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2012 Texas Medicaid Provider Procedures Manual

Gynecological and Reproductive Health and Family Planning Services Handbook : 5. Gynecological Health Services : 5.14 Claims Filing and Reimbursement

5.14 Claims Filing and Reimbursement
Gynecological services must be submitted to TMHP in an approved electronic format or on the CMS-1500 claim form. Providers may purchase CMS-1500 claim forms from the vendor of their choice. TMHP does not supply the forms. When completing a CMS-1500 claim form, all required information must be included on the claim, as TMHP does not key any information from claim attachments. Superbills, or itemized statements, are not accepted as claim supplements.
Refer to:
Section 3: TMHP Electronic Data Interchange (EDI) (Vol. 1, General Information) for information on electronic claims submissions.
Subsection 6.1, “Claims Information” in Section 6, “Claims Filing” (Vol. 1, General Information) for general information about claims filing.
Subsection 6.5, “CMS‑1500 Paper Claim Filing Instructions” in Section 6, “Claims Filing” (Vol. 1, General Information).
Texas Medicaid rates for physicians and certain other practitioners are calculated in accordance with TAC §355.8085. Providers can refer to the Online Fee Lookup OFL or the applicable fee schedule on the TMHP website at
Refer to:
Subsection, “Non-emergent and Non-urgent Evaluation and Management (E/M) Emergency Department Visits” in Section 2, “Texas Medicaid Fee-for-Service Reimbursement” (Vol. 1, General Information).
Section 104 of the Tax Equity and Fiscal Responsibility Act (TEFRA) of 1982 requires that Medicare and Medicaid limit reimbursement for those physician services furnished in outpatient hospital settings (e.g., clinics and emergency situations) that are ordinarily furnished in physician offices.

Texas Medicaid & Healthcare Partnership
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