TX HHS Form 1595. Billing Resolutions Request

The TX HHS Form 1595, Billing Resolutions Request, is a crucial document for resolving billing disputes in healthcare services. This form helps contractors and service providers resolve issues related to payment processing, ensuring timely and accurate reimbursement for the services they provide.

This form requires specific information from the contractor, including their contact details, the individual receiving services, and the HHS case manager (if known). The contractor must also provide a detailed breakdown of the services rendered, including units, amount, and error code number. Additionally, the form needs to be signed by both the contractor representative and the CMS coordinator, indicating that all supporting documentation has been attached.

Key features of this form include the requirement for supporting documentation, such as Forms 2101, 2065, and 2067, along with a report detailing the billing resolution. The form also outlines the responsibilities of both the contractor and the CMS coordinator in resolving billing disputes. By using this form, contractors can ensure that their billing issues are addressed promptly and accurately, minimizing delays and ensuring continued service delivery.

• This form is used by healthcare service providers to request assistance with billing resolution.
• The form requires specific information from the contractor, including contact details and a detailed breakdown of services rendered.
• The form must be signed by both the contractor representative and the CMS coordinator.