Texas Administrative Code
Title 1 - ADMINISTRATION
Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION
Chapter 363 - TEXAS HEALTH STEPS COMPREHENSIVE CARE PROGRAM
Subchapter E - EPSDT EYEGLASS PROGRAM
Section 363.504 - Claims Information Requirements
Current through Reg. 49, No. 38; September 20, 2024
Providers must meet the criteria established in this subchapter for vision services and the provisions for participation in the Medicaid Program established under Chapter 354, Subchapter A, Division 1, of this title (relating to Medicaid Procedures for Providers), and Chapter 354, Subchapter A, Division 11, of this title (relating to General Administration). In addition to the claims information requirements established in § RSA 354.1001 of this title (relating to Claim Information Requirements), the following information is required for claims for vision services:
(1) name, address, and Medicaid provider identification number of the ordering provider, as appropriate;
(2) description of lenses and frames provided;
(3) provider's signature on the claim verifying the diopter change required for the dispensing of eyeglasses;
(4) certification by the provider that the dispensed materials used for repairs meet the specifications for eyewear in § RSA 363.503 of this subchapter (relating to Specifications for Eyewear);
(5) claims for eyewear with special features, signed by the recipient, acknowledging selection of eyewear that is beyond the specifications for eyewear in § RSA 363.503 of this subchapter. A signed patient certification satisfies this requirement for claims the provider submitted electronically;
(6) a copy of the invoice for supplies dispensed, attached to a claim for repairs or kept the provider, as authorized by HHSC;
(7) if the claim is for replacement of prosthetic eyewear or of nonprosthetic eyewear when the records of HHSC show that less than 24 months have elapsed since the date of the original nonprosthetic eyewear service, then:
