Texas Forms
38 State Forms found
| name | number | revision | print or send online | |
|---|---|---|---|---|
Employers without coverage (non-subscribers) |
No Form Number | Updated 08/2022 | ||
Dispute Resolution |
CS05-012F | (10-13) | ||
Texas EDI Medical Data Element Requirement Table |
Version 2.0 | (09/2015) | ||
Texas EDI Medical Data Element Edits Table |
Version 2.0 | (09/2015) | ||
Texas EDI Medical Difference Table |
Version 3.0 | September 2015 | ||
Suspected Insurance Fraud Report (SIUs) |
FR028 | 0421 | ||
Suspected Insurance Fraud Report |
FR029 | 0421 | ||
Suspected Insurance Fraud Report (Spanish) |
FR029 | 0421 | ||
Disclaimer: These forms may not be the most recent version. Texas may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on this site. Please check official sources.
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