For texas health steps specimens only - Texas Department of State ... 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin with Section 1: Submitter Information. Fill in your Submitter/TPI Number, Submitter Name, and NPI Number. Ensure all required fields marked with ** are completed.
3. Proceed to Section 2: Patient Information. Enter the patient's Last Name, First Name, Medicaid Number, and Date of Birth. Remember that the name on the specimen must match this form.
4. In Section 4: Ordering Physician Information, provide the physician’s NPI Number and Name. This is crucial for billing purposes.
5. Complete Section 5: Payor Source by entering the necessary billing information including City, State, Zip Code, and Medicaid number.
6. Finally, review all sections for accuracy before submitting your form along with the specimen to avoid rejection due to incomplete information.

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