The number of units by which each product is measured must be included.All claims submitted for medical supplies must include the same quantities or units that are documented on the delivery slip or corresponding invoice and on the Home Health Services (Title XIX) forms.Corresponding tracking number from carrier.Itemized list of goods (includes descriptions and numberical quantities).The following must be included in the dated delivery slip:.The dated carrier tracking document must be attached. A dated carrier tracking document with shipping date and delivery date must be printed from the carrier’s website as confirmation.Delivery slip or corresponding invoice signed and dated by client or caregiver.Documentation of delivery must include one of the following:.Providers must retain individual delivery slips or invoices for each DOS that shows the date of delivery of all supplies provided to the client.Ordering Physicians must maintain copies of the completed, originally signed and dated forms in their records.Addendum to Home Health Services (Title XIX) DME/Medical Supplies Physician Order Forms.Home Health Services (Title XIX) DME/Medical Supplies Physician Order Forms.Home Health Services (Title XIX) DME/ Medical Supplies Physician Order forms.Required DME Documentsĭurable medical equipment providers must retain the following documents: Use of these service is subject to retrospective review. These records and claims must be retained for a minimum of five years from the date of service (DOS) or until the audit questions, appeals, hearings, investigations, or court cases are resolved. Medicaid (STAR) and CHIP Prior Authorization Formsĭurable Medical Equipment (DME) providers must disclose the following records to the Texas Health and Human Services Commission (HHSC) or its designee on request.Home Delivery Pharmacy (Mail-Order Pharmacy).Quality Improvements (QI) Toolkits and Tip Sheets.Medicaid Provider Information on COVID-19 Coverage.Value-Added Services for STAR, CHIP and STAR Kids.STAR Kids Referral and Authorization Process.Utilization Management (Prior Authorizations).
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