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December 2016 Texas Medicaid Provider Procedures Manual

Radiology and Laboratory Services Handbook : 2 Independent Laboratory : 2.4 Claims Filing and Reimbursement

2.4
2.4.1
When family planning test specimens, such as Pap smears, are collected, providers must direct the laboratory to indicate that the claim for the test is to be billed as a family planning service using a family planning diagnosis code.
Refer to:
Section 2.2, “Services, Benefits, Limitations, and Prior Authorization” in the Gynecological and Reproductive Health and Family Planning Services Handbook (Vol. 2 Provider Handbooks) for information about Medicaid Title XIX Family Planning Services.
Section 5.1, “Services, Benefits, Limitations, and Prior Authorization” in the Gynecological and Reproductive Health and Family Planning Services Handbook (Vol. 2 Provider Handbooks) for information about the Texas Women’s Health Program.
A National Provider Identifier (NPI) is required for all claims. In addition, for paper claims, the Texas Provider Identifier (TPI) is required for the billing and performing provider only. NPI-only is required for all other fields.
Providers must submit independent laboratory services to TMHP in an approved electronic format or on a CMS-1500 paper claim form. Providers must purchase CMS-1500 claim forms from the vendor of their choice. TMHP does not supply the forms.
When completing a CMS-1500 claim form, all required information must be included on the claim, as information is not keyed from attachments. Superbills, or itemized statements, are not accepted as claim supplements.
Refer to:
Section 3: TMHP Electronic Data Interchange (EDI) (Vol. 1, General Information) for information on 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” (Vol. 1, General Information). Blocks that are not referenced are not required for processing by TMHP and may be left blank.

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