| October 2009 |
 | Nursing Facilities – Update to PC E and PC M Assessments for a One – Day Gap |
| Information posted October 27, 2009: Effective October 30, 2009 Texas Medicaid and Healthcare Partnership (TMHP) will implement a correction to the issue with submitting Purpose Code (PC E) and Purpose Code M (PC M) assessments for a one-day gap (see posting from October 22, 2009). Providers will again be able to submit PC E and PC M assessments with the same Missed Assessment Start Date and the Missed Assessment End date. For questions, please contact TMHP at 1-800-626-4117, Option 1.
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| Updates to the Long Term Care (LTC) Online Portal |
| Information posted October 1, 2009: Attention Community Waiver Providers. Effective October 16, 2009, the following updates will be made to the Long Term Care (LTC) Online Portal: The effective date of Medical Necessity and Level of Care (MN and LOC) assessments submitted with Reason for Assessment (AA8a) = 01(Initial / Admission) or 02 (Annual Assessment), will be determined by the TMHP Received Date rather than the Date Assessment Completed (R2b).
For questions regarding this update, please contact the Texas Medicaid & Healthcare Partnership (TMHP) at 1-800-626-4117, Option 1 or Option 2.
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| Provider Notification - Clients With Applied Income and Co-Pay |
| Information posted October 2, 2009: Effective October 2, 2009, TexMedConnect will populate the Client Responsibilities column (Co-pay/Applied Income) of each claims detail line. The client's Medicaid ID and service date are used to calculate the Co-pay/Applied Income amounts. While the calculated client responsibility can be overridden by entering a new value in the field, the system will still pay the Co-pay/Applied Income that's on file at TMHP.
Note: During Adjustments the Unit Rate must be changed if the claim was billed using Applied Income. Please use the following formula to calculate the Unit Rate. The values for this formula can be found on the Claim Status Inquiry (CSI) for the claim. ((Paid Units * Paid Unit Rate + Applied Income) / Paid Units)
For questions regarding this new feature please contact the Texas Medicaid and Healthcare Partnership at 1-800-626-4117, Option 1. |
| LTC19: Provider Inquiry Mail System (PIMS) Issue |
| Information posted October 7, 2009: Due to technical difficulties being experienced at the Texas Department of Aging and Disability Services (DADS), the Provider Inquiry Mail System (PIMS) is unavailable. Currently no estimated resolution time is known. PIMS is the system the following providers use to contact DADS Provider Claims Services (PCS), particularly to comply with security and privacy regulations when transmitting Protected Health Information (PHI): Nursing Facilities, Hospices, and providers of services in the following Community Services Waiver programs: Community Living Assistance and Support Services (CLASS); Deaf-blind with Multiple Disabilities (DBMD); Home and Community-based Services (HCS); Texas Home Living (TxHmL). DADS will issue an update when PIMS is operational. Until that time, providers are requested to review MESAV and the LTC Online Portal. Contact PCS at 512/438-2200, option 1. DADS regrets this inconvenience and thanks providers for their patience. |
| LTC20: Provider Inquiry Mail System (PIMS) Issue Resolution |
| Information posted October 9, 2009: For NF/Hospice and CLASS/DBMD/HCS/TxHmL Waiver providers: The Provider Inquiry Mail System (PIMS) is now operational. Providers that used PIMS any time between October 1 and October 8, 2009, but do not see requested changes reflected on Medicaid Eligibility Service Authorization Verification (MESAV), should resubmit the request. Providers listed below may use the system to contact DADS Provider Claims Services (PCS):
Nursing Facilities, Hospices, Community Living Assistance and Support Services (CLASS), Deaf-blind with Multiple Disabilities (DBMD), Home and Community-based Services (HCS), Texas Home Living (TxHmL).
DADS regrets any inconvenience and thanks providers for their patience.
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| LTC Online Portal Enhancements: Community Services Waiver Providers |
| Information posted October 13, 2009: Effective October 16, 2009, the effective date of Medical Necessity and Level of Care (MN and LOC) assessments submitted with Reason for Assessment (AA8a) = 01 (Initial / Admission) or 02 (Annual Assessment), will be determined by the TMHP Received Date rather than by the Date Assessment Completed (R2b). Please direct all questions regarding this change to TMHP at 1-800-626-4117, Option 1. |
 | Long Term Care Information Letter 09-150 |
| Information posted October 15, 2009: DADS has issued DADS Information Letter No. 09-150: Hospice Ventilator Services, addressed to Hospice Providers. Click on the title to link to the information letter. |
| Important Information for Community Services Waiver Providers |
| Information posted October 16, 2009: Texas Medicaid & Healthcare Partnership (TMHP) has identified an issue related to the Long Term Care (LTC) Online Portal. As a result of this issue, Medical Necessity and Level of Care (MN and LOC) assessments submitted after August 29, 2009, may have been assigned an incorrect Resource Utilization Group (RUG) value when all tabs of the assessment were not selected prior to submission. Click the title for more information. |
| TMHP Extended Scheduled System Maintenance |
| Information posted October 21, 2009: TMHP will perform scheduled system maintenance to the claims engine and Long Term Care (LTC) systems on Sunday, November 8, 2009, from 4:00 p.m. until 4:00 a.m. Monday, November 9, 2009. During the system maintenance window, some applications will be unavailable for both Acute Care and Long Term Care systems. Click on the title to view the details. |
| November Long Term Care Bulletin No. 40 |
| Information posted October 29, 2009: The November 2009 Long Term Care Bulletin No. 40 is now available. Click the title to view the bulletin.
