TX HHS Form H1120. Medical Bills Transmittal

The TX HHS Form H1120, Medical Bills Transmittal, helps individuals or organizations transmit medical bills to the Texas Health and Human Services (HHS) Medically Needy Program. This form is typically used in situations where an individual requires financial assistance for medical expenses that exceed their private insurance coverage.

The form requires specific information, including the application number, case name, date of birth, and TPR (private insurance) details. It also asks for three months prior application dates, along with corresponding S.D. Amounts. The form must be printed and completed accurately to ensure timely processing.

Key features of this form include the requirement for accurate and complete information, as well as the need to provide follow-up actions or procedures for any additional documentation or clarification needed. By using this form, individuals can efficiently transmit medical bills and receive necessary financial assistance for their medical expenses.

• This form is used by individuals or organizations seeking financial assistance for medical expenses that exceed private insurance coverage.
• The form requires specific information, including application number, case name, date of birth, and TPR details.