May 15th, 2023
HCS and TxHmL Waiver Programs: Trending Issue Support, Volume 20
Since May 2, 2022, Home and Community-based Services and Texas Home Living program providers, local intellectual and developmental disability authorities, and financial management services agencies, billing on behalf of Consumer-Directed Services, have been submitting claims and forms to the Texas Medicaid & Healthcare Partnership (TMHP).
DH & ISS Billing
On March 1, 2023, day habilitation was replaced with individualized skills and socialization (ISS). To bill for day habilitation prior to March 1 and ISS after March 1, refer to the following unit information and prorating instructions.
Units:
· Day habilitation is a daily unit with a maximum of 260
· ISS is an hourly unit with a maximum of 1560
· 260 daily units of day habilitation equal 1560 hourly units of ISS
· The 1560 ISS unit maximum covers the extra day for leap year
Prorating instructions:
1. Determine how many days were used for day habilitation. (Example: 55 days used)
2. Subtract the number of days used for day habilitation from 260 (or the number of days requested) to determine the remaining days. (Example: 260 – 55 days used = 205 remaining days)
3. Multiply the remaining days by 6 (derived from dividing 1560 by 260) to determine how many hours remain to bill as ISS. (Example: 205 remaining days * 6 = 1230 ISS hours)
Other areas discussed were:
Dental Claims Units: Providers must bill dental claims with the dollar amount as the units.
Example: If the billed amount is $100, enter “100” as the number of units.
If previous claims were paid incorrectly because the dollar amounts were not billed as units, providers can rebill correctly by performing adjustments on the paid claims. Refer to the “Adjustments” section of the Long-Term Care (LTC) User Guide for TexMedConnect for assistance.
Submitting Transfer Forms: To avoid delays when submitting forms after transfers, the receiving providers should obtain confirmation that a transfer Individual Plan of Care (IPC) form is in Processed/Complete status before proceeding to the subsequent form
TMHP has received feedback from providers indicating additional support is needed. Resolutions regarding the most frequently reported issues may be found by reading the full alert.
HCS and TxHmL Waiver Programs: Trending Issue Support, Volume 19
HCS and TxHmL Waiver Programs: Trending Issue Support, Volume 18
January 28th, 2023
HCS and TxHmL Waiver Programs: Trending Issue Support, Volume 17
Trending Support Issues, Vol. 17: Access to PDF R&S and 835 Electronic R&S Reports, R&S Report Information and Videos
Click on link below for full report
https://www.tmhp.com/news/2023-01-27-hcs-and-txhml-waiver-programs-trending-issue-support-volume-17
Highlights from Vol. 17
Providers are encouraged to use both the PDF version and the American National Standards Institute (ANSI) 835 electronic version of their Remittance and Status (R&S) Reports.
Providers can view and save the PDF version of their R&S Reports through TexMedConnect. The PDF files are available for 90 days following the publication date of the R&S Reports.
To access their ANSI 835 electronic R&S Reports, providers must submit an Electronic Data Interchange (EDI) Agreement and set up ANSI 835 access. In addition, providers must use an approved third-party billing software vendor from the following list. Providers can retrieve their ANSI 835 electronic R&S Reports dating back to when their submitter number was linked to their contract number.
Providers should refer to the 835 Long Term Care Companion Guide for more information about the 835 Electronic R&S Reports.
In addition:
Providers can refer to the Remittance and Status (R&S) Reports for LTC Providers Quick Reference Guide (QRG) for more information.
Additionally, a three-part educational video series is available on TMHP’s HCS and TxHmL YouTube playlist and discusses the following topics:
- General R&S Report information and instructions for account administrators on how to set permissions for users to access R&S Reports (Part 1).
- How to read and understand the first section of the R&S Report: Non-Pending Claims (Part 2).
- How to read and understand the second, third, and fourth sections of the R&S Report: Pending Claims, Financial Summary, and EOB Codes and Descriptions (Part 3).
Approved 3rd party biller list
Don’t forget our friends at Millin Billing are on this list. Contact us at info@twogetherconsulting.com for assistance with getting a demo and discount on your rate.
January 15th, 2023
HCS and TxHmL Waiver Programs: Trending Issue Support, Volume 16
Trending Support Issues, Vol. 16: IPC Use as a Template button and Location Code Field on Individual Movement and IPC forms
https://www.tmhp.com/news/2023-01-13-hcs-and-txhml-waiver-programs-trending-issue-support-volume-16
**When creating IPC renewals, the Use as Template button can now be used to populate form data from the original form into the new form. This is incredibly helpful to providers now and less time-consuming.