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| September 2009 |
| Applied Income and Copayments |
| Information posted September 4, 2009: Beginning August 31, 2009 Long Term Care providers (with clients that have applied income or copayment) began experiencing some irregularities when billing batch or interactive LTC claims through TexMedConnect (TMC). These providers have seen the applied income or co-pay amounts or applied income or co-pay indicators change after the claim is submitted through TMC. Providers should continue to bill as normal. These irregularities do not affect a provider's ability to submit claims and be paid, because the provider is going to be paid what is on the Claims Management System. TMHP is working to resolve the issue as soon as possible. For questions about TexMedConnect, please contact TMHP at 1-800-626-4117, option 1 or option 3. |
| Long Term Care Remittance and Status (R&S) Reports |
| Information posted September 29, 2009: Some Long Term Care providers may be seeing discrepancies on their September 28, 2009 R & S Reports. Providers were paid appropriately but not all information was included on the non-pending R & S Report. TMHP and DADS have identified the problem and are working to resolve the discrepancy. Claims paid on 9/23/2009 that are not on the 9/28/2009 Non Pending R&S Report should be on the following week’s Non-Pending R&S Report. For specific information regarding claims payment, providers are directed to pull a Claim Status Inquiry as they normally would. For questions about the Remittance and Status Reports please call TMHP at 1-800-626-4117, option 1.
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| Enhancements to LTC Online Portal for Nursing Facilities and Hospice Providers |
| Information posted September 30, 2009: Effective October 2, 2009, the enhancements will be made to the Long Term Care (LTC) Online Portal for nursing facilities and hospice providers. Click on the title to view the details. |
| Enhancements to LTC Online Portal for Community Waiver Providers |
| Information posted September 30, 2009: Effective October 2, 2009, the enhancements will be made to the Long Term Care (LTC) Online Portal for Community Waiver providers. Click on the title to view the details.
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| August 2009 |
| Electronic Claims Submission Technical Issues Resolved |
| Information posted August 3, 2009: TMHP experienced a technical issue causing electronic claim submissions to reject with F0274 – “The billed applied income/billed co-pay amount is in an incorrect format." The issue has been resolved, and providers may resubmit electronic claims for processing. We apologize for the inconvenience. Please contact TMHP at 1-800-626-4117, option 1, for any further questions. |
| August 2009 Long Term Care Provider (LTC) Bulletin No. 39 |
| Information posted August 3, 2009: The August 2009 Long Term Care (LTC) Provider Bulletin No. 39 is now available for download from the TMHP.com file library.
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| Long Term Care Information Letter 09-73 |
| Information posted August 3, 2009: DADS has issued DADS Information Letter No. 09-73: FY09 Cutoff Dates for Miscellaneous Claims and Year-end Closeout Processing, addressed to Community Service Providers, Nursing Facility Providers, and Therapy Providers. Click on the title to link to the information letter. |
| Long Term Care Information Letter 09-74 |
| Information posted August 3, 2009: DADS has issued DADS Information Letter No. 09-74: FY09 Cutoff Dates for Miscellaneous Claims and Year-end Closeout Processing, addressed to ICF/MR Providers, Service Group 6. Click on the title to link to the information letter. |
| Long Term Care Information Letter 09-75 |
| Information posted August 3, 2009: DADS has issued DADS Information Letter No. 09-75: FY09 Cutoff Dates for Miscellaneous Claims and Year-end Closeout Processing, addressed to Home and Community-Based Service (HCS) Providers and Texas Home Living (TxHmL) Waiver Providers. Click on the title to link to the information letter. |
| Long Term Care Information Letter 09-76 |
| Information posted August 3, 2009: DADS has issued DADS Information Letter No. 09-76: FY09 Cutoff Dates for Miscellaneous Claims and Year-end Closeout Processing, addressed to ICF/MR Providers, Service Group 5. Click on the title to link to the information letter. |
| LTC17: For All LTC Online Portal Users |
| Information posted August 12, 2009: Due to technical difficulties at the Texas Department of Aging and Disability Services (DADS), in some instances, forms on the Long Term Care (LTC) Online Portal may be in "Processed/Complete" status but this may not be reflected on the Medicaid Eligibility Service Authorization Verification (MESAV). Providers should continue to check their MESAVs to determine if billing for services can be made. DADS is working to resolve this issue. We apologize for this inconvenience and thank providers for their continued patience.
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| LTC18: Provider Inquiry Mail System (PIMS) Issue – UPDATE |
| Information posted August 17, 2009: The Provider Inquiry Mail System (PIMS) is now operational.
Providers listed below may use the system to contact DADS Provider Claims Services (PCS): Nursing Facilities, Hospices, Community Living Assistance and Support Services (CLASS), Deaf-blind with Multiple Disabilities (DBMD), Home and Community-based Services (HCS), Texas Home Living (TxHmL).
DADS regrets any inconvenience and thanks providers for their continued patience.
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| System Upgrade to the Claims Engine and Long Term Care (LTC) Systems |
| Information posted August 19, 2009: TMHP will perform a system upgrade to the claims engine and Long Term Care (LTC) systems on Thursday, August 27, 2009, from 7:00 p.m. until midnight and on Friday August 28, 2009, from 7:00 p.m. until midnight. During the system upgrade window, some applications will be unavailable for both Acute Care and Long Term Care systems. Click on the title to view the details.
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| Nursing Facility/Hospice Providers: LTC Online Portal Updates Effective August 28, 2009 |
| Information posted August 19, 2009: Effective August 28, 2009, providers will no longer be able to submit Form 3652 Purpose Code E on the Long Term Care Online Portal. By this date, any gaps that had occurred while under the TILE payment system should have been filled. Providers should continue to refer to Information Letter No. 09-27, Clarification of Purpose Codes E and M, for how to complete Purpose Code E under the Resource User Group (RUG) Payment System. For questions regarding this update please contact the Texas Medicaid & Healthcare Partnership (TMHP) at 1-800-727-5436, Option 1.
