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December 2016 Texas Medicaid Provider Procedures Manual

Section 6: Claims Filing : 6.4 Claims Filing Instructions : 6.4.2 Claim Form Requirements : 6.4.2.3 Supervising Physician Provider Number Required on Some Claims

6.4.2.3
The supervising physician provider number is required on claims for services that are ordered or referred by one provider at the direction of or under the supervision of another provider, and the referral or order is based on the supervised provider’s evaluation of the client.
If a referral or order for services to a Texas Medicaid client is based on a client evaluation that was performed by the supervised provider, the billing provider’s claim must include the names and NPIs of both the ordering provider and the supervising provider. The billing provider must obtain all of the required information from the ordering or referring provider before submitting the claim to TMHP.
Providers who submit TexMedConnect electronic claims for professional, ambulance, or vision services can provide the claim information in the designated field for the supervising provider of the referring or ordering provider.
Providers can refer to TexMedConnect instructions on the TMHP website at www.tmhp.com for details about the “Referring/Other Supervising Provider” field for professional, ambulance, and vision electronic claims.
Note:

Texas Medicaid & Healthcare Partnership
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