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2012 Texas Medicaid Provider Procedures Manual

Index

A
AAPD periodicity guidelines
Abatacept (Orencia)
Abuse
DFPS Abuse Hotline
reporting
staff training
Accidents
see Third Party Resources (TPR)
ACD systems
accessories
items not covered
prior authorization
replacement
Acronym dictionary
Acute Care Inpatient
Additional Required Laboratory Tests Related to Medical Checkups for Adolescents 1, 2, 3, 4, 5, 6
Addresses
federal
state
TMHP
Administration With Counseling
Administration Without Counseling
Adoption agencies
Advance directives
Advanced practice registered nurse (APRN)
benefits and limitations
claims filing
resources
enrollment
Aerosol treatment 1, 2
AIS
see Automated inquiry system (AIS)
Allergy immunotherapy
Allergy services
Alveoloplasty
Ambulance
benefits
claims filing
appeals
claim form examples 1, 2, 3
origin and destination codes
place of service codes
disposable supplies
emergency transport
out-of-state
enrollment
extra attendant
emergency transport
nonemergency
limitations
Medicaid qualified Medicare beneficiary (MQMB)
Medicare denials
Medicare disposition
night calls
nonemergency transport
oxygen
prior authorization
nonemergency transport
retroactive eligibility
types, definitions
qualified Medicare beneficiary (QMB)
reimbursement 1, 2
subscription plans
time of death
transport multiple clients
transport types
transports
air or specialized vehicle 1, 2
emergency
hospital
no transport
nonemergency
not medically necessary
nursing facility
pregnancies
specialty care
to or from state institutions
waiting time
Ambulatory blood pressure monitoring
Ambulatory electroencephalogram (A/EEG)
Ambulatory surgical center (ASC)
benefits and limitations
brachytherapy
claim form example
claim form example (hospital-based)
claims filing
cochlear implants
colorectal cancer screening
dental services
documentation requirements
drugs and supplies
enrollment
fluocinolone acetonide
global services
implantable infusion pump
neurostimulators
planned admission
prior authorization 1, 2
reimbursement 1, 2
stereotactic radiosurgery
surgery
complications
incomplete procedures
Amifostine
Anemia Screening
Anesthesia
administered by surgeon
claims filing
claim form example
complicated
CRNA
dental 1, 2
for labor and delivery
modifiers
multiple procedures 1, 2
pain management
physician services
provided by the surgeon
reimbursement
medical direction
monitored anesthesia care
prior authorization requirements
reimbursement methodology
Antibiotics and steroids
Antihemophilic factor
Appeals
administrative
120-day appeal deadline exception
24-month payment deadline exception
95-day filing deadline exception
deadline exception requirements
deadline exceptions
standard
ambulance
automated inquiry system (AIS)
disallowed
guide
Business Records Affidavit Form
cost report settlements
deadlines
electronic
disallowed
electronic data interchange (EDI) rejections
inpatient hospital
medical necessity
Medicare crossovers
methods
paper
DRG adjustment
medical necessity denials
other insurance denial
submitted incorrectly
utilization review
admissions
continued stay denials
cost/day outlier denials
DRG revisions
final technical denials
Audiology
see Hearing services
Auditing of claims
Authorization requirements
electrodiagnostic (EDX) testing
Automated Inquiry System
Automated inquiry system (AIS)
appeals
disallowed appeals
guide
B
Bacillus Calmette-Guérin (BCG)
for treatment of bladder cancer
Bariatric surgery
prior authorization requirements
Bathroom equipment
documentation requirements
hand-held shower wand
payable procedure codes
prior authorization
Behavioral health
claims filing
court-ordered and DFPS-directed services
electroconvulsive therapy (ECT)
family therapy/counseling services
forms
Ambulatory (Outpatient) Substance Abuse Counseling Extension Request Form
Outpatient Psychotherapy/Counseling Request Form
Psychological/Neuropsychological Testing Request Form
inpatient services
consultations
discharge
documentation
prior authorization
psychological and neuropsychological testing services
mental health (MH) mental retardation (MR)
benefits and limitations
billing units
claims filing
documentation requirements
enrollment
mental health rehabilitation
rehabilitative services limitations
service coordination contact codes
narcosynthesis
non-covered services
outpatient services
annual encounter/visit limitations
prior authorization
pharmacological management services
claims filing
documentation requirements
indications for
prior authorization
pharmacological regimen oversight
claims filing
documentation
indications for
prior authorization
psychiatric diagnostic interviews
claims filing
documentation requirements
domains of a clinical evaluation
prior authorization
psychological and neuropsychological testing
documentation requirements
prior authorization
reimbursement
psychotherapy/counseling
documentation requirements
initial outpatient
insight oriented behavior modification
prior authorization
subsequent outpatient
supportive outpatient
screening, brief intervention, and referral to treatment (SBIRT)
benefits and limitations
brief intervention
brief treatment
claims filing
documentation requirements
referral to treatment
screening
see also Licensed clinical social worker (LCSW)
see also Licensed marriage and family therapist (LMFT)
see also Licensed professional counselor (LPC)
see also Licensed psychological associate (LPA)
see also Physician
see also Psychologist
substance use disorder (SUD) services
assessment
documentation requirements
medication assisted therapy (MAT)
non-covered services
prior authorization
Benefit code
prior authorization
Benefit codes
claims filing
Benefits and limitations
birthing centers
home health services (DME)
Bilevel positive airway pressure system
BiPAP S
prior authorization
BiPAP ST
prior authorization
with backup (such as BiPAP ST)
without backup (such as BiPAP S)
Billing clients
Medicaid spend down
Biologicals
reimbursement
Birthing center
claims filing
Claims filing
birthing centers
documentation requirements
newborn eligibility process
newborn hearing screening
prior authorization
provider enrollment
reimbursement
services
benefits and limitations
Blepharoplasty procedures
Blind Children’s Vocational Discovery and Development Program (BCVDDP)
behavioral health
claim form example
claims filing
documentation requirements
enrollment
reimbursement
Blood counts
Blood pressure devices 1, 2
prior authorization
Bone marrow aspiration
Botulinum toxin type A
Brachytherapy, radiation therapy
Breast cancer
Medicaid for breast and cervical cancer (MBCC)
Breast cancer screening
mammography
prognostic breast cancer studies
Breast imaging studies
Breast pumps
prior authorization
Breast reconstruction
C
Cancer
bladder cancer, Bacillus Calmette-Guérin (BCG) for treatment
breast cancer screening
mammography
chemotherapy
colorectal cancer screening
colonoscopies 1, 2
sigmoidoscopies
Prognostic breast and gynecological cancer studies
Cardiac blood pool imaging 1, 2
Cardiac nuclear imaging
Cardiopulmonary resuscitation (CPR)
Case Management for Children and Pregnant Women (CPW)
assistance with program concerns
behavioral health
benefits and limitations
claim form example
claims filing
documentation requirements
eligibility
enrollment
prior authorization
referral process
reimbursement
technical assistance
Catheters, implantation
CCP
see Comprehensive Care Program
Certified nurse-midwife (CNM)
claim form example
reimbursement
Certified registered nurse anesthetist (CRNA)
benefits and limitations
claims filing 1, 2
claim form example
enrollment 1, 2
interpreting the R&S report
reimbursement 1, 2
Certified respiratory care practitioner (CRCP)
benefits and limitations
claim form example
claims filing
documentation requirements
enrollment
prior authorization
reimbursement 1, 2
Cervical cancer
Medicaid for breast and cervical cancer (MBCC)
Change of ownership
Chelating agents
deferoxamine mesylate (Desferal)
dimercaprol
edetate calcium disodium
edetate disodium
Chemical dependency
reimbursement
Chemical dependency treatment facility (CDTF)
enrollment
reimbursement
Chemotherapy
procedure codes
Chemotherapy Administration
Chest physiotherapy devices
Chest X-rays
Child abuse
Child Abuse Reporting Guidelines
Child Abuse Reporting Guidelines, Checklist for HHSC Monitoring
reporting
reporting sexual abuse
Children with Special Health Care Needs (CSHCN) Services Program
TPR
Children’s hospitals
Children's Health Insurance Program (CHIP) Perinatal Coverage
CHIP benefits
CHIP perinatal program
claim filing
newborn transfer claims
CHIP perinatal services
Chiropractic services
benefits and limitations
claims filing
claim form example
enrollment
reimbursement 1, 2
Circumcisions
Claim form examples
lodging provider
meals provider
Claims filing 1, 2
2010 filing deadlines
2011 filing deadlines
95-day filing deadline exceptions
addresses
ambulance
ambulatory surgical center (ASC)
appeal deadlines
attachments
auditing of claims
behavioral health
benefit code
benefit codes
blank sample UB-04 CMS-1450
Blind Children’s Vocational Discovery and Development Program (BCVDDP)
Case Management for Children and Pregnant Women (CPW)
certified respiratory care practitioner (CRCP)
CHIP perinatal
CHIP perinatal newborn transfer claims
claim form example
certified respiratory care practitioner (CRCP)
physical therapy (PT)
skilled nursing visit 1, 2
claim form examples
ambulance 1, 2, 3
Ambulatory surgical center (ASC)
