2.10.6

Claims Information

Submit services provided by orthotic and prosthetic suppliers in an approved electronic format or on a CMS-1500 paper claim form. Providers must purchase CMS-1500 paper claim forms from the vendor of their choice. TMHP does not supply the forms.

Important:

Attach the invoice to the claim for any specialized equipment.

Include the name of the referring physician in Block 17 of the CMS-1500 paper claim form or its electronic equivalent. Orthotics or prosthetics may be billed in the office, home, or outpatient setting. Claims for services that have been prior authorized must reflect the PAN in Block 23 of the CMS-1500 paper claim form or its electronic equivalent.

Refer to:

Orthotic and Prosthetic Services (CCP Only) on the TMHP website at www.tmhp.com for a claim form example.