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December 2016 Texas Medicaid Provider Procedures Manual

Section 6: Claims Filing : 6.15 Claims Filing for Home Health Agency Services

6.15
Providers must use only type of bill (TOB) 321 in Form Locator (FL) 4 of the UB-04 CMS-1450. Other TOBs are invalid and will result in a claim denial. Home Health Services must be submitted to TMHP in an approved electronic format or on a CMS-1500 or a UB-04 CMS-1450 paper claim form. Submit home health DME and medical supplies to TMHP in an approved electronic format, or on a CMS-1500or on a UB-04 CMS-1450 paper claim form. Providers may purchase CMS-1500 or UB-04 CMS-1450 paper claim forms from the vendor of their choice. TMHP does not supply them.
When completing a CMS-1500 or a UB-04 CMS-1450 paper claim form, all required information must be included on the claim, as TMHP does not key information from attachments.
Refer to:
Subsection 6.5, “CMS‑1500 Paper Claim Filing Instructions” in this section for instructions on how to complete paper claims. Blocks that are not referenced are not required for processing by TMHP and may be left blank.
Subsection 6.6, “UB-04 CMS-1450 Paper Claim Filing Instructions” in this section.
Outpatient claims must have the appropriate revenue code and, if appropriate, the corresponding Healthcare Common Procedure Coding System (HCPCS) code or narrative description. The prior authorization number must appear on the CMS-1500 paper claim form in Block 23 and in Block 63 of the UB-04 CMS-1450 paper claim form. The certification dates or the revised request date on the POC must coincide with the DOS on the claim. Prior authorization does not waive the 95-day filing deadline requirement.

Texas Medicaid & Healthcare Partnership
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