Comprehensive Outpatient Rehabilitation Facility (CORF) (CCP Only)
Diagnosis and Treatment (Referral from THSteps Checkup)
Durable Medical Equipment (CCP Only)
Early Childhood Therapy
Early Childhood Intervention (CCP Only)
Family Planning Services for Hospitals, FQHCs
FQHC Encounter (T1015)
FQHC Follow-Up
independent laboratory
Inpatient Rehabilitation Hospital (CCP Only)
medical nutritional counseling (CCP only)
office visit with lab and radiology
Orthotic and Prosthetic Services (CCP Only)
physical therapy (PT) (CCP Only)
portable X-ray supplier
Private Duty Nurses (CCP Only)
radiological and physiological laboratory
renal dialysis facility CAPD Training
renal dialysis facility CAPD/CCPD
renal dialysis facility CMS-1500
rural health clinic (RHC) (immunization)
rural health clinic (RHC) hospital-based
rural health clinic freestanding
School Health and Related Services (SHARS)
Speech-Language Pathologists (CCP Only)
THSteps Established Patient and Referral, Immunizations with Counseling, and by a Physician
THSteps Established Patient and Referral, TB Skin Test, and Physical Examination by a Physician
THSteps New Patient/Immunization, Physical Examination by a Nurse Practitioner, and FQHC Billing (medical checkup)
tuberculosis
claim form requirements
clients with a designated provider
CMS-1500 instruction table
CMS-1500 instructions
coding
type of service (TOS)
Crossover Claim Type 30 TMHP Standardized MRAN Form
Crossover Claim Type 30 TMHP Standardized MRAN Form instructions
Crossover Claim Type 31 TMHP Standardized MRAN form
Crossover Claim Type 31TMHP Standardized MRAN form
Crossover Claim Type 50 TMHP Standardized MRAN form 1, 2
deadlines 1, 2
delegation of signature authority
dental claim form instruction table
dental claims
diagnosis coding
durable medical equipment (DME)
electronic
batch numbers
claim acceptance
CMS-1500
dental claims
family planning claims
forms
provider check amounts
rejections
submission
submitter ID
TexMedConnect
third-party billing agents
third-party software
training
UB-04 CMS-1450
expediting paper claims
family planning
Title XIX
Titles V, X, XX
Family Planning 2017 Claim Form instruction table
federally qualified health center (FQHC)
fiscal agent
general information
genetics
group providers
gynecological services
hearing devices
hearing services
HHSC payment deadline
holidays extending deadlines
home health services 1, 2
hospice clients
hospice lab and X-ray
hospital-based ambulatory surgical center (HASC)
instructions 1, 2
ITP
Julian dates
laboratory
independent
radiological and physiological
licensed clinical social worker (LCSW)
licensed marriage and family therapist (LMFT)
licensed professional counselor (LPC)
lodging provider
managed care organization (MCO) copayments
meals provider
Medically Needy Program (MNP)
Medicare primary paper
mental health (MH) mental retardation (MR)
modifier requirements
anesthesia
assistant surgery
interpretations
technical components
modifiers
multipage claim forms
national drug code (NDC)
newborn claim hints
newborns
occupational therapy (OT) 1, 2
occurrence codes
other insurance
other insurance credits
other insurance deductibiles
other insurance verbal denial
patient status codes
payment error rate measurement (PERM)
pharmacological management services
pharmacological regimen oversight
physical therapy (PT) 1, 2
place of service (POS) coding
portable X-ray supplier
preferred provider organization (PPO)
prior authorization number (PAN)
procedure code levels
procedure coding
processing procedures
provider designations
provider signatures
rate hearings
reminders
Remittance and Status (R&S) Report
renal dialysis facility
retroactive client eligibility
rural health clinic (RHC)
sample blank CMS-1500
sample blank Family Planning 2017 Claim Form
sample dental claim form
screening, brief intervention, and referral to treatment (SBIRT)
speech therapy (ST)
STAR Health Program
mental health rehabilitation
taxonomy codes
third party resources (TPR)
110-day rule
filing deadlines
forwarded other insurance claims
tips for outpatient claims
tuberculosis clinic
UB-04 CMS-1450 instruction table
UB-04 CMS-1450 instructions
vision claim form
vision services
Women’s Health Program (WHP)
zero paid claims appeals
Claims filing instructions
home health services
Claims Resources
Client eligibility
add date
CHIP perinatal program
verification
deceased individuals
dual eligibility
emergency
expedited
foster care
long term care
Medicaid Buy-In (MBI) Program
Medicaid for breast and cervical cancer (MBCC)
Medicaid limited program 1, 2
duration
Medicaid qualified Medicare beneficiary (MQMB)
Medicare Part B Crossovers
Medicare/Medicaid
clients without QMB, MQMB status
contract with outside parties
newborns
presumptive
process
qualified Medicare beneficiary (QMB)
renal dialysis facility
restricted Medicaid coverage
retroactive
verification
by phone
electronic 1, 2
mailed list
Medicaid ID 1, 2
Women’s Health Program (WHP)
Clinical nurse specialist (CNS)
benefits and limitations
claims filing
resources
enrollment 1, 2
reimbursement 1, 2
Clinical pathology consultations
Clinical records
Clinician-directed care coordination services
Comprehensive Care Program (CCP)
Clofarabine
CMS-1500 instruction table
CNS
see Clinical nurse specialist (CNS)
Cochlear implants 1, 2, 3
Coding
CDT 1, 2, 3
Colony stimulating factors
filgrastim
pegfilgrastim
sargramostim
Colorectal cancer
genetic testing
prior authorization
screening
Colorectal Cancer
Colorectal cancer screening
colonoscopies 1, 2
genetic testing
sigmoidoscopies
Communicable disease reporting
Communicable Disease Reporting
Community and Migrant Health Center Affiliation Affidavit
Complaints
fee-for-service providers
managed care
PCCM providers
policy
process
Complete blood count (CBC) 1, 2
Comprehensive Care Program (CCP) 1, 2
benefits and limitations
client eligibility
clinician-directed care coordination services
claims information
documentation requirements
medical home clinician telephone consult with specialist
specialist/subspecialist telephone consult with medical home clinician
face-to-face services
medically complex health care
multidisciplinary health care
non-face-to-face services
care plan oversight
clinician supervision of a home health client
clinician supervision of a hospice client
general requirements
medical conferences
medical team conference
other supervision
prolonged services
supervision of a nursing facility client
telephone consultation
prior authorization
reimbursement
clinician-directed care coordination services (CCP)
benefits and limitations
clinician-directed coordination services
face-to-face services
general requirements
comprehensive outpatient rehabilitation facility (CORF)
Diabetic Equipment and Supplies 1, 2
Prior Authorization and Documentation Requirements
Purchase of Tubeless External Insulin Pump
Tubeless External Insulin Pump Rentals
diagnosis coding
documentation requirements
drug and medical device approval
Durable Medical Equipment (DME Supplier
Mobility Aids
Feeder Seats, Floor Sitters, Corner Chairs, and Travel Chairs
Fitting of Custom Wheeled Mobility Systems
Portable Client Lifts for Outside the Home Setting
Prior Authorization and Documentation
Portable Client Lifts for Outside the Home Setting
Seating Assessments
Special-Needs Car Seats
Stroller Ramps-Portable and Threshold
Wheeled Mobility System
Prior Authorization and Documentation Requirements
Seating Assessment
Services/Benefits and Limitations
Special-Needs Car Seats
Stroller Ramps-Portable and Threshold
Travel Safety Restraints
Wheeled Mobility Systems
durable medical equipment (DME)
accessories
benefits and limitations
Blood Pressure Device Components, Replacements, and Repairs
cardiorespiratory apnea monitor
benefits and limitations
documentation requirements
prior authorization
claims information
cribs
croup tent
benefits and limitations
documentation requirements
prior authorization
DME certification and receipt form
documentation requirements
donor human milk
benefits and limitations
documentation requirements
prior authorization
electronic blood pressure monitoring device
enrollment
equipment
equipment adjustments
equipment modification
equipment repairs
hospital beds
hospital beds and safety enclosure
hospital beds, cribs, and equipment
benefits and limitations
documentation
positioning devices
prior authorization
repair or replacement
Hospital-Grade Blood Pressure Devices
incontinence supplies
benefits and limitations
documentation requirements
prior authorization
in-home total parental nutrition (TPN)
prior authorization and documentation
Manual and Automated Blood Pressure Devices
nutritional products
documentation
noncovered services
prior authorization
women, infants and children program (WIC)
pharmacies
phototherapy devices
benefits and limitations
documentation requirements
prior authorization
retroactive eligibility
policies specific to CCP
prior authorization
pulse oximeter
benefits and limitations
documentation requirements
prior authorization
purchase vs. rental
reimbursement
special needs car seats
benefits and limitations
documentation requirements
prior authorization
travel restraints
benefits and limitations
documentation requirements
prior authorization
Vitamin and Mineral Products 1, 2, 3
durable medical equipment (DME) supplier
blood pressure devices
prior authorization and documentation
croup tent/pulse oximeter
documentation
prior authorization
documentation of supply delivery
