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December 20, 2019
Note: The Health and Human Services Commission (HHSC) has requested that TMHP publish the following information:
As a reminder, HHSC has implemented Rider 43 of the 2018-2019 General Appropriations Act. Rider 43 requires that claims for physical, occupational, and speech therapy services submitted to Medicaid Managed Care Organizations (MCOs) include the National Provider Identifier (NPI) of the rendering therapist.
During implementation of Rider 43, HHSC identified limitations to the CMS-1450/UB-04 (institutional) claim form and 837I rendering provider when more than two providers are submitted. HHSC Leadership has suspended implementation of Rider 43 as it applies to providers who utilize the CMS-1450/UB-04 (institutional) claim form.
The Rider 43 rendering provider requirements will still apply to physical, occupational, and speech therapy providers who bill on a CMS-1500 (professional) claim form, including groups with performing therapy providers. As a reminder for filling out the CMS-1450/UB-04 claim form, the rendering provider goes in boxes 78 and 79.
HHSC has also communicated this direction to the Medicaid MCOs.
For more information, call the TMHP Contact Center at 800-925-9126.