Clean Claims 101: Read and Follow the Instructions

Correct completion of the CMS-1500 form is crucial in filing a clean claim. Texas Department of Insurance (TDI) regulations define clean claims. TDI has specified which fields are required for a claim to be considered clean, which fields are conditional, and which fields are optional under the regulations. The Texas Insurance Code at 28 TAC §21.2803, Elements of a Clean Claim , contains these definitions. 

In addition, be familiar with each of your contracted health plans' specific requirements for elements or attachments of a clean claim. A health plan may require additional elements and attachments, by written notice in your provider manual or other claims filing instructional documents, or by your contract with the HMO or preferred provider organization. You must satisfy all requirements of the TDI rules and satisfy the health plan's additional requirements to have a clean claim. Carefully read your contract, provider manual, or other claims filing instructional documents and any amendments for additional elements and attachments.

TMA has created  color-coded CMS-1500 forms members only with accompanying guidelines based on Medicare instructions and TDI clean claim regulations to help you accurately complete a claim form. Use this valuable tool to file clean claims every time!

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