Tenn. Comp. R. & Regs. 0780-01-73-.04 - UNIFORM FORMS REQUIRED

(1) Uniform Forms Required. TennCare program HMOs and TennCare Partners program BHOs shall accept and may require the applicable uniform claim forms completed with the uniform claim codes.

(2) Submission of Uniform Forms:

(a) For the purposes of submitting the HCFA-1500/CMS-1500 form, providers should complete the form in accordance with the instructions appended hereto as Appendix A to these rules.

(b) For the purposes of submitting the HCFA-1450/CMS-1450 (UB-92) form, providers should complete the form in accordance with the Medicare instructions.

(c) For the purposes of submitting the "American Dental Association, 1999 Version 2000" uniform dental claim form approved by the American Dental Association for use by dentists, as amended or updated by the American Dental Association, providers should complete the form in accordance with ADA instructions.

(d) For the purposes of submitting the NCPDP prescription drug claim form or its electronic counterpart, providers should complete the form in accordance with NCPDP instructions.

(e) CPT Code Usage. For the purposes of these rules, providers are authorized to use the expiring or updated CPT codes on claims submitted during the period January 1 through March 31 of each year. From April 1 through December 31 of each year, however, providers must use the updated/current CPT codes.

(f) CDT Code Usage. For the purposes of these rules, dentist providers shall utilize the most current CDT codes as required by the federal Health Insurance Portability and Accountability Act of 1996, Pub.L. 104-191, Aug. 21, 1996, 110 Stat. 1936 (HIPAA) rules and regulations for commercial dental benefit programs.

(g) ICD-9 Code Usage. For the purposes of these rules, providers are authorized to use the expiring or updated ICD-9 codes on claims submitted during the period October 1 through subsequent March 31 of each year. From April 1 through December 31 of each year however, providers must use the updated/current ICD-9 codes.

(h) HCPCS Code Usage. For the purposes of these rules, providers are authorized to use the expiring or updated HCPCS codes on claims submitted during the period January 1 through March 31 of each year. From April 1 though December 31 of each year, however, providers must use the updated/current HCPCS codes.

Notes

Tenn. Comp. R. & Regs. 0780-01-73-.04

Original rule filed April 4, 2002; effective June 18, 2002. Amendment filed October 24, 2002; effective January 7, 2003.

Authority: T.C.A. §§ 56-32-218(a), 71-5-191, and Public Acts of 2001, Chapter 209, § 1.