May 23, 2022
Very Important!
Please see information from TMHP below:
Some Rejected Claims May Be Resubmitted
Some Home and Community-based Services (HCS) and Texas Home Living (TxHmL) claims that were submitted to Texas Medicaid & Healthcare Partnership (TMHP) between May 2, 2022, and May 13, 2022, were rejected in error. HCS and TxHmL claims that were rejected with the following explanations of benefits (EOBs) may now be resubmitted for processing:
| Explanation of Benefits | Description |
|---|---|
| F0155 | Unable to determine appropriate Fund Code for Service billed, verify Medicaid Eligibility. |
| F0174 | Claim is for a Service Group that is mutually exclusive with Service Group for previous claim. |
| F0286 | Can only bill for incremental (0.50, 0.75, and whole) units for specified services. |
Billing Dates of Service
Claims cannot be submitted on the same day as the date of service; providers should wait until the following day to submit their claim. Providers that submit claims for current or future dates may have their claim rejected, and will receive the following EOB:
| Explanation of Benefits | Description |
|---|---|
| F0198 | Cannot bill for future Service Dates or current date. |
Top Claims Rejections and Steps to Avoid Claim Rejections
HCS and TxHmL providers might see one of the following EOBs when a claim is rejected:
| Explanation of Benefits | Description |
|---|---|
| F0138 | A valid service authorization for this client for this service on these dates is not available. |
| F0268 | A valid service authorization for this client for these service dates is not available, or claim dates cannot overlap more than one service authorization. |
| F0077 | Billing Code was not submitted or cannot be determined. |
| F0277 | National Code is missing, invalid, or not billable with Procedure Code Qual. |
| F0325 | Line Item Control Number-Required HHMM (military format.) |
To avoid having claims rejected, HCS and TxHmL providers should take the following steps before submitting claims to TMHP:
- Check the TexMedConnect Medicaid Eligibility Service Authorization Verification (MESAV) to get client Service Auth/Level/Client Hold/Eligibility information. The following client information should be verified:
- Services authorized for the client.
- Service dates authorized for the client.
- Levels authorized for the client.
- Use the HCS and TxHmL Bill Codes Crosswalk to check for important claims information, such as the Line Item Control Number (LICN).
Important: HCS and TxHmL claims should be submitted to TMHP for dates of service on or after May 1, 2022. Claims with dates of service before May 1, 2022, should be submitted using the HHSC Client Assignment and Registration (CARE) system.
For more information about submitting claims to TMHP, providers can refer to the following provider education resources:
- Home and Community-Based Services TexMedConnect Claims Submission Webinar
- HCS and TxHmL Waiver Programs Frequently Asked Questions (FAQ)
Note: To access the TMHP Learning Management System (LMS), users must have an account. Users can register for an account here. New TMHP LMS users can access the Learning Management System (LMS) Registration and Navigation Job Aid for Providers located on the LMS homepage, or send an email to TMHP Training Support for support creating an LMS account or navigating the LMS.
For additional questions about submitting HCS and TxHmL claims to TMHP, contact the TMHP LTC Help Desk at 800-626-4117, Option 1, then Option 7.
Tip from Twogether Consulting: If you are not getting a timely response from the Help Desk, or are unable to find answers to your TMHP Claim Submission Issues, please email: Provider.relations@TMHP.com
