Texas Administrative Code
Title 26 - HEALTH AND HUMAN SERVICES
Part 1 - HEALTH AND HUMAN SERVICES COMMISSION
Chapter 365 - KIDNEY HEALTH CARE
Section 365.7 - Claims Submission and Payment Rates
Current through Reg. 49, No. 38; September 20, 2024
(a) Drug benefit claims must be submitted electronically by the pharmacy to the designated claims processor for the program, except when paper submissions are allowed or required.
(b) Medical benefit claims must be submitted to the program by the provider who rendered the service(s) to the program client or by the provider's designee.
(c) Transportation benefit claims must be submitted to the program by the client or an authorized entity. Claims must be submitted electronically through the current automated claims payment system, except when the program allows or requires paper submissions.
(d) Payments are made using the rates in effect on the date the service is rendered.
(e) Claims for medical benefits will not be considered for payment by the program until the program has a fully executed agreement with the provider.
(f) Incomplete or incorrect claims will not be considered for payment.
