Providers must meet the criteria established in this subchapter
for vision services and the provisions for participation in the Medicaid
Program established under Chapter 354, Subchapter A, Division 1, of
this title (relating to Medicaid Procedures for Providers), and Chapter
354, Subchapter A, Division 11, of this title (relating to General
Administration). In addition to the claims information requirements
established in §354.1001 of this title (relating to Claim Information
Requirements), the following information is required for claims for
vision services:
(1) name, address, and Medicaid provider identification
number of the ordering provider, as appropriate;
(2) description of lenses and frames provided;
(3) provider's signature on the claim verifying the
diopter change required for the dispensing of eyeglasses;
(4) certification by the provider that the dispensed
materials used for repairs meet the specifications for eyewear in §363.503
of this subchapter (relating to Specifications for Eyewear);
(5) claims for eyewear with special features, signed
by the recipient, acknowledging selection of eyewear that is beyond
the specifications for eyewear in §363.503 of this subchapter.
A signed patient certification satisfies this requirement for claims
the provider submitted electronically;
(6) a copy of the invoice for supplies dispensed, attached
to a claim for repairs or kept the provider, as authorized by HHSC;
(7) if the claim is for replacement of prosthetic eyewear
or of nonprosthetic eyewear when the records of HHSC show that less
than 24 months have elapsed since the date of the original nonprosthetic
eyewear service, then:
(A) submission of a statement justifying the need for
the replacement eyewear (reimbursement is made only if the eyewear
was lost or damaged beyond repair or if the recipient's visual acuity
has changed significantly, as specified in §363.502(3)(B)(i)
or (ii)(II) of this subchapter (relating to Benefits and Limitations)).
If the original eyewear has been lost or damaged beyond repair, the
recipient must sign the claim form or a patient certification if the
provider submits claims electronically; and
(B) claim form signed by the recipient if the original
eyewear was lost or damaged beyond repair.
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| Source Note: The provisions of this §363.504 adopted to be effective July 1, 1986, 11 TexReg 2758; amended to be effective July 1, 1987, 12 TexReg 1779; amended to be effective June 15, 1988, 13 TexReg 2557; transferred effective September 1, 1993, as published in the Texas Register September 7, 1993, 18 TexReg 5978; transferred effective September 1, 2002, as published in the Texas Register December 6, 2002, 27 TexReg 11527; amended to be effective November 4, 2003, 28 TexReg 9521; amended to be effective December 10, 2015, 40 TexReg 8754 |
