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December 2016 Texas Medicaid Provider Procedures Manual

Section 6: Claims Filing : 6.2 TMHP Electronic Claims Submission : 6.2.3 Electronic Rejections : 6.2.3.1 Newborn Claim Hints

6.2.3.1
The following are to be used for newborns:
Enter “Boy Jane” or “Girl Jane” in first name field and “Jones” in last name field. Always use “boy” or “girl” first and then the mother’s full name. An exact match must be submitted for the claim to process.
The following are the most common reasons for electronic hospital UB-04 CMS-1450 claim rejections:
Health coverage ID blank or invalid. This number must be the valid nine-digit Medicaid client number. Incorrect data includes: a number less than nine digits; PENDING; 999999999; and Unknown.
Referring physician information on outpatient claim is blank when laboratory/radiology services are ordered or a surgical procedure is performed. The referring physician’s NPI is required in Fields 78–79. Consult the software vendor for the location of this field on the electronic claims entry form.

Texas Medicaid & Healthcare Partnership
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