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| Community Waiver Providers: LTC Online Portal Updates Effective August 28, 2009 |
| Information posted August 19, 2009: A small number of providers have experienced a problem with receiving a BC1 RUG (Resource User Group) when entering a ‘1’ in Field B1 of the Medical Necessity and Level of Care (MN and LOC) assessment. Providers should not have been receiving BC1 RUGs. Effective August 28, 2009, this problem has been corrected and providers may submit an MN and LOC assessment with a value of ‘1’ in Field B1 and receive a valid RUG level. For questions regarding this update please contact the Texas Medicaid & Healthcare Partnership (TMHP) at 1-800-727-5436, Option 1.
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| LTC Online Portal Updates Effective August 28, 2009: Nursing Facility/Hospice Providers |
| Information posted August 27, 2009: Effective August 28, 2009, providers will no longer be able to submit Form 3652 Purpose Code E on the Long Term Care Online Portal. By this date, any gaps that had occurred while under the Texas Index for Level of Effort (TILE) payment system should have been filled. Providers should continue to refer to Information Letter No. 09-27, Clarification of Purpose Codes E and M, for how to complete Purpose Code E under the Resource Utilization Group (RUG) Payment System. For questions regarding this update please contact the Texas Medicaid & Healthcare Partnership (TMHP) at 1-800-727-5436, Option 1.
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| LTC Online Portal Updates Effective August 28, 2009: Community Waiver Providers |
| Information psoted August 27, 2009: A small number of providers have experienced a problem with receiving a BC1 RUG (Resource Utilization Group) when entering a ‘1’ in Field B1 of the Medical Necessity and Level of Care (MN and LOC) assessment. Providers should not have been receiving BC1 RUGs. Effective August 28, 2009, this problem has been corrected and providers may submit an MN and LOC assessment with a value of ‘1’ in Field B1 and receive a valid RUG level. For questions regarding this update please contact the Texas Medicaid & Healthcare Partnership (TMHP) at 1-800-727-5436, Option 1.
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| Extended System Maintenance Window Scheduled |
| Information posted August 28, 2009: The hours for the system maintenance scheduled for Sunday, September 13, 2009, has been extended. TMHP will perform the scheduled system maintenance to the claims engine and Long Term Care (LTC) systems from Sunday, September 13, 2009, at 6:00 p.m. until Monday, September 14, 2009, at 3:00 a.m. During the system maintenance window, some functions will be unavailable for both Acute Care and LTC systems. Click on the title to view the details. |
 | CMS Advisory Council Meeting Minutes Now Available |
| Information posted August 31, 2009: The minutes of the August 12, 2009, meeting of the CMS Advisory Council are now available. Click on the title to view the minutes. Providers are reminded that they can view the minutes of past meetings by clicking on the CMS Advisory Council Meeting Minutes link in the main column on this webpage. |
| July 2009 |
| LTC Online Portal Enhancements Effective July 31, 2009 |
| Information posted July 31, 2009: The following enhancements to the Long Term Care (LTC) Online Portal are effective July 31, 2009. For questions regarding any of these portal enhancements please contact the Texas Medicaid & Healthcare Partnership (TMHP) at 1-800-727-5436, Option 1.
Click on the title for more details.
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| LTC15:NF - MDS AT&T Client Connection Issues |
| Information posted July 9, 2009: It has been reported that there has been a recent increase in the number of facilities having problems transmitting their MDS assessments to the State MDS Database using the AT&T Global Network Client software. The AT&T Global Network Client software is used by Nursing Facilities to connect to the Minimum Data Set (MDS) server and subsequently to submit MDS assessments. Nursing Facilities will know there is a connection issue if the MDS Welcome website is not displayed when trying to connect. An error message may be displayed. Click on the title for more information. |
| Attention: All LTC Providers |
| Information posted July 28, 2009: TMHP has identified a small number of instances (affecting relatively few providers) where multiple ‘child’ forms have been created and associated with a single ‘parent’ Document Locator Number (DLN). This has occurred with both Minimum Data Set (MDS) and Medical Necessity and Level of Care (MN and LOC) assessments as well as with Forms 3618 and 3619. This situation should not occur and is creating processing difficulties for the forms involved. To resolve this, TMHP will be removing certain pre-identified ‘child’ forms from the Long Term Care (LTC) Online Portal through a manual process. TMHP has contacted all affected providers via phone to alert them to the situation and elicit input to determine which forms should be removed from the LTC Online Portal. Please direct all questions on this matter to TMHP at 1-800-626-4117, Option 2.
