28 Tex. Admin. Code § 134.800
Required Billing Forms and Information
Effective Jul 15, 200025 TexReg 2139Source Note: The provisions of this §134.800 adopted to be effective February 20, 1991, 16 TexReg 671; amended to be effective June 1, 1992, 17 TexReg 3250; amended to be effective July 15, 2000, 25 TexReg 2139.Texas Secretary of State
- (a) Except as provided by §134.801 of this title (relating to Submitting Medical Bills for Payment), health care providers shall submit medical bills for payment on the forms prescribed in this section in accordance with Commission-prescribed instructions. All information on medical bills shall be legible when submitted.
- (b) Except as provided in subsections (c), (d), and (e) of this section, all health care providers, as defined in §401.011 of the Texas Labor Code, shall submit medical bills using the national standard HCFA-1500 health insurance claim form, prepared according to Commission-prescribed instructions.
- (c) Hospitals, including hospital-based emergency centers and ambulatory surgical centers, shall submit bills using the UB-92 billing form for institution services and the national standard HCFA-1500 health insurance claim form for professional services, prepared according to Commission-prescribed instructions for each form.
- (d) Pharmacists shall submit bills using the Commission-prescribed form TWCC-66a or TWCC-66c, Statement for Pharmacy Services, prepared according to Commission-prescribed instructions.
- (e) Dentists shall submit bills using the J-504 or J-505 form.
- (f) Health care providers may submit medical bills by facsimile or electronic transmission, when mutually agreed upon between the health care provider and the insurance carrier, unless the bill and/or supporting documentation cannot be sent by those media, in which case the health care provider shall send the documentation by mail or personal delivery.
- (g) The Medical Review Division may order the health care provider to reimburse a carrier when the carrier pays the health care provider in excess of the amount allowed by the appropriate Commission fee guideline.
- (h) This rule shall apply to all dates of service on or after July 15, 2000.
Source Note:The provisions of this §134.800 adopted to be effective February 20, 1991, 16 TexReg 671; amended to be effective June 1, 1992, 17 TexReg 3250; amended to be effective July 15, 2000, 25 TexReg 2139.