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December 2016 Texas Medicaid Provider Procedures Manual

Children’s Services Handbook : 2 Medicaid Children’s Services Comprehensive Care Program (CCP) : 2.7 Early Childhood Intervention (ECI) Services : 2.7.4 Claims Filing and Reimbursement

Claims for ECI therapy, SST, and TCM services that have been rendered by an ECI provider must be submitted to TMHP in an approved electronic format or on the CMS-1500 paper claim form. Providers may purchase CMS-1500 paper claim forms from the vendor of their choice; TMHP does not supply the forms. When completing a CMS-1500 paper claim form, all required information must be included on the claim, as TMHP does not key any information from claim attachments. Superbills or itemized statements are not accepted as claim supplements.
Claims for ECI services must include the ECI provider identifier and EC1 benefit code.
Refer to:
Section 3: TMHP Electronic Data Interchange (EDI) (Vol. 1, General Information) for information on electronic claims submissions.
Subsection 6.1, “Claims Information” in Section 6, “Claims Filing” (Vol. 1, General Information) for general information about claims filing.
Subsection 6.5, “CMS‑1500 Paper Claim Filing Instructions” in Section 6, “Claims Filing” (Vol. 1, General Information) to find the instructions for completing paper claims.
Subsection 2.2, “Fee-for-Service Reimbursement Methodology”in Section 2, “Texas Medicaid Fee-for-Service Reimbursement” (Vol. 1, General Information) for more information about reimbursement.
All claims for reimbursement are based on the actual amount of billable time associated with the service. For those services for which the unit of service is 15 minutes (1 unit = 15 minutes), partial units should be rounded to the nearest quarter hour.
The following table shows the time intervals for 1 through 8 units:
ECI case management and specialized skills training are carved-out of Medicaid managed care and must be billed to TMHP for payment consideration. TCM services funded by a criminal justice agency (submitted with modifier HZ) are carved-out of Medicaid managed care. Carved-out services are those that are rendered to Medicaid managed care clients but are administered by TMHP and not the client’s MCO.
ECI therapies (PT/OT/ST) are not carved out and must be submitted to the managed care organization (MCO) that administers the client’s managed care benefits.

Texas Medicaid & Healthcare Partnership
CPT only copyright 2014 American Medical Association. All rights reserved.