Provider Alert! Invoices Required for Manually Priced Laboratory Testing Claims Submissions

Attention: Laboratory Providers

Effective Date: September 21, 2020

Providers should monitor the Texas Children’s Health Plan (TCHP) Provider Portal regularly for alerts and updates associated to the COVID-19 event.  TCHP reserves the right to update and/or change this information without prior notice due to the evolving nature of the COVID-19 event.

Call to action: 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.

References:

TMHP Notice September 21, 2020
TMHP Notice November 5, 2020
TMHP Notice November 30, 2020

The six codes identified as manually priced are as follows:

How this impacts providers: 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

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

The reimbursement rate is 89.5% of the submitted invoice.

Next steps for providers: Providers submitting new manually priced laboratory testing claims (Including COVID-19 Testing) 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.”

If you have any questions, please email Provider Network Management at: providerrelations@texaschildrens.org.

For access to all provider alerts, log into:
www.thecheckup.org or www.texaschildrenshealthplan.org/for-providers.