Clinics and Other Outpatient Facility Services Handbook - TMHP

TEXAS MEDICAID PROVIDER PROCEDURES MANUAL: VOL. 2 - JANUARY 2013
“Adjusted Fee” to display the individual fees with all mandated percentage reductions applied.
Additional information about rate changes is available on the TMHP website at
www.tmhp.com/pages/topics/rates.aspx.
8.5.2.1 NCCI and MUE Guidelines
The HCPCS and CPT codes included in the Texas Medicaid Provider Procedures Manual are subject to
NCCI relationships, which supersede any exceptions to NCCI code relationships that may be noted in
the Texas Medicaid Provider Procedures Manual. Providers should refer to the CMS NCCI web page at
www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Data-and-Systems/National-
Correct-Coding-Initiative.html for correct coding guidelines and specific applicable code combinations.
In instances when Texas Medicaid limitations are more restrictive than NCCI MUE guidance, Texas
Medicaid limitations prevail.
9. CLAIMS RESOURCES
Refer to the following sections or forms when filing claims:
Resource
Location
Automated Inquiry System (AIS) TMHP Telephone and Address Guide (Vol. 1,
General Information)
CMS-1500 Paper Claim Filing Instructions Subsection 6.5 (Vol. 1, General Information)
2006 American Dental Association (ADA) Dental Subsection 6.7 (Vol. 1, General Information)
Claim Filing Instructions
Newborn Child or Children (Form 7484) Form OP. 2 in Section 11 of this handbook
FQHC Encounter (T1015) Claim Form Example Form OP. 6 in Section 11 of this handbook
FQHC Follow-Up Claim Form Example Form OP. 7 in Section 11 of this handbook
Renal Dialysis Facility CAPD Training
Form OP. 8 in Section 11 of this handbook
Renal Dialysis Facility CAPD/CCPD
Form OP. 9 in Section 11 of this handbook
Rural Health Clinic Freestanding Claim Form Form OP. 11 in Section 11 of this handbook
Example
Rural Health Clinic Hospital-Based Claim Form Form OP. 13 in Section 11 of this handbook
Example
Appendix A: State and Federal Offices Communication
Appendix A (Vol. 1, General Information)
Guide
TMHP Electronic Claims Submission
Subsection 6.2 (Vol. 1, General Information)
Section 3: TMHP Electronic Data Interchange Section 3 (Vol. 1, General Information)
(EDI)
Tuberculosis Claim Form Example
Form OP. 14 in Section 11 of this handbook
Tuberculosis Screening and Guidelines
Subsection A.5, Children’s Services Handbook
(Vol. 2, Provider Handbooks)
UB-04 CMS-1450 Paper Claim Filing Instructions Subsection 6.6 (Vol. 1, General Information)
10. CONTACT TMHP
The TMHP Contact Center at 1-800-925-9126 is available Monday through Friday from 7 a.m. to 7 p.m.,
Central Time.
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