in-home total parental nutrition (TRN)
enrollment
inpatient rehabilitation hospital (freestanding)
benefits and limitations
claims information
comprehensive treatment
documentation requirements
enrollment
continuity of eligibility through change of ownership
prior authorization
reimbursement
client transfers
medical nutrition counseling services
benefits and limitations
claims information
enrollment
reimbursement
nutritional products
enteral feeding pumps
prior authorization
enteral supplies
prior authorization
nasogastric, gastrostomy, or jejunostomy feeding tube
prior authorization
Services/Benefits and Limitation
occupational therapy (OT)
benefits and limitations
claims information
documentation requirements
enrollment
prior authorization
reimbursement
orthotic and prosthetic services
claims information
orthotics services
benefits and limitations
documentation
foot orthoses
foot inserts
orthopedic shoes
wedges and lifts
lower-limb orthoses
noncovered orthotic services
other orthopedic devices
dynamic splints
protective helmets
prior authorization
related services
modifications
repairs
replacements
spinal orthoses
upper-limb orthoses
prosthetic services
benefits and limitations
craniofacial prostheses
documentation
external breast prostheses
lower-limb prostheses
ankle prosthesis
foot prostheses
knee prostheses
microprocessor-controlled
sockets
substitutions or additions
noncovered prosthetic services
prior authorization
related services
accessories
modifications
repairs
replacements
upper-limb prostheses
myoelectric
reimbursement
orthotics and prosthetics
cranial molding orthotics
benefits and limitations
documentation requirements
prior authorization
enrollment
thoracic-hip-knee-ankle orthoses (THKAO)
benefits and limitations
documentation requirements
parapodium
benefits and limitations
prior authorization
standing frame/brace
benefits and limitations
vertical stander
benefits and limitations
outpatient rehabilitation facility (ORF)
personal care services (PCS)
benefits and limitations
claims information
client eligibility
accessing the PCS benefit
primary practioner’s role
documentation requirements
enrollment
place of service
prior authorization
provided in group settings
provider responsibilities
reimbursement
retrospective review
physical therapy (PT)
benefits and limitations
claims information
documentation requirements
enrollment
prior authorization
reimbursement
physician signature
prior authorization
private duty nursing
authorization appeals
authorization for revision of current services
benefits and limitations
CCP Prior Authorization Request Form
claims information
client/provider notification
criteria
amount and duration of PDN
client eligibility
medical necessity
place of service
documentation requirements
enrollment
home health plan of care
Nursing Addendum to Plan of Care (CCP) Form
prior authorization
initial requests
recertifications of authorizations
reimbursement
responsible adult or identified contingency plan requirement
retroactive client eligibility
retrospective review
skilled nursing visit
TPN administration education
start of care (SOC)
termination of authorization
School Health and Related Services (SHARS)
appealing denied claims
audiology
benefits, limitations, and prior authorization
billing
billing units based on 15 minutes
billing units based on an hour
claims filing
counseling services
billing
documentation requirements
eligibility verification
enrollment
nonschool SHARS enrollment
nursing services
billing
occupational therapy (OT)
overview
personal care services (PCS)
physical therapy (PT)
billing
physician services
prior authorization
private school enrollment
psychological services
psychological testing
record retention
reimbursement
speech therapy (ST)
description of services
provider and supervision requirements
referral
transportation services
speech therapy (ST)
benefits and limitations
claims information
documentation requirements
enrollment
prior authorization
reimbursement
texas health steps (THSteps)
dental
eligibility
texas health steps (THSteps) dental
change of provider
client rights
complaints and resolution
dental therapy under general anesthesia
therapy services
Comprehensive Health and Development History
Comprehensive Health and Developmental History 1, 2, 3, 4
Comprehensive health center (CHC)
Comprehensive outpatient rehabilitation facility (CORF)
Comprehensive Unclothed Physical Examination 1, 2, 3, 4, 5
Computer-aided detection (CAD)
Contact Center
TMHP
Contact information
federal
state
Contact TMHP
Contacting MTP
Continuous glucose monitoring (CGM)
prior authorization requirements
Continuous passive motion device
prior authorization
Continuous positive airway pressure (CPAP)
Cost report settlements
appeals
Cost reporting
hospital
CPAP
prior authorization
prior authorization renewal
Crime Victims’ Compensation Program
Croup tent
Cytogam
Cytogenetics testing for leukemia and lymphoma
Cytopathology studies other than gynecological
D
Darbepoetin alfa
Deferoxamine mesylate (Desferal)
Delegation of signature authority
Dental
adjunctive general services
anesthesia 1, 2
criteria 1, 2
client eligibility
dentures
diagnostic services
doctor of dentistry practicing as a limited physician
emergency services
clients over 21 1, 2
fee schedule
first dental home
handicapping labiolingual deviation (HLD)
HLD score sheet 1, 2
hospitalization
ICF-MR dental services
provisions
informed consent
mandatory prior authorization
oral/maxillofacial surgery
orthodontic procedure codes
orthodontic services
comprehensive treatment
mandatory prior authorization
special orthodontic appliances
transfer of services
treatment plans
periodicity
periodontal services
preventive services
prophylaxis
prosthodontics, removable
radiographs
referrals
reimbursement 1, 2
restorations
services
space maintenance (passive appliance)
supernumerary tooth identification
tests and examinations
Texas Health Steps (THSteps) guidelines
therapeutic services
third party resources
THSteps dental services 1, 2, 3, 4
provisions
TMHP information and assistance
tooth identification (TID) and surface identification (SID)
treatment plans
utilization review
Dental Referral
Dentist (Doctor of Dentistry)
Dentures
Department of Assistive and Rehabilitative Services
Department of Assistive and Rehabilitative Services (DARS), Blind Services
Developmental Surveillance or Screening
Diabetes
Diagnostic tests
Dialysis 1, 2
claim form example
Dimercaprol
Direct supervision
Division for Blind Services
DME benefits for Medicare/Medicaid clients
DME home health services
augmentative communication device (ACD) system
benefits limitations prior authorization
prior authorization
supply procedure codes
DME medical supplier
cancellation
Doctor of dentistry
claims filing
claim form example
limited physician
diagnosis codes
mandatory prior authorization
Document retention
prior authorization
Documentation requirements
birthing centers
Donor human milk
Drugs
reimbursement
Dual eligibility
see Client eligibility
Durable medical equipment (DME)
bath and bathroom equipment
blood pressure devices 1, 2
Breast pumps
claims filing
claim form example (CCP)
cochlear implants
continuous passive motion device
reimbursement
E
Early Childhood Intervention (ECI)
claim form example
claim form example (CCP only)
referral
referrals
reimbursement
statutory requirements
Early Childhood Therapy
claim form example
Echoencephalography
ECT
see Electroconvulsive therapy (ECT)
Edetate calcium disodium
Edetate disodium
EDI
see Electronic data interchange (EDI) 1, 2
EDX testing
see electrodiagnostic (EDX) testing
EFT
see Electronic funds transfer (EFT)
Electrical percussor
prior authorization
Electrocardiogram (ECG)
Electroconvulsive therapy (ECT)
Electrodiagnostic (EDX) testing 1, 2
authorization requirements
electromyography (EMG)
maximum number of studies
nerve conduction studies (NCS)
reimbursement
Electromyography (EMG)
electrodiagnostic (EDX) testing
Electronic blood pressure monitoring device
Electronic claims
Electronic data interchange (EDI) 1, 2
automated maintenance process
batch numbers
claim acceptance files
claim submission
claims filing options
electronic services
electronic transmission reports
file rejections
forms
Claim Status Inquiry (CSI) Authorization Form
Electronic Remittance and Status (ER&S) Agreement
newborn claims
provider check amounts
submitter ID
supported file types
TexMedConnect
third-party billing agents
third-party software
third-party vendor implementation
training
Electronic funds transfer (EFT)
advantages
Electronic Funds Transfer (EFT) Authorization form
enrollment procedures
Electronic Remittance and Status (ER&S) Reports
see Remittance and Status (R&S) Reports
Eligibility
see Client eligibility
Emergency Department Services
Emergency Medical Treatment and Active Labor Act
EMTALA
Endodontics 1, 2
Enrollment
see Provider enrollment 1, 2, 3, 4, 5, 6, 7, 8, 9
Epidural, implantable infusion pumps
Epoetin alfa (EPO)
EPSDT
see also Texas Health Steps (THSteps)
Esophageal pH probe monitoring
Experimental or Investigational Services
Extracorporeal membrane oxygenation (ECMO)
F
Fair hearings
managed care
Family planning
claim form example
family planning services
nurse practitioner/clinical nurse specialist
forms
Sterilization Consent Form 1, 2
Overview
Title V
natural family planning
Title XIX
annual exams
FQHC claims filing
benefits and limitations
contraceptives
capsules
external
intrauterine device
drugs and supplies
injections