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| Long Term Care Information Letter 09-94 |
| Information posted July 30, 2009: DADS has issued DADS Information Letter No. 09-94: Reminder: 12-Month Claims Payment Rule, addressed to Community Service Providers. Click on the title to link to the information letter. |
| LTC16: State Schools Name Changed to State Supported Living Centers |
| Information posted July 31, 2009: Effective June 11, 2009, the Texas Department of Aging and Disability Services' 11 state schools (Abilene, Austin, Brenham, Corpus Christi, Denton, Lubbock, Lufkin, Mexia, Richmond, San Angelo and San Antonio) and one state center (El Paso) were renamed “state supported living centers.” The Rio Grande State Center, administered by the Texas Department of State Health Services, is unaffected by this change. |
| June 2009 |
| LTC Online Portal Updates |
| Information posted June 5, 2009: Effective June 5, 2009 multiple changes to the LTC Online Portal will be noted by providers. These updates will include changes that affect correcting and inactivating all form types, diagnosis codes, My Draft functionality and 3rd party vendor submissions. Click on the title to view the details. |
| TMHP Scheduled System Maintenance for June 14, 2009 |
| Information posted June 5, 2009:TMHP will perform scheduled maintenance to the claims engine and Long Term Care (LTC) systems on Sunday, June 14, 2009, from 6:00 p.m. until 11:59 p.m. Some functions will be unavailable during this time period. Click on the title to view the details. |
| TMHP Requests Provider Feedback on Workshops |
| Information updated June 8, 2009: As part of the planning for 2010 provider education activities, the Texas Medicaid and Healthcare Partnership (TMHP) is asking for provider input on how educational workshops can be made more helpful to providers and their staff. Providers can give feedback to TMHP by completing a brief survey, which will be available through June 18, 2009. The survey takes about 10 minutes to complete. Click on the title to access the survey. |
| CMS Advisory Council Meeting Minutes Now Available |
| Information posted June 9, 2009: The minutes of the May 13, 2009, meeting of the CMS Advisory Council are now available. Click on the title to view the minutes. Providers are reminded that they can view the minutes of past meetings by clicking on the CMS Advisory Council Meeting Minutes link in the main column on this webpage.
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| Long Term Care Information Letter 09-61 |
| Information posted June 10, 2009: DADS has issued DADS Information Letter No. 09-61: ICM 1915(c) Waiver (ICMW) and Medical Necessity/Level of Care (MN/LOC) Assessments, Addressed to Integrated Care Management (ICM) Home and Community Support Services Agencies (HCSSAs). Click on the title to link to the information letter. |
| LTC12: Actions Needed to Resolve NF Provider Action Workflow Issues |
| Information posted June 12, 2009: This message is being provided to encourage Nursing Facility (NF) providers to promptly address the following Long Term Care (LTC) Online Portal Provider Action Required (PAR) workflow errors. These are the most common errors now being reported, and typically involve missing admission/discharge forms. Most if not all of these errors can be simply handled so that providers can successfully submit MDS assessments in order to begin billing and receiving payment. Providers are reminded to submit missing Form 3618/3619 admissions and discharges, and to inactivate invalid forms promptly, in order to clear issues from the NF PAR workflow. Please click on the title of this message for detailed information regarding specific PAR error messages. |
| Long Term Care Information Letter 09-72 |
| Information posted June 12, 2009: DADS has issued DADS Information Letter No. 09-72: TMHP Remittance and Status (R&S) Report Information, addressed to DADS Long Term Care Services and Supports (LTSS) Providers. Click on the title to link to the information letter. |
| LTC13: NF MDS Modifications resulting in a Purpose Code E |
| Information posted June 17, 2009: On May 8, 2009, TMHP released an enhancement to the Long Term Care (LTC) Online Portal to allow Nursing Facility (NF) provider modifications to an on-time Minimum Data Set (MDS) assessment to be accepted into the LTC Online Portal without requiring a Purpose Code for up to one year. Click on the title for more information.
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| NF MDS Form Extract Issue – Resolved |
| Information posted June 18, 2009: Attention Nursing Facility Providers: Beginning Tuesday June 9, 2009, the MDS Form extraction process from the State database returned to the normal hourly process. Providers should ensure that all pertinent and correct information is on the MDS form so that it will be extracted. If you experience problems with the form extract process, please contact the TMHP LTC Help Desk at 1-800-626-4117, Option 1.
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| LTC14: Nursing Facilities - Reminders on Submitting MDS Assessments |
| Information posted June 23, 2009: Nursing Facilities - Reminders on Submitting MDS Assessments for Residents who have previously established Permanent Medical Necessity (PMN). In order for the TMHP LTC Online Portal to recognize that a resident has already established permanent MN, the resident’s Medicaid number must be entered in Field AA7 (Medicaid No.). If a resident with PMN receives a pending denial or denied MN, verify if Field AA7 contains the correct Medicaid number. If it does not contain the correct Medicaid number, submit a modification to the CMS State Database to add the Medicaid number.
If the Field AA7 does contain the correct Medicaid number and the resident has previously established PMN Nursing Facilities are reminded to call PCS at 1-512-438-2200, Option 1 regarding denial or pending denials of MN.
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| Attention Nursing Facility/Hospice Providers:LTC Online Portal Update - Save LTCMI Feature |
| Information posted June 25, 2009: Effective May 29, 2009, the "Save LTCMI" feature was added to the LTC Online Portal. This new feature allows providers to save the Long Term Care Medicaid Information (LTCMI) section so any previously entered LTCMI data is not lost. This eliminates the need for providers to re-enter the information if the LTC Online Portal times out or additional time is needed to complete the LTCMI. The new "Save LTCMI" button is available in the Forms Action bar when a Minimum Data Set (MDS) Assessment is displayed. Click on the title for more information.
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| Permanent Medical Necessity for NFs |
| Information posted June 26, 2009: TMHP has identified an LTC Online Portal defect where the Medical Necessity record of Permanent (P) on the Medicaid Eligibility Service Authorization Verification (MESAV) for nursing facility (NF) residents is being changed to Approved MN Only (Y). It is not necessary to phone TMHP or DADS to resolve this issue. We apologize for this inconvenience; however, this incorrect indicator for Permanent MN should not affect payment or result in a denial of medical necessity. The type of Minimum Data Set (MDS) submitted also is not affected by the PMN indicator so this should not change any submissions for a provider’s MDS coordinator. When the defect has been resolved, an automated cleanup will occur to correct all of the Permanent indicators. Any questions or concerns may be addressed to the TMHP Help Desk at 1-800-626-4117, Option 1.
