Claim Form Examples

December 2016 Texas Medicaid Provider Procedures Manual

Inpatient and Outpatient Hospital Services Handbook : 10 Claim Form Examples

10

Claim Form Examples

The following linked claim form examples can also be found on the Claim Form Examples page of the Provider section of the TMHP website at www.tmhp.com:

Claim Form Examples

Ambulatory Surgical Center

Hospital-Based ASC

Hospital Inpatient

Military Hospital (Emergency Inpatient)

Claim Form Examples
Ambulatory Surgical Center
Hospital-Based ASC
Hospital Inpatient
Military Hospital (Emergency Inpatient)

Texas Medicaid & Healthcare Partnership