prescriptions
guidelines
laboratory procedures
CLIA requirements
documentation requirements
reference laboratory
specimen handling
medical counseling
non-family planning services during visit
outpatient visits
claims filing
radiology services
Title XX
natural family planning
see also Family planning, Titles V, X, XX
wrap-around services
Titles V, X, XX
annual exams
FQHC reimbursement
benefits and limitations
claims filing
deadlines
contraceptives
capsules
external
intrauterine device
medroxyprogesterone acetate/estradiol cypionate
documentation requirements
drugs and supplies
education
enrollment
medical nutrition Therapy
outpatient services
FQHC reimbursement
prescriptions
radiology
sterilization
consent
incomplete sterilization
tubal ligation
vasectomy
third party liability
Family planning services
physician services
reimbursement
Federal financial participation (FFP)
reimbursement
Federally qualified health center (FQHC)
after-hours care
benefits and limitations 1, 2
claim form example 1, 2, 3
claims filing
cost reporting
crossover claims
documentation requirements
enrollment
managed care referral
prior authorization
reimbursement
Fee schedules
dental
orthodontic
Filgrastim
Fluocinolone acetonide
Form H1027-A
see Medicaid ID
Form H1027-B
see Medicaid ID
Form H1027-C
see Medicaid ID
Form H1027-F
see Medicaid ID
Forms
Abortion Certification Statements Form 1, 2
Ambulatory (Outpatient) Substance Abuse Counseling Extension Request Form
Authorization for Use and Release of Health Information
Authorization to Release Confidential Information
Business Records Affidavit Form
CCP
ECI Request for Outpatient Therapy
Prior Authorization Request for Non-Face-to-Face Clinician-Directed Care Coordination Services
Prior Authorization Request Form
Private Duty Nursing 6 Month Authorization
Child Abuse Reporting Guidelines
Child Abuse Reporting Guidelines, Checklist for HHSC Monitoring
Claim Status Inquiry (CSI) Authorization Form
Crossover Claim Type 30 TMHP Standardized MRAN Form
Crossover Claim Type 30 TMHP Standardized MRAN Form instructions
Crossover Claim Type 31 TMHP Standardized MRAN form 1, 2
Crossover Claim Type 50 TMHP Standardized MRAN form 1, 2
DME Certification and Receipt Form 1, 2, 3
Donor Human Milk Request Form
Electronic Funds Transfer (EFT) Authorization form
Electronic Remittance and Status (ER&S) Agreement
External Insulin Pump 1, 2
Family Planning 2017 Claim Form
Hearing Evaluation, Fitting, and Dispensing Report (Form 3503)
Home Health
Addendum to Home Health Services (Title XIX) DME/Medical Supplies Physician Order Form
Home Health Services (Title XIX) DME/Medical Supplies Physician Order Form
Home Health Services (Title XIX) DME/Medical Supplies Physician Order Form Instructions
Home Health Services Plan of Care (POC) 1, 2
Plan of Care
Prior Authorization Checklist 1, 2
Home Health Plan of Care
Home Health Services (Title XIX) DME/Medical Supplies Physician Order Form
Home Health Services Plan of Care (POC) 1, 2
Hospital Report (Form 7484) 1, 2
Hysterectomy Acknowledgement Form
Hysterectomy Acknowledgment Form 1, 2
Informational Claims Submission Form
Medicaid Certificate of Medical Necessity for Chest Physiotherapy Devices
Extended Request
Initial Request
Medicaid Certificate of Medical Necessity for CPAP/BiPAP or Oxygen Therapy
Medicaid Certificate of Medical Necessity for Reduction Mammaplasty
Newborn Child or Children Report (Form 7484)
Nonemergency Ambulance Prior Authorization Request 1, 2
Nonemergency Ambulance Prior Authorization Request Form
Nursing Addendum to Plan of Care
Other Insurance Form
Outpatient Psychotherapy/Counseling Request Form
Physician’s Examination Report
Private Pay Agreement
Provider Information Change (PIC) Form
Psychological/Neuropsychological Testing Request Form
Pulse Oximeter Form 1, 2
Radiology Prior Authorization Request Form 1, 2
Request for Extension of Outpatient Therapy (Form TP-2)
Request for Initial Outpatient Therapy (Form TP-1)
Special Medicaid Prior Authorization (SMPA) Request Form
Statement for Initial Wound Therapy System In-Home Use
Sterilization Consent Form 1, 2, 3
instructions
Instructions
Spanish 1, 2
Texas Health Steps
Dental Criteria for Dental Therapy Under General Anesthesia 1, 2
Dental Mandatory Prior Authorization Request 1, 2, 3, 4
laboratory
Referral Form
Referral Form Instructions
Specialist or Subspecialist Telephone Consultation Form for Non-Face-to-Face Clinician-Directed Care Coordination Services-Comprehensive Care Program (CCP)
Texas Health Steps (THSteps)
claim forms
TVFC Patient Eligibility Screening Record
TVFC Patient Eligibility Screening Record (Spanish)
TVFC Provider Enrollment
TVFC Questions and Answers
Texas Medicaid Refund Information Form
THSteps
Dental Mandatory Prior Authorization Request
Tort Response Form
Ventilator Service Agreement
Vision Care Eyeglass Patient Certification Form
Wheelchair Seating Assessment Form 1, 2
Wound Therapy System In-Home Use
Recertification
G
Gamma globulin/immune globulin
general information
Genetic testing
colorectal cancer screening
Genetics
claims filing
claim form example
genetic evaluation and counseling
reimbursement 1, 2
Gonorrhea and Chlamydia Infection Testing
Group clinical visits
asthma
diabetes
physician
Gynecological services
abortions
prior authorization
anesthesia
assays for vaginitis
benefits and limitations
claims filing
documentation requirements
endometrial cryoablation
hysterectomy
hysterectomy acknowledgment form
hysteroscopy
Pap smear
salpingostomy
prior authorization
surgery for masculinized females
uterine suspension
H
Health Education and Anticipatory Guidance
Health Insurance Premium Payment (HIPP) Program
managed care not an option
Hearing aids and audiometric evaluations
reimbursement
Hearing devices
auditory brainstem implant (ABI)
limitations
prior authorization
benefits and limitations
bone-anchored hearing aid (BAHA)
limitations
prior authorization
claim form example
claims filing
cochlear implants 1, 2
limitations
prior authorization
speech therapy
documentation requirements 1, 2, 3, 4
implantable
benefits and limitations
limitations 1, 2
nonimplantable 1, 2
prior authorization
reimbursement
related services
see also Hearing services
sound processor
limitations
prior authorization
third party liability
Hearing screening
early hearing detection and intervention
Hearing Screening
Hearing services
benefits and limitations
claim form example
claims filing
documentation requirements 1, 2
enrollment
evaluation and diagnostic services
forms
Hearing Evaluation, Fitting, and Dispensing Report (Form 3503)
hearing screening
abnormal results
additional
routine
inpatient facilities
limitations
noncovered
reimbursement
school districts
School Health and Related Services (SHARS) 1, 2, 3
see also Hearing devices
state agencies
third party liability (TPL)
Heart transplants
Helicobacter pylori (H. pylori)
Hematopoietic agents
Hematopoietic injections
HFCWCS
documentation requirements
High-volume providers
reimbursement
HIV Testing
HIV/AIDS
HIV testing
CDC recommendations for testing
pregnant women
state agencies
testing procedure codes
where to go for help
workplace guidelines
ability to work
accommodation
assistance
confidentiality and privacy
coworker concerns
development
discrimination
employee education
employment rights
governance
performance standards
Home health (DME)
reimbursement
Home health services
benefit period 1, 2
benefits and limitations
catheters
certification
change of address/telephone number
claim form example
DME/medical supplies
physical therapy (PT)
skilled nursing visit
claims filing
occupational therapy (OT)
physical therapy (PT)
claims information
benefit code
client eligibility
client evaluation
DME modifications, adjustments, and repairs
documentation requirements
durable medical equipment (DME)
enrollment
nursing and therapy
exclusions
forms
Home Health Services (Title XIX) DME/Medical Supplies Physician Order Form
Home Health Services Plan of Care (POC) 1, 2
Home Health Services Prior Authorization Checklist
group 1 support surfaces
group 2 support surfaces
group 3 support surfaces
home health aide (HHA)
assessments
prior authorization requirements
services not prior authorized
visits
hospital beds and equipment procedure code
incontinence supplies
intravenous (IV) therapy equipment and supplies
limitations
medical supplies
medication administration limitations
mobility aids
mobility aids that are not a benefit
nursing and therapy
nutritional (enteral) products, supplies, and equipment
occupational therapy (OT)
limitations
prior authorization
procedure codes
pending agency certification
physical therapy (PT)
limitations
prior authorization
procedure codes
plan of care (POC)
possible Medicare clients
prior authorization 1, 2
prior authorization cancellation
professional nursing
prohibition of Medicaid payment 1, 2
provider information changes
reimbursement 1, 2
respiratory equipment and supplies
procedure codes and limitations
skilled nurse (SN)
assessments
care
prior authorization requirements
services
services not prior authorized
visits
skilled nursing visit
claim form example
supervision of home health aides (HHA)
supplies submitted with a plan of care
vocational nursing
Home mechanical ventilation equipment
Home oxygen therapy
documentation requirements
Home phototherapy
Hospice Program
claims filing
Medicaid ID
Medicaid services unrelated to terminal illness
physician oversight services
Hospital
claims filing
client transfer
cost reporting
