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Claim Form Examples

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The following are examples about done claim forms needed to Texas Medicaid providers. This forms are grouped by handbook to make locating of correct example easier.

Ambulance Support Handbook

Behavioral Health, Rehabilitation, and Case Administration Services Handbook

Certified Respiratory Care Practitioner (CRCP) Services Handbook

Children's Services Handbook

Medical and Other Outpatient Facility Services Handbook

Durable Medical Equipment, Medical Supplies, and Wholesome Products Handbook

Gynecological and Reproductive Health and My Planning Services Handbook

Domestic Heath Nurse plus Private Duty Nursing Services Handbook

Inpatient and Outpatient Hospital Services Operator

Medical and Nursing Specialists, Medical, and Doctor Assistant Handbook

File

Physical Therapy, Occupational Therapy, and Speech Therapy Services Handbook

File
Physical Therapist (251.05 KB)

Radiology and Laboratory Services Manual

Vision both Hearing Services Handbook

File
Vision Benefits (247.09 KB)