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When billing the CRS program for services, providers must submit with the invoices:
- the participant’s Explanation of Benefits; and
- the denial letters from the insurance company, including denial letters from Medicaid, Medicare or both, or other pay sources.
When the provider’s facility is closed within a participant's dates of service, payment is not made for that date.
Invoices must be submitted at least monthly, and no later than the fifteenth of each month following the service, using one of the following forms:
- UB-04 Centers for Medicare and Medicaid (CMS) 1450;
- HHSC generated invoice; or
- Health Insurance Billing Form (CMS 1500).
To receive payment, a contractor must follow §TAC 20.487 and submit an invoice to the address on the CRS service authorization, comply with the terms and conditions of the CRS contract, and include, at a minimum, the following:
- contractor's complete name, mailing address, and e-mail (if applicable) address;
- contractor's phone number;
- the name and phone number of a person designated by the contractor to answer questions regarding the invoice;
- HHSC agency number 529, CRS delivery address;
- CRS service authorization number;
- HHSC CRS contract number;
- contractor’s valid Texas identification number (TIN) issued by the comptroller;
- a description of the goods or services provided, in sufficient detail to identify the order which relates to the invoice. This may include but is not limited to the CPT (current procedural terminology) codes;
- Maximum Affordable Payment Schedule (MAPS) rate, or general codes set by the program;
- dates of service;
- quantity and unit-cost being billed, as documented on the service authorization;
- if submitting an invoice after receiving an assignment of a contract, the TIN of the original contractor and the TIN of the successor vendor;
- other relevant information supporting and explaining the payment requested;
- participant’s Individualized Program Plan (IPP), signed by the interdisciplinary team (IDT) (for initial billing for services only), if applicable;
- summaries of monthly meetings, signed by the IDT (for monthly services that are not admission or discharge services), if applicable; and
- discharge summary, signed by the IDT or other appropriate team member (upon final billing).
The provider must:
- respond to billing-related inquiries and disputed invoices from CRS program staff members within two business days; and
- submit all documentation requested within five to 10 business days following the request.
The CRS Program must;
- confirm that goods or services were received in accordance with the service authorization;
- receive, inspect, and accept delivery of goods or services covered by the invoice; and
- receive and accept a complete accurate invoice to request payment from the comptroller.