*Another major issue that slowed down transfers I believe with LIDDA’s and also caused glitches for providers, in terms of wrong locations noted in the dropdown menu and then not being able to revise those location errors was also addressed. See “fix” below:
Effective January 13, 2023, a text box will replace the location code drop-down box on the following IMT and IPC form fields:
· IPC transfers (3608/8582) field 39a: Receiving Program Provider Location Code
· IMTs field 18: Location Code
· IMT Individual Update fields 122: Current Location Code and 123: New Individual Location Code
· IMT LA Reassignment field 111: New Location Code
The manually entered text will be validated upon submission to ensure that the submitted location code is valid for the provider. This enhancement will improve the overall system performance related to the location code fields.
The following item-by-item (IBI) guides have been updated to reflect enhancements:
For further information, contact the TMHP LTC Help Desk at 800-626-4117. Select option 1 and then option 7.
January 12th, 2023
HCS and TxHmL Waiver Programs: Trending Issue Support, Volume 15
- Trending Support Issues, Vol 15: If you missed it, know that it includes information about determining your ARPA payments: https://www.tmhp.com/news/2022-12-30-hcs-and-txhml-waiver-programs-trending-issue-support-volume-15
HCS and TxHmL Waiver Programs: Trending Issue Support, Volume 14
Trending Support Issues, Vol 14: PEMS Revalidation and Enhancements to updating effective date of some forms : https://www.tmhp.com/news/2022-12-30-hcs-and-txhml-waiver-programs-trending-issue-support-volume-14
December 16th, 2022
HCS and TxHmL Waiver Programs: Trending Issue Support, Volume 13
Since May 2, Home and Community-based Services and Texas Home Living program providers, local intellectual and developmental disability authorities, and financial management services agencies billing on behalf of Consumer-Directed services have been submitting claims and forms to the Texas Medicaid and Healthcare Partnership (TMHP).
TMHP has received feedback from providers and LIDDAs indicating additional support is needed. Resolutions regarding the most frequently reported issues may be found by reading the full alert.
November 20th, 2022
HCS and TxHmL Waiver Programs: Trending Issue Support, Volume 12
Since May 2, Home and Community-based Services and Texas Home Living program providers, local intellectual and developmental disability authorities, and financial management services agencies, billing on behalf of Consumer-Directed Services, have been submitting claims and forms to the Texas Medicaid and Healthcare Partnership (TMHP).
TMHP has received feedback from providers indicating additional support is needed. Resolutions regarding the most frequently reported issues may be found by reading the full alert.
HCS and TxHmL Waiver Programs: Migration Trending Issue Support, Volume 11
The following is a list of common form submission statuses with descriptions and actions needed:
- Pending DADS Review
- Description: The form is pending Texas Health and Human Services Commission (HHSC) long-term care (LTC) staff review.
- Action:
- Forms 8578, 3608, and 8582: For Change LON on Existing Assessment, renewals and revisions, the submitter may need to submit a review packet to the HHSC Utilization Review (UR) department. For questions and to provide supplemental documentation, submitters can contact the HHSC UR department at 512-438-5055 or email deskURLONIPC@hhs.texas.gov.
- 8578, 3608, 8582, and 3615 Forms: For questions and to provide supplemental documentation about enrollments, transfers, or continuation of suspensions, LIDDAs can contact HHSC Program Eligibility and Support (PES) at 512-438-2484.
- 3616 Termination Forms: For questions and to provide supplemental documentation, providers and LIDDAs can contact HHSC Program Eligibility and Support (PES) at 512-438-2484.
- Suspensions Pending….. read more
October 17th, 2022
HCS and TxHmL Waiver Programs: Migration Trending Issue Support, Volume 10
October 7th, 2022
HCS and TxHmL Waiver Programs: Trending Issue Support, Volume 9
Since May 2, Home and Community-based Services and Texas Home Living program providers, local intellectual and developmental disability authorities, and financial management services agencies, billing on behalf of Consumer-Directed Services, have been submitting claims and forms to the Texas Medicaid and Healthcare Partnership.
TMHP has received feedback from providers indicating additional support is needed. Resolutions regarding the most frequently reported issues may be found by reading the full alert
-Preventing claim denials for invalid date spans
Claims billed with date spans may deny with one of the following explanations of benefits (EOBs):
F0126: Claim line items cannot span current fiscal years.
The new state fiscal year (SFY) runs from September 1, 2022, through August 31, 2023. Claims will be denied with EOB F0126 if they are submitted with line item dates of service (DOS) spanning the previous SFY ending August 31, 2022, and the current SFY. Providers and LIDDAs submitting claims with DOS spanning the previous and current SFYs should submit separate claims for each SFY.
