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December 2016 Texas Medicaid Provider Procedures Manual

Section 6: Claims Filing : 6.5 CMS‑1500 Paper Claim Filing Instructions : 6.5.2 CMS‑1500 Claim Form (Paper) Billing

6.5.2
CMS‑1500 Claim Form (Paper) Billing
Claims must contain the billing provider’s complete name, address, and a provider identifier. Claims without a provider name, address, and provider identifier cannot be processed. Each claim form must have the appropriate signatory evidence in the signature certification block.
Refer to:
The Professional Paper Claim Form (CMS-1500) page of the CMS website at www.cms.gov for more information about the CMS-1500 paper claim form. Providers can purchase CMS-1500 paper claim forms from the vendor of their choice. TMHP does not supply the forms. Providers can find examples of completed claim forms on the Claim Form Examples page of the TMHP website at www.tmhp.com.
Important:
When completing a CMS‑1500 paper claim form, all required information must be included on the claim in the appropriate block. Information is not keyed from attachments. Superbills or itemized statements are not accepted as claim supplements.

Texas Medicaid & Healthcare Partnership
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