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December 2016 Texas Medicaid Provider Procedures Manual

Inpatient and Outpatient Hospital Services Handbook : 5 Ambulatory Surgical Center and Hospital Ambulatory Surgical Center : 5.4 Claims Filing and Reimbursement

Freestanding ASC claims must be submitted to TMHP in an approved electronic claims format or on a CMS‑1500 paper claim form. Hospital-based ASCs must submit claims to TMHP in an approved electronic claims format or on a UB-04 CMS-1450 paper claim form.
Claims must contain the billing provider’s complete name, address, and a provider identifier. When completing a UB-04 CMS-1450 or a CMS‑1500 paper claim form, providers must include all required information on the claim; TMHP does not key any information from claim attachments. Providers must purchase UB-04 CMS-1450 and CMS-1500 paper claim forms from the vendor of their choice. TMHP does not supply them.
Scheduled procedures performed in a HASC must be submitted for reimbursement using the HASC provider identifier with TOB 131. Emergency or unscheduled procedures performed in a hospital when the client is an outpatient must be submitted for reimbursement using the hospital provider identifier with TOB 131.
To submit claims for services performed by certified registered nurse anesthetists (CRNAs), an ASC must enroll as a CRNA group provider and indicate the CRNA performing provider identifier on claims for those services.
Refer to:
Section 4, “Certified Registered Nurse Anesthetist (CRNA)” in the Medical and Nursing Specialists, Physicians, and Physician Assistants Handbook (Vol. 2, Provider Handbooks) for specific billing instructions for CRNA services.
Section 6: Claims Filing (Vol. 1, General Information).
Section 10, “Claim Form Examples” in this handbook.

Texas Medicaid & Healthcare Partnership
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