Family Planning Frequently Asked Questions
Q: Where can I obtain a copy of the new 2017 claim form or a sterilization consent form?
A: The new 2017 claim form and sterilization consent forms can be found in the following locations:
• In Appendix D of the 2005 Texas Medicaid Provider Procedures Manual
• Fax-back server is available through AIS at 1-800-925-9126
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Q: What number do I use to fax my Sterilization consent forms?
A: Fax your sterilization consent forms to Texas Medicaid & Healthcare Parternship (TMHP's) Family Planning department at 1-512-514-4229.
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Q: How do I bill for Teen Group Counseling on the new 2017 claim form if I don't have all the required information for each individual participant?
A: When billing for Teen Group Counseling, you will not need all the usual required information for the 2017 claim form. Entering the following information will allow your claim to process:
Family Planning Number = F99999999
Patient's Name = Teen Group Counseling (electronic billers : Last Name = Teen Group, first Name = Counseling
Patient's Social Security Number = 999-99-9999 Gender, Address, and Date of Birth will have a default value due to HIPAA.
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Q: What if the client refuses to give us his/her social security number?
A: You must enter a number in this field. If the client refuses to give his/her social security number or does not have one, you may enter 000-00-0001 as a default number.
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Q: If I am a Title X provider, do I have to give Level of Practitioner even if I'm billing for Title V, XIX, or XX?
A: Yes, all Title X providers must enter the Level of Practitioner regardless of the title being billed.
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Q: When and where can I find an existing client's Family Planning Number?
A: New clients are assigned a Family Planning Number by TMHP. This number will appear on your weekly Remittance & Status report. You may then keep it for your own records and submit it on future claims. However, if you do not have this number on file you may submit your claim without it. TMHP will search their eligibility file by name, social security number, and date of birth and assign the number.
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Q: Do I have to enter my Tax Identification Number on every claim? Doesn't TMHP have this number on file?
A: TAX ID is required by HIPAA.
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Q: How can I check the status of a claim before I receive my Remittance & Status report?
A: You may check the status of all claims using the AIS (Automated Inquiry System) by calling 1-800-925-9126. Upon entering the system, enter your new TPI number and select 6 # (pound) for Family Planning from the main menu. You will need the following information in order to check the status of your claim: patient's Family Planning Number, Date of Service and amount billed. You may also check the status of claims submitted through TDHConnect by using the Claim Status Inquiry feature.
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Q: Who do I call if I have questions and want to talk to a customer service representative about Family Planning claims?
A: You may call TMHP's Family Planning customer service at the AIS line, 1-800-925-9126.
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Q: Do I bill Title X like Title XX and XIX?
A: Title X contractors must submit a 2017 encounter form for each client visit. The 2017 form must be completed in the same manner as if it were a XX or XIX claim; i.e., the client demographic, birth control and service information must be filled out. Title X payment reimbursement must be submitted directly to DSHS using the DSHS required billing claim forms. For more information about billing Title X claims, visit the DSHS Family Planning website or call the DSHS Family Planning
Preventive and Primary Care Unit at
1-512-458-7796.
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Q: Have the claims submission timelines changed now that V and XX claims are also being processed by TMHP?
A: Yes and No. For Title XIX providers still have a 95-day limit for the submission of claims, with a 180 day period for appeals. Titles V and XX claims must be submitted within 120 days of the date of service, or 180 days for appeals. Title X encounters should also be submitted within 120 days of the date of service.
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Q: Do I still have to submit sterilization and complications claims on paper, or can I submit them electronically?
A: With Compass21, all sterilization and complications claims can be submitted electronically. You may submit them on paper if you desire, but it is no longer required. For sterilizations, the consent form must be faxed to TMHP's Family Planning department at 512-514-4229. If consent forms are not received within 10 days of claims submission, the claim cannot be processed. All complications will be sent to DSHS FPD for manual review. All attachments related to a complication claim must be mailed, or faxed to TMHP's Family Planning department. The fax number is 512-514-4229. The mailing address is: TMHP, Attn: Family Planning, P.O. Box 200555 , 78720-0555, Austin , TX ,
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Q: How do I bill laboratory tests under Compass21?
A: The procedures for billing laboratory tests will not change. All Medicaid claims must follow the CLIA guidelines; providers can only bill for tests for which they have a CLIA certificate.
For Title XX, providers contract with reference laboratories and pay the lab directly for any lab tests provided. On the claim form, Title XX providers will bill for all lab authorized tests provided to Title XX clients.
For Title V family planning providers, certain laboratory tests are provided at no additional cost through the DSHS lab - these tests are pre-paid by the Title V program (see reimbursement rate list). However, on the claim form, providers must report all laboratory tests provided. Providers will be reimbursed for those provided onsite, and the data will be captured for those sent to the DSHS labs.
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Q: What do I need to do if my claims have been denied (EOB 00356) for no consent on file?
A: The provider will need to fax the consent form using the 1-512-514-4229 number. Valid consent forms are entered in Compass21 within 24 hours of receipt. Providers must appeal denied claims by submitting a paper adjustment claim or an electronic adjustment. Providers can avoid sterilization denials for an invalid consent by faxing a complete, valid consent 2 days prior to submitting the claim.
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Q: If my consent was sent back to me as an invalid consent, what do I do?
A: Consents are returned to the provider with an explanation of the additional information required for a valid consent. Resubmit the corrected consent form to TMHP. If you don't understand why the consent was invalid, please contact a call center representative by calling the customer service line at 1-800-925-9126.
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Q: What type of service or place of service is used for sterilization?
A: Place of service 1 and type of service 1 are used when you are billing for Title V & XX sterilizations only. Title XIX sterilizations will continue to be billed as always using place of service 3 or 5 and type of service 2. This is for procedure code 58600 and 55250.
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