Invoices Required for Manually Priced Laboratory Testing Claims Submissions

Attention: Laboratory Providers Effective Date: September 21, 2020Providers 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, 2020TMHP Notice November 5, 2020TMHP Notice November 30, 2020The six codes identified as manually priced are as follows:

Effective date	Procedure Code
10-Apr-20	86328
10-Aug-20	86408
10-Aug-20	86409
10-Apr-20	86769
25-Jun-20	87426
10-Nov-20	87428
1-Apr-20	S8301

 

Place of Service	Provider Type
Office	Family Planning Clinics, Physician, Physician Groups, Physician Assistant, Nurse Practitioner, Clinical Nurse Specialist, Certified Nurse Midwife
Outpatient Hospital	Family Planning Clinics, Hospital Providers
Independent Laboratory	Independent Laboratory/Privately Owned Laboratory Providers

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.