid or Denied” section of the Medicaid/Managed Care R&S Report. If the claim includes services that are not benefits of Texas Medicaid but are benefits of the CSHCN Services Program, a claim will be created with a unique claim number that will be listed under the “Claims – Paid or Denied” section of the CSHCN Services Program R&S Report.
Note:
If all of the services that are submitted on the claim are Texas Medicaid benefits, a CSHCN Services Program claim will not be created. Only a Texas Medicaid claim will be created, and the claim number will appear on the provider’s Medicaid/Managed Care R&S Report.

Texas Medicaid & Healthcare Partnership
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