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Important Reminder: Provide Correct PCNs and Benefit Codes on Claims

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Reminder: Texas Medicaid and Children with Special Health Care Needs (CSHCN) Services Program providers must include the correct patient control numbers (PCNs) when submitting electronic claims. The PCN is sent in the NM109 Subscriber Primary Identifier segment. Refer to the 837 Acute Care Companion Guide on tmhp.com.

Additionally, the appropriate benefit codes must be sent on electronic acute care claims in the SBR03 segment. Refer to the 837 Acute Care Companion Guide.

If an incorrect PCN or benefit code is submitted on the claim, or if the PCN or benefit code is missing from the claim, then delays or rejections in processing may occur. The claim may also be forwarded incorrectly to a managed care organization (MCO).

For more information, call the TMHP Contact Center at 800-925-9126 or the TMHP-CSHCN Services Program Contact Center at 800-568-2413.