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| May 2009 |
| LTC8: Portal Status of Med ID Pending - For NFs |
| Information posted May 1, 2009: This Long Term Care (LTC) News notice applies to Forms 3618, 3619 and Minimum Data Set (MDS) Assessments. Nursing facility providers that have submitted a form with a Medicaid ID greater than 9 characters and the portal status is "Medicaid ID Pending" should follow these steps: (1) Forms 3618/3619 - 'Inactivate' the form and 'Use as template' to submit the corrected Medicaid ID; (2) MDS - Submit an MDS Modification at the State MDS Database with the corrected Medicaid ID and then complete the Long Term Care Medicaid Information (LTCMI) on the LTC Online Portal. Effective May 31, 2009, the Texas Department of Aging and Disability Services (DADS) will 'Inactivate' any forms that were submitted with a Medicaid ID greater than 9 characters with a portal status of "Medicaid ID Pending" that have not been addressed by the nursing facility provider. If needed, contact the TMHP Helpdesk at 1-800-727-5436 or 1-800-626-4117, Option 1. |
| MDS Form Extraction Update |
| Information posted May 1, 2009: A technical issue was identified that has disrupted the hourly MDS form extraction process from the State database. The MDS form extraction process is running on a daily basis during off-business hours. Further research has revealed there are MDS forms that were submitted to the Federal database between April 12, 2009 and April 29, 2009 that are not on the LTC Online Portal. These forms will be available on the LTC Online Portal by Monday, May 4, 2009 for completion of the LTCMI section by providers.
During the following week, TMHP will look for forms submitted to the Federal database prior to April 12, 2009 to identify if other forms were missed in the extraction process.
Any further questions or concerns should be directed to the LTC Help Desk at 1-800-626-4117, option 1.
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| MDS Extract Update |
| Information posted May 6, 2009: Beginning Tuesday May 5, 2009, duplicate MDS forms were reported by nursing facility providers in their Current Activity report on the LTC Online Portal. Effective May 6, 2009, the duplicate MDS forms are no longer viewable to providers when accessing the Current Activity report or through a Form Status Inquiry. Providers do not need to take any action on the duplicate forms. Please contact the TMHP Help Desk at 1-800-626-4117, Option 1 for further questions.
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| LTC9: Payment for Hurricane Ike-related Costs |
| Information posted May 6, 2009: On January 12, 2009, providers were notified via Information Letters No. 2009-04 and 2009-03 that funds had been appropriated to Texas for Hurricane Ike-related costs. DADS began collecting information on hurricane-related costs September 7, 2008, from Long Term Care (LTC) providers that accepted non-Medicaid eligible evacuees. [Information Letter 2009-03, Cost Information Requested by January 22, 2009, for LTC Services Provided to non-Medicaid evacuees during Hurricane Ike, and Information Letter No. 2009-04, Cost Information Requested by January 22, 2009, for Transportation Services Provided to DADS clients during Hurricane Ike]. Note: These letters have expired and been withdrawn from the DADS Letters to Providers Webpage.
This is to inform providers that DADS has now been authorized to reimburse providers for hurricane-related costs (uncompensated care and non-reimbursed transportation costs.
Click on the title for more information.
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| MDS Form Extract Update |
| Information posted May 6, 2009: The MDS forms that were missed in the daily extraction process between April 12, 2009 and May 3, 2009 have been extracted and are available on the LTC Online Portal for providers to complete the LTCMI section. If you have submitted the MDS on-time to the Federal Database, you will have until May 15, 2009 to complete the associated LTCMI. The LTCMI must be completed as a Purpose Code E; however, providers will be paid at the calculated rate if the MDS was submitted on time . TMHP continues to evaluate forms submitted to the Federal database prior to April 12, 2009 to identify if other forms were missed in the extraction process. The MDS form extraction process is running on a daily basis. For any questions regarding the MDS extraction process, please contact TMHP at 1-800-626-4117, Option 1.
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| Attention Nursing Facility Providers |
| Information posted May 7, 2009: Effective 5/8/09 changes have been made to the LTC Online Portal that will allow Pending LTCMI on Modifications on MDS from the State Database and corrections to the LTCMI to be submitted without having to complete a Purpose Code E provided that the original assessment (MDS with a LTCMI) met the established timeliness rules. For Modifications and corrections to MDS assessments that did not originally meet the timeliness rules (including the submission of the LTCMI), a Purpose Code E will still be required. For further questions, please contact the TMHP Help Desk at 1-800-626-4117, Option 1.
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| MDS Form Extract Update |
| Information posted May 8, 2009: This is an update to the information posted May 6, 2009, and replaces that information.
Click on the title to view the updated information. |
| LTC10: Minimum Data Set (MDS) Server Maintenance May 14-15 |
| Information posted May 12, 2009: On May 14 and May 15, 2009, the state MDS server will be shut down for maintenance. Providers should submit assessments prior to May 14 if necessary to avoid any that may become late. The state MDS server will be unavailable from 12:00 a.m. on May 14 until 11:59 p.m. on May 15 (possibly earlier). The Minimum Data Set (MDS), Outcome and Assessment Information Set (OASIS), and Swing Bed systems will not be available during this time. We appreciate your patience.
