Revision 10-0, Effective October 1, 2009

 

 

5100 Applicable Service Components

Revision 10-0; Effective October 1, 2009

 

Section 5000 applies only to the following service components:

  • adaptive aids;
  • minor home modifications; and
  • dental treatment.

 

5200 Service Claim Requirements

Revision 14-1; Effective March 21, 2014

 

A program provider must submit an electronic service claim that meets the following requirements:

  • DADS has given authorization for payment for the claim in accordance with Section 3210, General Requirements;
  • the claim must be for a service component that is authorized by an IPC that meets the requirements of 40 TAC, §9.157;
  • the claim must be for a service component or subcomponent provided during a period of time for which the individual has a LOC;
  • the claim must be for a service component provided to only one individual;
  • the claim must be for the date the individual received the service component;
  • the claim must be supported by written documentation as described in Section 5300, Written Documentation, and Section 6000, Adaptive Aids, Minor Home Modifications and Dental Treatment, for the particular service component being claimed; and
  • the claim must be a clean claim and be submitted:
    • after authorization for payment is given by DADS, as described in Section 2000, Definitions (see definition for clean claim); and
    • to the state Medicaid claims administrator no later than 12 months after the last day of the month in which:
      • the individual received the adaptive aid;
      • the minor home modification was completed; or
      • the individual received the dental treatment.

 

5300 Written Documentation

Revision 10-0; Effective October 1, 2009

 

  1. Legible

A program provider must have written, legible documentation as described by this section and Section 6000 to support a service claim.

  1. Proof of Licensed Professional Qualifications

A program provider must have a written document from the appropriate state licensing agency or board to prove that a licensed professional, as required by Section 6160, Required Documentation for an Adaptive Aid (see No. 1, Item a), and a provider of dental treatment, as described in Section 6350, Provider of Dental Treatment, is properly licensed.