TX HHS Form 3079. Facility Payment Rate Request

The TX HHS Form 3079, Facility Payment Rate Request, is a crucial document for healthcare facilities seeking reimbursement from the Texas Health and Human Services (HHS) County Indigent Health Care Program (CIHCP). This form helps solve the problem of determining payment rates for indigent health care services provided by facilities.

The form requires facilities to provide essential information, including their name, address, and 10-digit National Provider Identifier (NPI) number. Facilities must also specify the rate(s) requested, which can include inpatient and outpatient rates per visit. The form is typically submitted by healthcare facilities to HHS for review and processing.

Key features of this form include the requirement for facilities to check boxes indicating the rate(s) requested and provide their NPI number. Facilities are also responsible for ensuring that the information provided is accurate and complete. Upon submission, the facility can expect follow-up actions from HHS regarding the status of their payment request.

• The form is used by healthcare facilities seeking reimbursement from the Texas Health and Human Services (HHS) County Indigent Health Care Program (CIHCP).
• Facilities must provide essential information, including their name, address, and NPI number.
• The form requires facilities to specify the rate(s) requested, which can include inpatient and outpatient rates per visit.