Welcome Providers - El Paso First Health Plans, inc.

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Exceptions to Periodicity • Exceptions are based on medical need such as – developmental delay, – environmental risk, – suspected abuse, – or state and federal requirements for Head Start, day care, foster care or adoption, – or for dental services under general anesthesia – If they client will not be available at the time the next checkup is due such as the case of children of migrant farm workers – If the provider is aware that the child is not due for a checkup based on age and the date of the last checkup or their Medicaid 3087 form does not state that the client is due the visit must be submitted as an exception to periodicity. (TMHP Provider Procedures Manual 43-9)
Exceptions to Periodicity • When billing for an exception to periodicity visit, provider must also <strong>inc</strong>lude the most appropriate exception to periodicity modifiers. • Claims for periodic THSteps medical checkups exceeding periodicity that do not <strong>inc</strong>lude one for these modifiers will be denied as exceeding periodicity. Source: THMP Provider Procedures Manual 2009 Section 43.1.7.7
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Page 9 and 10: SAMPLE ER REPORT
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Page 16 and 17: Changes in the Timeliness of THStep
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Page 43 and 44: CLAIMS DEPARTMENT Important Claim E
Page 45 and 46: Billing Provider -NPI Provider LOOP
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Page 51 and 52: Electronic Claim Growth YR 2006 YR
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Welcome Providers - El Paso First Health Plans, inc.

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