F0326: Incorrect number of days billed for this service.
Services that only allow billing for individual DOS may be denied with EOB F0326 if they are billed with date spans. These services should be billed as separate line items for each service date.
-Claims adjustments reminder
Claims that have processed successfully can be adjusted. For instructions on how to adjust claims, refer to the “Adjustment” section of the LTC User Guide for TexMedConnect.
Providers can also adjust a previously adjusted claim in TexMedConnect. For instructions, refer to HCS and TxHmL Waiver Programs: How to Adjust a Previously Adjusted Claim
September 11th, 2022
HCS and TxHmL Waiver Programs: Trending Issue Support, Volume 8
-Termination Forms Submitted by LIDDAs
For clients who have CDS services only, termination forms are submitted by LIDDAs. After form submission, LIDDAs need to contact HHSC Program & Eligibility Support (PES) to acknowledge and review the forms. LIDDAs can contact HHCS PES by calling 512-438-2484, faxing 512-438-4249, or emailing enrollmenttransferdischargeinfo@hhs.texas.gov.
Read more on the following items:
–Long-Term Care Online Portal Sessions Must Be Restarted Daily
–Using the “Resubmit to SAS” Button
Access to Electronic R&S and PDF R&S Reports
August 31st, 2022
Migration Trending Issue Support Vol 7:
August 16th, 2022
HCS and TxHmL Waiver Programs: Trending Issue Support Volume 6
–Individual’s residential address in Individual Search
–“Pending LA Review” status and action needed
–Using the correct IMT Form to update the service coordinator (SC)
–HCS and TxHmL call queue
For info on these trending issues see the following link:
https://www.tmhp.com/news/2022-08-16-hcs-and-txhml-waiver-programs-trending-issue-support-volume-6
August 13th, 2022
HCS and TxHmL Waiver Programs: Trending Issue Support Volume 5
Since May 2, 2022, Home and Community-based Services (HCS) and Texas Home Living (TxHmL) program providers, local intellectual and developmental disability authorities (LIDDAs), and financial management services agencies (FMSAs) that bill on behalf of consumer-directed services (CDS) have been submitting claims and forms to Texas Medicaid & Healthcare Partnership (TMHP). TMHP has received feedback from providers indicating that additional support is required.
Here are the latest resolutions to trending issues below:
HCS and TxHmL Call Queue
Status: When contacting TMHP, providers need to select option 1 then option 7 to enter the HCS and TxHmL Waiver Programs queue. The full number is 800-626-4117, Option 1, then Option 7.
Location Code Issue
Resolution: LIDDAs submitting Individual Plan of Care (IPC) transfers for clients were receiving incorrect location codes. This issue has been resolved. Providers that received an incorrect location code need to resubmit the IPC transfer.
See previous Volumes and info below:
HCS and TxHmL Waiver Programs: Trending Issue Support, Volume 4
HCS and TxHmL Waiver Programs: Trending Issue Support, Volume 3
HCS and TxHmL Waiver Programs: Trending Issue Support, Volume 2
HCS and TxHmL Waiver Programs: Trending Issue Support
Important Claims Submission Information for HCS and TxHmL Programs
LTC Online Portal Dashboard Accessibility Issue Resolved
IPC Forms 3608 and 8582 Issue Resolved
HCS and TxHmL FAQ Updates Available May 9, 2022, and May 23, 2022
Individual Plan of Care (IPC) Training Materials for HCS and TxHmL Waiver Programs
Now Available: HCS and TxHmL Programs Forms and Claims Submissions to TMHP
EVV Updates for the HCS and TxHmL Transition to TMHP for Claims Submission
June 1st, 2002
Resolutions to the most frequently reported issues may be found at the following link for TMHP issues concerning entering IPC’s, dual entry into CARE, submitting claims, and more: “Trending Issue Support” Table
In addition, please see helpful links below including recent HCS/TxHmL FAQ’s in May of 2022.
View previous postings:
- Important Claims Submission Information for HCS and TxHmL Programs
- LTC Online Portal Dashboard Accessibility Issue Resolved
- IPC Forms 3608 and 8582 Issue Resolved
- HCS and TxHmL FAQ Updates Available May 9, 2022, and May 23, 2022
- Individual Plan of Care (IPC) Training Materials for HCS and TxHmL Waiver Programs
- Now Available: HCS and TxHmL Programs Forms and Claims Submissions to TMHP
- EVV Updates for the HCS and TxHmL Transition to TMHP for Claims Submission