general information
inpatient claim form example
inpatient reimbursement
observation to inpatient admission
outliers
outpatient claims information
outpatient reimbursement
reimbursement
revenue codes (outpatient)
services
aerosol treatment
contraction stress testing
fetal nonstress testing
hyperbaric oxygen therapy
pentamidine aerosol
pulmonary function studies
radiation therapy
submission of birth information to TVSU
teaching hospitals
third party liability reporting 1, 2
Hospital visits
physician services
Hospital-based ambulatory surgical center (HASC)
benefits and limitations
brachytherapy
claims filing
cochlear implants
colorectal cancer screening
documentation requirements
drugs and supplies
enrollment
fluocinolone acetonide
global services
implantable infusion pump
neurostimulators
planned admission
prior authorization 1, 2
reimbursement
stereotactic radiosurgery
surgery
complications
incomplete procedures
HSteps
Services/Benefits, Limitations, and Prior Authorization
Mandated Components 1, 2, 3
Human donor milk
Humidification Units
Hyperbaric oxygen therapy (HBOT), physician services
Hyperlipidemia
Hysterectomy Acknowledgment Form
Hysterectomy Services
I
ICN
see Internal control number (ICN)
Ilizarov device, physician services
ImmTrac 1, 2
how to report records
Immune globulin (Cytogam)
Immunizations 1, 2, 3, 4
administrations and immunizations
exemption for schools and child-care facilities
free vaccines
general recommendations
how to report records
physician services
recommended childhood schedule
requirements for TVFC
Texas Health Steps
TVFC requirements
Vaccine Adverse Event Reporting System (VAERS)
Texas Health Steps (THSteps)
Implantable fusion pump
Implantable infusion pumps
Important Codes for All MTP providers
Incontinence
procedure codes with limitations
supplies
documentation requirements
prior authorization
Independent laboratory
reimbursement
Independent practitioners
reimbursement
Indian Health Services
reimbursement
Individual transportation provider (ITP)
claims filing
enrollment
prior authorization
In-home total parenteral nutrition
reimbursement
Injection port
prior authorization
Injections
abatacept (Orencia)
allergy
amifostine
antibiotics and steroids
antihemophilic factor
botulinum toxin type A
chelating agents
dimercaprol
edeferoxamine mesylate (Desferal)
edetate calcium disodium
edetate disodium
clofarabine
family planning
filgrastim
gamma globulin/immune globulin
hematopoietic agents
darbepoetin alfa
epoetin alfa (EPO)
implantable infusion pumps
interferon
joint and trigger point
leuprolide acetate (Lupron Depot)
maternal serum alpha-fetoprotein
omalizumab
paclitaxel
pegfilgrastim
sargramostim
trastuzumab
Inpatient Hospital
Inpatient Psychiatric Services
Inpatient Rehabilitation Services
Inpatient Utilization Review
Interferon
Internal control number (ICN)
Intestinal transplants
Intraocular lens (IOL)
Intraocular lenses
Intrathecal infusion, implantable infusion
Intravitreal drug delivery system
IPPB devices
prior authorization
IV equipment
prior authorization
IV supplies
documentation requirements
J
JCIH 2007 position statement
Joint injections
L
Laboratory
ATP Level Pricing
automated tests
fee calculations
claim form example
independent laboratory
office visit with lab and radiology
radiological and physiological
clinical laboratory procedures
colorectal cancer genetic testing
prior authorization
complete blood count (CBC)
family planning
handling fees
forms
Radiology Prior Authorization Request Form
HIV drug resistance testing
independent
benefits and limitations
claims filing
CLIA Certificates
Clinical Laboratory Improvement Amendments (CLIA)
documentation requirements
electronic claims filing
enrollment
handling fees
reimbursement
iron studies
laboratory panels
fee calculations
outpatient hospital
handling fees
physician
handling fees
radiological and physiological
benefits and limitations
cardiac nuclear imaging
claims filing
computed tomography (CT)
diagnosis requirements
documentation requirements 1, 2
enrollment
enrollment for mammography providers
functional MRI
intraoperative MRI
magnetic resonance imaging (MRI)
modifier requirements
positron emission tomography (PET)
prior authorization
prior authorization 1, 2
reimbursement
request forms
reference
renal dialysis facility
continuous ambulatory peritoneal dialysis (CAPD)
nonroutine laboratory
routine laboratory
specimens
urinalysis
Laboratory Reporting
Laboratory services 1, 2
blood counts
clinical lab panel implementation
clinical pathology consultations
handling fee
Laboratory Submission
Laboratory Supplies
Laboratory Test 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18
LCSW
see Licensed clinical social worker (LCSW)
Lead poisoning
Lead screening
forms
measuring blood lead levels
prevention materials
procedures
symptoms of lead poisoning
Lead Screening and Testing
Leuprolide acetate (Lupron Depot)
Licensed clinical social worker (LCSW)
behavioral health services
benefits and limitations
claim form example
claims filing
documentation requirements
enrollment
prior authorization
court-ordered and DFPS-directed services
more than 30-encounters per year
subsequent prior authorization requests
reimbursement
Licensed marriage and family therapist (LMFT)
behavioral health services
benefits and limitations
claims filing
documentation requirements
enrollment
prior authorization
court-ordered and DFPS-directed services
more than 30-encounters per year
subsequent prior authorization requests
reimbursement
Licensed professional counselor (LPC)
behavioral health services
benefits and limitations
claim form example
claims filing
documentation requirements
enrollment
prior authorization
court-ordered and DFPS-directed services
more than 30-encounters per year
subsequent prior authorization requests
reimbursement
Licensed psychological associate (LPA)
behavioral health services
benefits and limitations
12-hour system limitation
formula applied
procedure codes
retrospective review
enrollment
Life support
levels of service
Liver transplants
LMFT
see Licensed marriage and family therapist (LMFT)
Lodging provider
claims filing
enrollment
prior authorization
LPC
see Licensed professional counselor (LPC)
Lung transplants
Lung volume reduction surgery (LVRS)
M
Magnetic resonance angiography (MRA)
Magnetic resonance imaging (MRI)
Maintenance of provider information
see Provider information
Mammography
Managed care
administrator-initiated HMO plan changes
advance directives
after-hours guidelines
client responsibilities
client rights
client-initiated HMO plan changes
complaints
cultural competency
fair hearings
health plan changes
limited English proficiency
primary care provider
eligible provider types
unacceptable telephone arrangements
Manual pricing
Mastectomy
Maternal and child health
Maternal serum alpha-fetoprotein
Maternity care
Maternity Care
Maternity clinics
reimbursement
Maternity service clinic (MSC)
Meals provider
claims filing
enrollment
prior authorization
Medicaid for breast and cervical cancer (MBCC)
client eligibility
Medicaid ID
client eligibility verification
Form H1027-A
Form H1027-B
Form H1027-C
Form H1027-F
Form H3087
samples 1, 2
Hospice Program
Medicaid limited program
presumptive eligibility
Medicaid limited program
claims payment
definition of medical necessity for
duration
eligibility
see Client eligibility
exceptions
hospital services
Medicaid ID
pharmacy
referrals
selection of provider/pharmacy
waste, abuse, and fraud
Medicaid relationship to Medicare
Medical necessity
definition for Medicaid limited program
Medical nutrition counseling
Medical nutritional counseling
CCP claim form example
Medical record documentation requirements
Medical supplies
prior authorization
Medical Transportation Program
Medically Needy Clearinghouse (MNC)
see Medically Needy Program (MNP)
Medically Needy Program (MNP)
claims filing
closing MNP case
spend down
processing
Medically Unlikely Edit
Medicare
crossover reimbursement
Part A
Part B
participation as a condition of enrollment
Medicare and Medicaid DME prior authorization
Medicare and Medicaid Prior Authorization
Medicare Part C
Mental health case management
claim form example
Mental Health Screening
Military hospital
benefits and limitations
claim form example (emergency inpatient)
claims information
enrollment
inpatient services
reimbursement
MNP
see Medically Needy Program (MNP)
Mobility aids
not a benefit
procedure codes and limitations
Modifiers
anesthesia
Mucous clearance valve
reimbursement
MUE 1, 2, 3, 4
Muscular Dystrophy Association
Myocardial perfusion imaging
N
National Correct Coding Initiative 1, 2, 3, 4
National Drug Codes
National Marrow Donor Program
National Provider Identifier (NPI)
definition
NPI Verification
NCCI 1, 2, 3, 4
NDC
see National drug code (NDC)
Nebulizers
prior authorization
Negative pressure ventilators
prior authorization
Neglect
reporting
staff training
Nerve conduction studies (NCS)
electrodiagnostic (EDX) testing
Neurostimulators
Newborn
blood screening
claim hints
eligibility
enrollment
STAR Program
hearing screening
1-3-6 Month Practitioner’s Guide
birth screen
ECI referral
evaluation
monitoring
outpatient rescreen
screening, statutory requirements
services
circumcisions
Newborn Care
Newborn eligibility process
Newborn hearing screening
Newborn Screening
Newborn Screening Supplies
NorthSTAR Program
appeals
behavioral health billing
client eligibility
complaints
hospital billing
prior authorization requirements
NP