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| Long Term Care Information Letter 09-47 |
| Information posted May 14, 2009: DADS has issued DADS Information Letter No. 09-47: ICM Contract Termination and Program Changes, addressed to Integrated Care Management (ICM) Long-term Services and Supports (LTSS) Providers. Click on the title to link to the information letter. |
| Long Term Care Information Letter 09-62 |
| Information posted May 20, 2009: DADS has issued DADS Information Letter No. 09-62: Medical Necessity and Level of Care (MN and LOC) Changes, addressed to Community Service Waiver Providers. Click on the title to link to the information letter. |
| Waiver Providers – LTC Online Portal Enhancements |
| Information posted May 28, 2009: Effective May 29, 2009, multiple enhancements to the LTC Online Portal will be available to Long Term Care (LTC) Waiver providers. LTC Waiver providers will notice that field I1aa2, Frequency of Seizure, will now accept a ‘0’ in that field. Waiver providers will also see that Medical Necessity and Level of Care (MN and LOC) assessments that result in a BC1 RUG will no longer be accepted onto the LTC Online Portal and providers will receive an error at the time of submission. For additional, detailed information on these enhancements, click on the title of this message.
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| Nursing Facility Providers – LTC Online Portal Enhancements |
| Information posted May 28, 2009: Effective May 29, 2009, multiple enhancements to the LTC Online Portal will be available to Nursing Facility (NF) providers. NF providers now have a button to “Save LTCMI” in draft form prior to submitting the Long Term Care Medicaid Information; NF providers can now “Populate LTCMI” with demographic data from previous Long Term Care Medicaid Information (LTCMI) sections; 3619 forms may receive an error message related to the Medicare qualifying stay days; and five additional LTC Online Portal error messages have been added to the Provider Action Required (PAR) workflow. For additional, detailed information on these new features, click on the title of this message.
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| Nursing Facility Providers - Populate LTCMI Enhancement Update |
| Information posted May 29, 2009: TMHP has identified an issue with the new "Populate LTCMI" enhancement. Incorrect client information may be populated to the new LTCMI when using this feature if the following criteria exist: multiple clients with the same last name, in the same facility (vendor/contract) and where the Medicaid, SSN and Medicare fields are blank on both the new and old MDS forms. Providers should be certain to verify that the information populated to the LTCMI matches the MDS form and is correct and complete before submitting the LTCMI. TMHP is working to resolve this issue as quickly as possible. For any questions regarding the Populate LTCMI feature please contact the TMHP Help Desk at 1-800-626-4117, Option 1.
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| LTC11: Update on Planned Automation Changes for NFs |
| Information posted May 29, 2009: Please click on the title of this message for information regarding release of May 29, 2009, Long Term Care (LTC) system enhancements for nursing facility (NF) providers. |
| April 2009 |
| TMHP Scheduled System Maintenance |
| Information posted April 3, 2009: TMHP will perform scheduled system maintenance to the claims engine and long term care (LTC) systems on Sunday, April 12, 2009, from 6:00 p.m. until 11:59 p.m. Some functions will be unavailable during this time period. Click on the title to view the details.
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| Attention Community Waiver Providers: Provider Action Required – Messages and Detailed Instructions |
| Information posted April 14, 2009: Recent enhancements have been made to 4 common error messages that Waiver providers see on the LTC Online Portal. Changes have been made to the Provider Messages and instructions to assist providers with processing the MN and LOC. A copy of the new messages can be viewed and printed out by clicking on the title of this message. |
| LTC6: PCS Hotline Request |
| Information posted April 16, 2009: In an effort to better serve NF providers by addressing and reducing the current inventory of forms and telephone cases, Claims Management is taking a three-fold approach. Click on the title for more information. |
| Technical difficulties affecting the MDS form extraction process |
| Information posted April 16, 2009: Due to technical difficulties affecting the MDS form extraction process through the TMHP LTC Online Portal, providers may experience unusual or unexpected results. The issue has been identified, and we are working to resolve the problem as quickly as possible. A message will be posted to notify providers when the issue has been resolved. We apologize for any inconvenience. |
| Long Term Care Information Letter 09-43 |
| Information posted April 16, 2009: DADS has issued DADS Information Letter No. 09-43: MDS Admission Assessment, addressed to Nursing Facility (NF) Providers. Click on the title to link to the information letter. |
| LTC7: Process for inactivating duplicate forms |
| Information posted April 16, 2009: The purpose of this communication is to inform providers of the process for handling duplicate 3618 and 3619 forms submitted on the TMHP LTC Online Portal. Click on the title to view the details. |
| Update to the MDS Form Extraction Process |
| Information posted April 22, 2009: Issues with the MDS Form extraction process have been partially resolved.
