August 4, 2022
Key Information
Representatives of the Chickasaw and Choctaw tribes notified Health and Human Services Commission (HHSC) of an issue regarding claim denials based on missing General Medical Services T1015 without modifiers. For Indian Health Care Providers (IHCPs) using an IHCP-facility National Provider Identifier (NPI) to bill the General Medical Services T1015 code, a modifier is not a requirement to be reimbursed.
Requests for reimbursement for any additional physician services must be submitted using the physician’s Medicaid provider identifier.
HHSC is developing additional policies regarding service delivery for Indian Health Service Medicaid members.
Questions
For questions or additional information please:
- Contact your BCBSTX Medicaid Network team at 1-855-212-1615, or
- Submit via email to: Texas Medicaid Network Department
The above material is for informational purposes only and is not a substitute for the independent medical judgment of a physician or other health care provider. Physicians and other health care providers are encouraged to use their own medical judgment based upon all available information and the condition of the patient in determining the appropriate course of treatment. References to other third-party sources or organizations are not a representation, warranty or endorsement of such organization. Any questions regarding those organizations should be addressed to them directly. The fact that a service or treatment is described in this material is not a guarantee that the service or treatment is a covered benefit and members should refer to their certificate of coverage for more details, including benefits, limitations and exclusions. Regardless of benefits, the final decision about any service or treatment is between the member and their health care provider.