see nurse practitioner
NPI
see National Provider Identifier (NPI)
NPWT wound care system
Nurse
see certified nurse midwife, nurse practitioner, clinical nurse specialist, or certified registered nurse anesthetist
Nurse practitioner
benefits and limitations
claims filing
resources
enrollment
reimbursement 1, 2
Nutritional Screening
O
Observation
less than 24 hours
Observation services
Obstetrics/prenatal care
Occupational therapy (OT)
benefit criteria
benefits and limitations
claims filing
home health services
documentation requirements
enrollment
home health services
in a nursing facility
limitations
noncovered services
procedure codes
rehabilitative services
School Health and Related Services (SHARS) 1, 2
Omalizumab
Online Fee Lookup (OFL)
Online Provider Lookup (OPL)
Ophthalmology 1, 2
see Vision services
Optometry
see Vision services
Oral Evaluation and Fluoride Varnish in the Medical Home (OEFV)
Oral Health Screening
Oral surgery
Orencia
see Abatacept (Orencia)
Organ procurement
Organ Procurement and Transportation Network
organ transplant
Organ Transplant
Orthodontic services
mandatory prior authorization
procedure codes
special orthodontic appliances
Orthotic and prosthetic services
claim form example
Osteogenic stimulation 1, 2
documentation requirements
invasive electrical osteogenic stimulator
noninvasive electrical osteogenic stimulator
prior authorization
professional services
ultrasound osteogenic stimulator
Osteopathic manipulation treatment (OMT)
Outliers
cost outlier
day outlier
Out-of-state Medicaid providers 1, 2
reimbursement
Outpatient Hospital
Outpatient rehabilitation facility (ORF)
Overpayments
refunds to TMHP 1, 2
Oxygen therapy
home delivery system types
prior authorization
recertification
P
Paclitaxel
Paper claims
CMS-1500 instruction table
tips on expediting
Parapodium
Parental accompaniment
statutory requirements
Payment error rate measurement (PERM) 1, 2
Payment Information
PCCM
enrollment
Pediatric nurse practitioner
see nurse practitioner
Pediatric pneumogram
Pegfilgrastim
Percutaneous transluminal coronary intervention
PERM
see Payment error rate measurement (PERM) 1, 2
Personal care services
School Health and Related Services (SHARS)
Personal Comfort Items
Personal supervision
Pharmacy
Medicaid limited program
Phototherapy devices
Comprehensive Care Program (CCP)
see Comprehensive Care Program (CCP)
Physical therapy (PT)
benefit criteria
benefits and limitations
claim form example 1, 2
claim form examples (CCP only)
claims filing
home health services
documentation requirements
enrollment
home health services
in a nursing facility
limitations
noncovered services
procedure codes
rehabilitative services
reimbursement
Physician
behavioral health services
benefits and limitations
enrollment
retrospective review
claims filing
dentistry, doctor of
domiciliary, rest home, or custodial care
enrollment
evaluation and management services
group clinical visits
asthma
diabetes
home services
inpatient hospital services
concurrent care
hospital admissions, initial visits, and subsequent visits
hospital discharge
nursing facility services
observation
kidney transplant
office or other outpatient hospital services
consultation services
new and established patient services
observation services
preventive care visits
services outside of business hours
prior authorization
referrals
see also PCCM, referrals
reimbursement 1, 2
services
aerosol treatment
allergy
allergy immunotherapy
allergy testing
direct nasal mucous membrane test
inhalation bronchial challenge testing
ophthalmic mucous membrane test
patch or application tests
percutaneous and intracutaneous skin test
photo or photo patch skin test
RAST/MAST tests
anesthesia
claims filing
complicated
for labor and delivery
for THSteps dental
modifiers
multiple procedures 1, 2
pain management
provided by the surgeon
Bacillus Calmette-Guérin (BCG) for treatment of bladder cancer
bariatric surgery
prior authorization requirements
cardiopulmonary resuscitation (CPR)
casting
chemotherapy
procedure codes
circumcision
cochlear implants
colorectal cancer screening
sigmoidoscopies
colorectal screening
colonoscopies 1, 2
genetic testing
continuous glucose monitoring (CGM)
prior authorization
corneal transplants
diagnostic tests
ambulatory blood pressure monitoring
ambulatory electroencephalogram (A/EEG)
bone marrow aspiration
cytopathology studies other than gynecological
echoencephalography
electrocardiogram (ECG)
electrodiagnostic (EDX) testing
esophageal pH probe monitoring
Helicobacter pylori (H. pylori)
myocardial perfusion imaging
pediatric pneumogram
extracorporeal membrane oxygenation (ECMO)
eye surgery
incision
laser
family planning
Helicobacter pylori
hospital visits
hyperbaric oxygen therapy (HBOT)
Ilizarov device
immunizations
injections
abatacept (Orencia)
amifostine
antibiotics and steroids
antihemophilic factor
botulinum toxin type A
chelating agents
deferoxamine mesylate (Desferal)
dimercaprol
edetate calcium disodium
edetate disodium
clofarabine
filgrastim
gamma globulin/immune globulin
hematopoietic agents
darbepoetin alfa
epoetin alfa (EPO)
implantable infusion pumps
interferon
joint and trigger point
leuprolide acetate (Lupron Depot)
omalizumab
paclitaxel
pegfilgrastim
sargramostim
trastuzumab
intraocular lenses
laboratory
blood counts
clinical lab panel implementation
clinical pathology consultations
handling fee
long term care nursing facility
magnetic resonance angiography (MRA)
magnetic resonance imaging (MRI)
mastectomy and breast reconstruction
maternity care
neuromuscular electrical stimulation (NMES)
neurostimulators
doral column neurostimulator (DCN)
intracranial neurostimulators (ICN)
NMES and TENS supplies
NMES/TENS garments
percutaneous electrical nerve stimulators (PENS)
prior authorization
sacral nerve stimulators (SNS)
transcutaneous electrical nerve stimulators (TENS)
newborn
nuclear medicine
obstetrics/prenatal care
occupational therapy
ophthalmology
orthognathic surgery
physical therapy
radiation therapy
radiology
reduction mammoplasties
renal disease
splinting
stereotactic radiosurgery
strapping
telemedicine
transplant prior authorization
vaccinationsee Immunizations
vagal nerve stimulators (VNS)
ventilation assist and management
sign language interpreting services
substitute physician
supervision
teaching attending physician and resident physician
supplies, trays, and drugs
visits
wearable cardiac defibrillator
Physician assistant (PA)
benefits and limitations
claims filing
resources
enrollment
reimbursement 1, 2
Physician services
School Health and Related Services (SHARS)
Physiological laboratory
reimbursement
Podiatrist services
clubfoot casting
flat foot treatment
routine foot care
Portable X-ray supplier
claims filing
diagnosis requirements
reimbursement 1, 2
Positive airway pressure system devices
PPO
see Preferred provider organization (PPO)
Preferred provider organization (PPO)
Prenatal care
Prior authorization
acknowledgement statement
ambulance
nonemergency transport
retroactive eligibility
ambulatory surgical center (ASC) 1, 2
and retroactive eligibility
appealing denials
auditory brainstem implant (ABI)
benefit codes
birthing centers
bone-anchored hearing aid (BAHA)
by fax 1, 2
by mail 1, 2
by telephone 1, 2
Case Management for Children and Pregnant Women (CPW)
certification statement
certified respiratory care practitioner (CRCP)
clients with private insurance
closing
cochlear implants
codes awaiting a rate hearing
colorectal cancer genetic testing
Comprehensive Care Program (CCP)
contact lenses
continuous glucose monitoring (CGM)
copies of documents
definition of documents
document requirements and retention
dual eligible clients
emergency transport
federally qualified health center (FQHC)
forms
Addendum to Home Health Services (Title XIX) DME/Medical Supplies Physician Order Form
CCP ECI Request for Outpatient Therapy
CCP Prior Authorization Private Duty Nursing 6 Month Authorization
CCP Prior Authorization Request for Non-Face-to-Face Clinician-Directed Care Coordination Services
CCP Prior Authorization Request Form
Donor Human Milk Request Form
External Insulin Pump 1, 2
Home Health Services (Title XIX) DME/Medical Supplies Physician Order Form
Home Health Services (Title XIX) DME/Medical Supplies Physician Order Form Instructions
Home Health Services Plan of Care (POC) 1, 2, 3, 4
Home Health Services Plan of Care (POC) Instructions
Home Health Services Prior Authorization Checklist 1, 2
Medicaid Certificate of Medical Necessity for Chest Physiotherapy Devices
Extended Request
Initial Request
Medicaid Certificate of Medical Necessity for CPAP/BiPAP or Oxygen Therapy
Medicaid Certificate of Medical Necessity for Reduction Mammaplasty
Nonemergency Ambulance Prior Authorization Request
Plan of Care
Home Health
Pulse Oximeter Form 1, 2
Radiology Prior Authorization Request Form
Request for Extension of Outpatient Therapy (Form TP-2)
Request for Initial Outpatient Therapy (Form TP-1)
THSteps Dental Mandatory Prior Authorization Request Form 1, 2, 3, 4, 5
general information
gynecological services
salpingostomy
hearing devices
home health aide (HHA)
home health services (DME)
hospital ambulatory surgical center (HASC) 1, 2
inpatient behavioral health services
ITP
laboratory
radiological and physiological
Licensed clinical social worker (LCSW)
Licensed marriage and family therapist (LMFT)
Licensed professional counselor (LPC)
lodging provider
mandatory prior authorization (dental)
meals provider
MedSolutions
