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December 2016 Texas Medicaid Provider Procedures Manual

Children’s Services Handbook : Appendix C. Lead Screening : C.4 Environmental Lead Investigation Services : C.4.4 Claims Filing and Reimbursement

C.4.4
C.4.4.1
ELI services must be submitted to Texas Medicaid & Healthcare Partnership (TMHP) in an approved electronic format or on 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.
The following documentation must be submitted with the claim:
An ELI is subject to retrospective review and may be recouped if the documentation maintained by the health-care and ELI providers does not support medical necessity.
Refer to:
Section 3: TMHP Electronic Data Interchange (EDI) (Vol. 1, General Information) for information about electronic claims submissions.
Section 6: Claims Filing (Vol. 1, General Information) for general information about claims filing.
Subsection 6.5, “CMS‑1500 Paper Claim Filing Instructions” Section 6, “Claims Filing” (Vol. 1, General Information) for instructions on completing paper claims.

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