January 15th, 2023

TMHP Recoupment Letters

Recoupment Letters:   Upon request, TMHP will send a list of affected/over-paid claims to providers.
Providers who experience any issues receiving the list should contact Marie Redman at HHSC (marie.redman@hhs.texas.gov).
HHSC urges providers to keep their ticket numbersWhy? Because the calls are recorded, and if there’s an issue, the ticket number allows HHSC to listen to the call associated with the ticket number.  This is just one of the numerous ways for HHSC to monitor TMHP for compliance.  That said, please keep a list of ticket numbers by date and brief notation of purpose of your call.
When asked if there could be an extension in adjusting the affected claims, HHSC replied no extension will be granted.

December 12th, 2022

Avoiding HCS and TxHmL Overpayment of Services

Effective Jan. 2, 2023, Texas Medicaid and Healthcare Partnership (TMHP) will perform monthly calculations on services for the Individual Plan of Care that overlaps the May 1, 2022 implementation of the new process for submitting Home and Community-based Services and Texas Home Living forms and claims.

On a quarterly basis, TMHP will calculate all services that have been paid through Client Assignment and Registration System and TMHP and will recoup services that exceed the authorized IPC amount.

Read the full alert.