neurostimulators
newly enrolled providers
nonemergency transport
NorthSTAR Program
notification
orthodontic services
outpatient behavioral health services
pharmacological management services
pharmacological regimen oversight
physician
positron emission tomography (PET)
psychiatric diagnostic interviews
psychological and neuropsychological testing
psychotherapy/counseling
radiology
renal dialysis facility
retention of documents
retroactive authorization
skilled nurse (SN)
sound processor
storage of documents
submitting claims with
submitting through TMHP website
substance use disorder (SUD) services
terms and conditions
THSteps and ICF-MR dental prior authorization
total in-home parental nutrition
transplants
verifying status
Prior Authorization and Documentation Requirements
Private duty nursing
claim form examples (CCP only)
Procedure codes
orthodontic
THSteps dental 1, 2, 3
Prognostic breast and gynecological cancer studies
Prosthodontics
fixed
removable
Provider
education
out-of-state
professional organizations
resolution of problems
Provider complaints
see Complaints
Provider enrollment
advanced practice registered nurse (APRN)
ambulance
ambulatory surgical center (ASC)
application 1, 2
Certificate of Authority
Certificate of Filing
Certificate of Formation
Certificate of Good Standing
Certificate of Incorporation
Corporate Board of Directors Resolution
Disclosure of Ownership and Control of Interest Statement
HHSC Medicaid Provider Agreement
IRS W-9 Form
Medicaid Audit Information Form
Provider Information Form
temporary license/certification
birthing center
certified registered nurse anesthetist (CRNA)
certified respiratory care practitioner (CRCP)
chiropractic services
clinical nurse specialist (CNS)
criteria for out-of-state providers
DME home health services
federally qualified health center (FQHC)
group information changes
hearing services
hospital ambulatory surgical center (HASC)
ITP
licensure renewal
lodging provider
meals provider
Medicaid managed care programs
PCCM
STAR and STAR+PLUS Programs
Medicare participation
nurse practitioner (NP)
occupational therapy (OT)
online enrollment
physical therapist
physician
physician assistant (PA)
presumptive eligibility determination
provider responsibilities
reenrollment
change in principal information
change in provider status
change of ownership
change of physical address
new Medicare number
renal dialysis facility
required forms
rural health clinic (RHC)
speech therapy (ST)
Texas Health Steps (THSteps)
tuberculosis clinic
types of
facility
group
individual
performing provider
vision services
Provider information
change in principal information
change in provider status
change of physical address
NPI Verification
Online Provider Lookup (OPL)
Provider Information Change (PIC) Form
requirement to notify of changes
Provider Information Change (PIC) Form
Provider payments
see also Electronic Funds Transfer (EFT)
stale-dated checks
Provider responsibilities
billing clients
Client Acknowledgment Statement
billing requirements
certification of submitted claims
child support
compliance with
Americans with Disabilities Act of 1990
Civil Rights Act of 1964
Rehabilitation Act of 1973
Texas Family Code
compliance with federal legislation
delegation of signature authority
informing pregnant clients about CHIP benefits
Medicaid access to records and premises
medical record documentation requirements
release of confidential information
reporting child abuse
reporting suspected sexual abuse
retention of records
tamper-resistant prescription pads
training
tuberculosis clinic
utilization control
Provider-specific visits
reimbursement
Psychiatric Inpatient Extended Stay Request Form
Psychiatric Inpatient Initial Admission Request Form
Psychologist
behavioral health services
benefits and limitations
12-hour system limitation
formula applied
procedure codes
retrospective review
claim form example
enrollment
reimbursement
Pulsatile jet irrigation wound care system
Pulse oximeter
prior authorization
Pulse oximetry
Pumps, implantation
Q
Qualified Medicare Beneficiary (QMB)
Quick Reference Guide
Texas Health Steps
R
R&S Report
see Remittance and Status (R&S) Report
Radiation services
Radiation therapy
brachytherapy
claim form example
procedure code limitations
Radiological laboratory
reimbursement
Radiology services
diagnosis requirements
therapeutic radiopharmaceuticals
RAST/MAST tests
physician
Record retention
electronic transmission reports
Reduction mammoplasties
Reenrollment
see Provider enrollment
Referrals
Case Management for Children and Pregnant Women (CPW)
family planning
genetic services
THSteps 1, 2
THSteps dental
Refunds to TMHP
as a result of other insurance payments
as a result of overpayment
Registered nurse
additional THSteps educational requirements
Rehabilitation hospital
claim form example (inpatient - CCP only)
Rehabilitation hospital (freestanding) (CCP)
reimbursement
Reimbursement
ambulance
ambulatory surgical center (ASC) 1, 2
birthing centers
case management
for children and pregnant women
for children who are blind and visually impaired
for early childhood intervention
certified nurse-midwife
certified registered nurse anesthetist
certified respiratory care practitioner
certified respiratory care practitioner (CRCP)
chemical dependency treatment facility
chiropractic services
clinical nurse specialist (CNS)
cost reimbursement
dental 1, 2
drugs/biologicals
durable medical equipment
family planning services
federal financial participation (FFP)
federally qualified health center (FQHC)
genetic services
hearing aid and audiometric evaluations
high-volume providers
home health services
hospital
hospital-based ambulatory surgical center (HASC)
independent laboratory 1, 2
independent practitioners
Indian Health Services
in-home total parenteral nutrition
laboratory
radiological and physiological
licensed clinical social worker
licensed marriage and family therapist
licensed professional counselors
manual pricing
maternity service clinic
Medicare crossover
Part A
Part B
methodology
nurse practitioner
Online Fee Lookup (OFL)
out-of-state Medicaid providers
personal care services
physical therapy
physician 1, 2
physician assistant 1, 2
physiological laboratory
portable X-ray supplier 1, 2
provider-specific visits
psychologist
radiological laboratory
reasonable cost/interim rates
reductions
renal dialysis facility 1, 2
rural health clinic (RHC)
School Health and Related Services (SHARS) 1, 2
certification of funds
cost reconciliation and cost settlement
cost reporting
static fee schedules
THSteps
tuberculosis clinic
tuberculosis clinics
vision services
Reimbursement methodology
anesthesia
Reimbursement reductions
Remittance and Status (R&S) Report
adjustments to claims
banner pages
claim status
claims being processed
claims payment summary
delivery options
example accounts receivable
example adjustments
example appendix
example backup withholding penalty
example banner page
example claims in process
example IRS levy
example managed care refunds
example manual payouts
example Medicaid refunds
example paid or denied hospital claims
example paid or denied physician claims
example reissues
example sub-owner recoupments
example summary
example system payouts
example void and stop pay
examples
explanation of benefit codes
explanation of pending status codes
explanation of sections Report
section explanation
field explanations
financial transactions
internal control number (ICN)
paid or denied claims
paper reports eliminated
Remittance and Status (R&S) Reports
electronic
Renal dialysis facility
benefits and limitations
blood transfusions
claim form example 1, 2, 3
claims filing
client eligibility
composite rate
continuous ambulatory peritoneal dialysis (CAPD)
continuous cycling peritoneal dialysis (CCPD)
dealing direct-support services
documentation requirements
enrollment
hematopoietic injections
hemodialysis
intermittent peritoneal dialysis (IPD)
laboratory services
continuous ambulatory peritoneal dialysis (CAPD)
nonroutine
routine
physician supervision
prior authorization
radiology services
reimbursement 1, 2
revenue codes
self-dialysis training
Renal disease
Reporting abuse and neglect, statutory requirements for
Required Laboratory Tests Related to Medical Checkup 1, 2, 3, 4, 5, 6
Reservoirs, implantation
Respiratory care
Respiratory equipment
prior authorization
Respiratory equipment and supplies
Retention of prior authorization documents
Retroactive eligibility
see Client eligibility
Root canal therapy
Rural health clinic (RHC)
after-hours care
claim form example 1, 2, 3
claims filing
cost reporting 1, 2
documentation requirements
enrollment
freestanding 1, 2
hospital-based 1, 2
record retention
reimbursement
S
Sargramostim
SBIRT
see Behavioral health
School Health and Related Services (SHARS)
claims filing
claim form examples
hearing services 1, 2, 3
personal care services
reimbursement
Screening, brief intervention, and referral to treatment (SBIRT)
see Behavioral health
Second opinions
Secretion clearance devices
Self-Administered Drug
Self-dialysis
Send Comments
Sensory Screening 1, 2
Services/Benefits, and Limitations
Sign language interpreting services, physician
Silver nitrate applicators
Skin testing
tuberculosis
Special needs car seats 1, 2
Special needs travel restraints
Specialized skills training for ECI
Speech therapy (ST)
aural rehabilitation
benefit criteria
benefits and limitations
claims filing
documentation requirements
enrollment
in a nursing facility