MDS forms are not currently being extracted hourly as providers have become accustomed to. However, forms are being extracted at least once a day from the MDS database. Providers should now be able to view all forms that were submitted up through the previous day. TMHP and DADS continue to work towards a complete resolution of this issue. A message will be posted to notify providers when the issue has been resolved. We apologize for any inconvenience. For further questions please contact the TMHP Help Desk at 1-800-626-4117, Option 1
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| Long Term Care Information Letter 09-47 |
| Information posted April 28, 2009: DADS has issued DADS Information Letter No. 09-47: ICM Contract Termination and Program Changes, addressed to Integrated Care Management (ICM) Long-term Services and Supports (LTSS) Providers. Click on the title to link to the information letter |
| Long Term Care Information Letter 09-52 |
| Information posted April 28, 2009: DADS has issued DADS Information Letter No. 09-52: ICM 1915(c) Waiver (ICMW) -- Quarterly Nursing Assessments, addressed to Integrated Care Management (ICM) Home and Community Support Services Agencies (HCSSAs). Click on the title to link to the information letter. |
| Long Term Care Information Letter 09-56 |
| Information posted April 28, 2009: DADS has issued DADS Information Letter No. 09-56: Clarification That Time Using Continuous Positive Airway Pressure (CPAP) or Bi-level Positive Airway Pressure (BIPAP) Devices Cannot Be Counted as Time to Request Reimbursement for Ventilator/Respirator for Residents, addressed to Nursing Facility (NF) Providers. Click on the title to link to the information letter. |
| May 2009 Long Term Care Bulletin No. 38 |
| Information Posted April 28, 2009: The May 2009 Long Term Care Bulletin No. 38 is now available. Click the title to view the bulletin. |
| March 2009 |
| LTC2: Upcoming Changes to NF Provider Action Required Workflow (Provider Workflow) Messages |
| Information posted March 5, 2009: Attached are the portal error codes that DADS and TMHP have determined to be the top eleven error codes that nursing facilities are receiving in their Provider Workflow on the LTC Online Portal. The intent of this document is to assist nursing facilities in better understanding and resolving forms in the Provider Action Workflow. Click on the title for more information and for a link to the Provider Action Required Message Instructions. |
| Regarding the Long Term Care Portal |
| Information posted March 2, 2009: Due to technical difficulties at DADS, in some instance forms on the portal may be in "Processed/Complete" status but may not be reflected on the MESAV. Providers should continue to check their MESAVs to determine if billing for services can be made. DADS is working to resolve this issue. We apologize for this inconvenience and thank providers for their continued patience. |
| LTC1: NF Tips for Clearing Forms |
| Information posted March 5, 2009: Beginning in February, DADS and TMHP began making system changes to clear out the LTC Online Portal inventory. See attached information that nursing facilities can use to clear forms from their Provider Workflow (Provider Action Required Workflow) without waiting for DADS or TMHP to do so. Click on the title for more information.
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| LTC3: Resolution of Technical Difficulties Affecting LTC Forms |
| Information posted March 5, 2009: Technical difficulties affecting forms submission on the LTC Online Portal have been resolved. Providers should continue to access MESAV for accurate status: information on the MESAV indicates the services providers can bill for regardless of the status in the TMHP LTC Online Portal. Again, DADS apologizes for any inconvenience and thanks providers for their patience with technical difficulties experienced this week.
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| CMS Advisory Council Meeting Minutes Now Available |
| Information posted March 11, 2009: The minutes of the February 11, 2009, meeting of the CMS Advisory Council are now available. Click on the title to view the minutes. Providers are reminded that they can view the minutes of past meetings by clicking on the CMS Advisory Council Meeting Minutes link in the main column on this webpage.
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| TMHP EMERGENCY System Maintenance - March 15, 2009 |
| Information posted March 11, 2009: TMHP will perform emergency system maintenance from 6:00 p.m. this Sunday, March 15, 2009 until 3:00 a.m. on Monday, March 16, 2009. During the system maintenance window, some applications will be unavailable for both Acute Care and Long Term Care systems. Click on the title to view the details. |
| Attention NF/Hospice Providers: Provider Action Required – Messages and Detailed Instructions |
| Information posted March 16, 2009: Recent enhancements have been made to the 11 most common error messages that nursing facilities see on the LTC Online Portal. Detailed instructions have been added to assist nursing facilities with processing LTC forms and assessments. A copy of the new messages and detailed instructions can be viewed and printed out by clicking on the title of this message. |
| Attention NF/Hospice Providers |
| Information posted March 19, 2009: With the March 6, 2009 system release the LTC Online Portal is not allowing providers to submit a 3618/3619 admission and discharge with the same Date of Above Transaction as they had previously been able to do. TMHP is aware of the problem and is working to develop a solution. Please check the tmhp.com webpage for further updates.
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| LTC4: NF Problem Escalation Reminder |
| Information posted March 20, 2009: This information has been removed and is no longer applicable. |
| Long Term Care Information Letter 09-23 |
| Information posted March 20, 2009: DADS has issued DADS Information Letter No. 09-23: Clarification of Nursing Facility Form Submission Procedures, addressed to Nursing Facility (NF) Providers. Click on the title to link to the information letter. |
| Attention NF/Hospice Providers |
| Information posted March 26, 2009: Effective March 23, 2009 providers are once again able to submit 3618/3619 forms with the same Date of Above Transaction. We apologize for any inconvenience providers might have experienced with submitting these forms.
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| LTC5: MDS modifications to NF assessments outside the 92-day timeframe |
| Information posted March 27, 2009: DADS and TMHP have received questions regarding modifications to MDS assessments that are received outside of the 92-day timeframe. Please click on the title of this message to read additional information on this subject. |
| February 2009 |
| Attention Waiver Providers |
| Information posted February 10, 2009: Recent enhancements to the LTC Online Portal have resulted in changes. Click on the title for details of the changes.
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| Attention NF/Hospice Providers |
| Information posted February 10, 2009: Recent enhancements to the LTC Online Portal have resulted in changes. Click on the title for details of the changes.
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| Technical Difficulties Affecting Forms Submission |
| Information posted February 20, 2009: Due to technical difficulties affecting forms submission through the TMHP LTC Online Portal, providers may be experiencing unusual or unexpected results. The issue has been identified and we are working to resolve the problem as quickly as possible. A message will be posted to notify providers when the issue has been resolved. We apologize for any inconvenience.
