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Invoices are Required for Manually Priced Laboratory Testing Claims Submissions

Last updated on 11/5/2020

Note: Texas Medicaid managed care organizations (MCOs) must provide all medically necessary, Medicaid-covered services to eligible clients. Administrative procedures such as prior authorization, pre-certification, referrals, and claims/encounter data filing may differ from traditional Medicaid (fee-for-service) and from MCO to MCO. Providers should contact the client's specific MCO for details.

Laboratory providers submitting claims for COVID-19 testing or other services for a manually priced test must include the appropriate invoice(s) and documentation to ensure that manually priced laboratory claims (including claims that may or may not be for Coronavirus [COVID-19] testing) are processed timely and correctly.

COVID-19 testing claims that are submitted with manually priced procedure codes will need to be submitted as paper claims.

Note: Procedure code pricing is subject to change, and providers will need to check the Online Fee Lookup to determine if a code is manually priced.

Process for Submitting Claims for Manually Priced Services

Denied Laboratory Claims (Including COVID-19 Testing Claims)

Manually priced laboratory testing claims submitted without the appropriate invoice for a paper claim will be denied. Testing claims that do not have the invoices will be denied with the following explanation of benefits (EOB):

00275: This claim has been denied and will be returned for additional information. Refile original claim with invoice for payment of this service.

COVID-19 testing claims that are denied for lack of documentation must be resubmitted to the following address:

Texas Medicaid & Healthcare Partnership
Appeals/Adjustments
PO Box 200645
Austin, TX 78720-0645

New Manually Priced Laboratory Testing Claims (Including COVID-19 Testing)

Providers submitting new manually priced laboratory testing claims must send the invoices with the paper claims to:

Texas Medicaid & Healthcare Partnership
Claims
PO Box 200555
Austin, TX 78720-0555

Providers can refer to the current Texas Medicaid Provider Procedures Manual, section 6.1.3,TMHP Paper Claims Submission.”

For more information, call the TMHP Contact Center at 800-925-9126.