noncovered services
rehabilitative services
School Health and Related Services (SHARS)
Speech-language pathology
claim form examples (CCP only)
Spell of Illness
Spend down
see Medically Needy Program (MNP)
Standing frame/brace
STAR Health Program
benefits
claims filing
mental health rehabilitation
client eligibility
STAR Program
benefits
client enrollment
newborns
pregnant women
national drug code (NDC)
prescription drugs
spell of illness
State Legalization Impact Assistance Grant (SLIAG)
State requirements
early childhood intervention (ECI)
reporting abuse and neglect
Texas Health Steps (THSteps)
newborn blood screening
State Supported Living Centers
Statutory requirements
Early Childhood Intervention (ECI)
newborn screening
parental accompaniment
reporting abuse and neglect
teen confidentiality issues
Texas Health Steps (THSteps)
Stereotactic knife radiosurgery
Subcutaneous injection port
documentation requirements
prior authorization
Subcutaneous injection ports
Submission of birth information to TVSU
Substance use disorder (SUD) services
assessment
documentation requirements
medication assisted therapy (MAT)
non-covered services
prior authorization
Surgery
anesthesia administered by surgeon
assistant surgeons
bariatric
prior authorization requirements
bilateral procedures
biopsy
cosurgery 1, 2
global fees
lung volume reduction
multiple
office procedures
orthopedic hardware
primary
prostate
second opinions
Syphilis Testing
T
Take-Home Drugs
Targeted Case Management with Face-to-Face Interaction Claims filing
claim form examples
Early Childhood Intervention (CCP Only)
Tax Equity and Fiscal Responsibility Act (TEFRA)
physician reimbursement
Taxonomy codes
claims filing
provider enrollment
TB
see Tuberculosis
Teen confidentiality issues, statutory requirements
TEFRA
see Tax Equity and Fiscal Responsibility Act (TEFRA)
Telemedicine
Telephone numbers
federal
state
TMHP
Testing for Sexually Transmitted Diseases (STDs) 1, 2, 3, 4
Texas Band of Kickapoo Equity Health Program
Texas Board of Nursing (BON)
Texas early hearing detection and intervention (TEHDI)
Texas Health Steps (THSteps)
administrative information
assistance contacts
claim forms
claims filing
claim form examples
THSteps medical checkup 1, 2
diagnosis and treatment claim form example
claims filing and reimbursement
communicable disease reporting
Comprehensive Care Program (CCP)
claim filing resources
dental
claim appeals
claims information
dental
orthodontic services
premature removal of appliances
dental checkup
documentation
general anesthesia
orthodontic services
emergency dental referrals
ICF-MR services
prior authorization
cone beam imaging
general anesthesia
referrals
reimbursement
billing after loss of eligibility
routine dental referrals
services
treatment facilities
dental guidelines
AAPD Periodicity Guidelines
documentation requirements
early hearing detection and intervention
ECI referral
forms
How to Determine Tuberculosis Risk
TVFC Patient Eligibility Screening Record
TVFC Patient Eligibility Screening Record (Spanish)
TVFC Provider Enrollment
TVFC Questions and Answers
hearing monitoring
immunizations
exemption for schools and child-care facilities
free vaccines
general recommendations
ImmTrac
recommended childhood schedule
immunizations overview
JCIH 2007 position statement
lead screening 1, 2
prevention education and forms
medical checkup
facilities
newborn blood screening
newborn hearing screening 1, 2
provider enrollment
Quick Reference Guide 1, 2
referrals
registered nurse
additional education requirements
reimbursement
reporting abuse and neglect
state legislative requirements
statutory requirements
statutory state requirements
tuberculosis
screening and education tool
tuberculosis skin testing
TVFC versus non-TVFC vaccines/toxoids
Texas immunization registry
Texas Kidney Health Care Program
Texas Medicaid Refund Information Form
Texas Medical Assistance Program (Medicaid)
Texas Vaccines for Children (TVFC) Program
TexMedConnect 1, 2
training
Therapeutic apheresis
Therapeutic phlebotomy 1, 2
Third Party Liability (TPL)
see Third Party Resources (TPR)
Third Party Resources (TPR)
110-day rule
accident-related claims
adoption cases
converting informational claims to claims for payment
deductibles
definition
dental
filing deadlines
forwarded other insurance claims
informational claims
managed care organization (MCO) copayments
nonsources
other insurance credits
provider liens for reimbursement
submission of informational claims
Third Party Liability (TPL)
THSteps requirements
tort
verbal denial
Workers’ Compensation
Third party vendor implementation
THSteps
Services/Benefits, Limitations, and Prior Authorization
Acute Care Visits
Eligibility for a Medical Checkup
Exception-to-Periodicity Checkups
Follow-up Medical Checkup
Mandated Components 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32
Medical Home
Newborn Examination
Non-Mandated Components 1, 2
THSteps Medical Checkups
THSteps Medical Checkups Periodicity Schedule
Verification of Medical Checkups
Tips on expediting paper claims
Tissue Transplant
TMHP
Contact Center
TMHP EDI
Help Desk
Julian dates
TMHP electronic data interchange (EDI)
TMHP Provider Relations
TMHP Website
Tooth identification (TID) number
Total parenteral nutrition (TPN)
Total Parenteral Nutrition (TPN) Solutions
TPN
documentation requirements
prior authorization
TPR
see Third Party Resources (TPR) 1, 2
Tracheostomy tubes
prior authorization
Tracheostomy Tubes
Transfers of client
Transplant Benefits and Limitations
Transplants
heart
intestinal
liver
lung
services
Transportation services
School Health and Related Services (SHARS)
Trastuzumab
Travel restraints
Trigger point injections
Tuberculosis
How to Determine Tuberculosis Risk
reimbursement
screening and education tool
Tuberculosis (TB) Screening
Tuberculosis clinic
ancillary services
benefits and limitations
claim form example
claims filing
documentation requirements
enrollment
provider responsibilities
reimbursement
Tuberculosis skin testing
Texas Health Steps (THSteps)
TVFC
see Texas Vaccines for Children
TVFC requirements
TVFC versus non-TVFC vaccines/toxoids
U
Ultraviolet (U-V) Protection
Undocumented aliens
emergency-only eligibility
United Network for Organ Sharing
Utilization review
appeals
dental
V
Vaccinations
see Immunizations
Vaccine Adverse Event Reporting System (VAERS) 1, 2
Vaccine Information Statement (VIS)
Vaccines
TVFC
Vagal nerve stimulators
Vaporizers
prior authorization
Vendor Drug Program
Vendor Drug Program (VDP)
Vendor software
Ventilator service agreement
documentation requirements
prior authorization
Ventilators
prior authorization
Vertical stander
Vestibuloplasty
Vision Screening
Vision services
angiography
angioscopy
benefits and limitations
claim form example
claims filing
contact lenses
prior authorization
corneal bandage
corneal topography
documentation requirements
federally qualified healthcare centers (FQHC)
forms
Physician’s Examination Report
Vision Care Eyeglass Patient Certification Form
long-term care facilities
medically necessary exams
noncovered
non-prosthetic eyewear
dispensing requirements
eyeglass lenses and frames
Medicare coverage
polycarbonate lens
repair
replacement
undeliverable eyeglasses
ophthalmic ultrasound
ophthalmological exam with general anesthesia
ophthalmoscopy
optometrists
orthoptic and pleoptic training
other services
circulatory system
complications of pregnancy, childbirth, and puerperium
conditions in the perinatal period
congenital anomalies
endocrine, nutritional and metabolic, immunity
infectious and parasitic diseases
injury and poisoning
metabolic disorders
musculoskeletal system and connective tissue
nervous system and sense organs
skin and subcutaneous tissue
V codes
prosthetic eyewear
artificial eyes
contact lens fitting
intraocular lens (IOL)
repair
replacement
temporary
provider responsibilities
reimbursement 1, 2
routine vision testing
sensorimotor examination
THSteps checkup vision screening
vision screening outside THSteps checkup
vision testing
Volume ventilators
prior authorization
W
Waste, abuse, and fraud
administrative actions
administrative sanctions
employee education requirements
Medicaid limited program
policy
reporting
sanctionable providers
suspected cases
types of violations
claims and Billing
cost-reports
delivery of health-care services
improper collection and misuse of funds
kickbacks and referrals
licensure actions
managed care organizations
program compliance
program-related convictions
provider eligibility
records and documentation
Wearable cardiac defibrillator
WHP
see Women’s Health Program (WHP)
Women’s Health Program (WHP)
abortions
annual exam
FQHC reimbursement
benefits and limitations
claims filing
client eligibility 1, 2
contraceptives
documentation requirements
drugs and supplies
enrollment
family planning guidelines
laboratory
natural family planning
outpatient services
FQHC reimbursement
overview
prescriptions
radiology services
referrals
sterilization
anesthesia
consent
facilities
hysteroscopic
tubal ligation
third party liability (TPL)
wrap-around services
Workers’ Compensation
Third Party Resources (TPR)
Wound care
noncovered services
prior authorization
procedures and limitations
supplies
documentation requirements
prior authorization
systems
documentation requirements
NPWT system
prior authorization
pulsatile jet irrigation
X
X-ray
chest

Texas Medicaid & Healthcare Partnership
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