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| February 2009 Long Term Care Bulletin No. 37 |
| Information posted February 9, 2009: The February 2009 Long Term Care Bulletin No. 37 is now available. Click the title to view the bulletin. |
| Resolution of Technical Difficulties Affecting LTC Forms Processing |
| Information posted February 17, 2009: Technical difficulties that were being experienced by users of the LTC Online Portal have been resolved. DADS apologizes for the inconvenience and thanks providers for their patience during this time. |
| Technical Difficulties Affecting LTC Forms Processing |
| Information posted February 5, 2009: As the result of a power outage affecting systems at DADS, technical difficulties are affecting all forms processed through the TMHP LTC Online Portal. This may cause providers to experience unusual or unexpected results. Errors that are being experienced include: forms remaining in certain statuses without processing, some MDS forms recently submitted to Federal CMS not being visible on the portal, permanent medical necessity not being displayed for a qualifying client, and forms not being accepted by the portal or being rejected for incorrect reasons. While there currently is no estimated resolution time, work is underway to resolve the issues as quickly as possible. DADS apologizes for the inconvenience. Additional information will be posted to the LTC web page as it becomes available.
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| Long Term Care Program - Delays Affecting LTC Forms Processing |
| Information posted February 10, 2009: There is a delay in updating forms status in the LTC Online Portal. Due to technical difficulties providers may see a discrepancy between what is reflected in the LTC Portal and what is reflected in their MESAVs. Providers are reminded that information on the MESAV is correct and indicates the services providers can bill for regardless of the status in the Portal. DADS apologizes for the inconvenience. Providers will be notified when this has been resolved.
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| Nursing Facility Forms Inventory Cleanup Notice |
| Information posted February 16, 2009: During the month of February, beginning Friday, February 13, 2009, DADS and TMHP will be making some system changes and taking automated steps to clear out the LTC Online Portal inventory. The inventory includes those forms and assessments that are in either the Provider Claims Services (PCS) Workflow (“Submitted to PCS”) or the Provider Workflow (“NH Provider Action Required”). Click on the title for more information.
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| Attention NF/Hospice Providers |
| Information posted February 16, 2009: On February 13, 2009, a new release of the LTC Online Portal was implemented. Prior to the February 13th Portal release, providers had been receiving a rejection error if they submitted a 3618/3619 admission and discharge with the same Date of Above Transaction (client being admitted and discharged on the same day). With this new release, providers can now submit a 3618/3619 admission and discharge with the same Date of Above Transaction and the forms that were previously rejected from the Portal can be re-submitted.
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| CMS Advisory Council Directory Now Available |
| Information posted February 17, 2009: The LTC Claims Management System Advisory Council membership list has been updated. The CMS Advisory Council meets quarterly to discuss upcoming changes and projects affecting users of the DADS Claims Management System. Notes from Council meetings are posted on TMHP.com under "CMS Advisory Council Meeting Minutes." Click on the title to access this document. |
| DADS TPR Faxes Not Received from NFs February 17-noon February 18. |
| Information posted February 20, 2009: Due to a fax system error, anything faxed to the DADS Third Party Recovery (TPR) Unit at (512) 438-3400 from Tuesday, February 17, through noon Wednesday, February 18, 2009, should be faxed to this number again. DADS apologizes for this inconvenience and, although it was not possible to restore the lost faxes, is working with the fax system vendor to determine cause/s in an effort to prevent further problems of this nature.
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| Update to TMHP Scheduled System Maintenance for March 8, 2009 |
| Information posted February 20, 2009: This is an update to the announcement of scheduled system maintenance for Sunday March 8, 2009. The outage window for March 8, 2009, will be extended by two hours from 6:00 p.m. until 2:00 a.m. on Monday, March 9, 2009, to allow for the performance of additional operating system maintenance. Some functions will be unavailable during this time period. Click on the title to view the details. |
| Technical Difficulties Affecting LTC Forms Processing – Resolved |
| Information posted February 24, 2009: Technical difficulties that were being experienced by users of the LTC Online Portal affecting forms submission have been resolved. We apologize for the inconvenience and thank providers for their patience during this time. |
| Reminder to All LTC Providers |
| Information posted February 24, 2009: In some instances, there may be a discrepancy between what is reflected in the TMHP LTC Online Portal and what is reflected in their MESAVs (Medicaid Eligibility Service Authorization Verifications). Providers are reminded that information on the MESAV is correct and indicates the services providers can bill for regardless of the status in the TMHP LTC Online Portal. After 10 business days, from the date the form shows up on the NH Provider Action Required workflow, facilities may contact PCS or TMHP for assistance.
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| Long Term Care Information Letter 09-27 |
| Information posted February 26, 2009: DADS has issued DADS Information Letter No. 09-27: Clarification of Purpose Codes E and M, addressed to Nursing Facility (NF) Providers. Note: This letter replaces DADS Information Letter No. 08-181, RUGs Information Requiring Special Attention, which is hereby rescinded. Click on the title to link to the information letter. |
| January 2009 |
| MESAV Reviews Needed |
| Information posted January 6, 2009: Providers are being requested to review Medicaid Eligibility Service Authorization Verifications (MESAVs) to determine how the January 1, 2009, Social Security Income (SSA) changes affected Applied Income (AI) for their consumers. |
| Request for NFs to Resend Rehab / Specialized Therapy Faxes |
| Information posted January 27, 2009: Nursing Facility Providers - due to a phone line outage, requests faxed to (512) 438-2302 on the following dates need to be retransmitted: Friday, January 23; Saturday, January 24; Sunday, January 25; and prior to 10 a.m. Monday, January 26, 2009. DADS apologizes for the inconvenience.
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| Provider Training Materials Available |
| Information posted January 22, 2009: REMINDER: DADS and TMHP wish to remind all LTC providers that all training materials provided by TMHP are available on TMHP.com. The materials are available on the LTC home page of this web site at the top right just above the LTC News section. The LTC Training Materials section includes provider training materials listed by program and also includes updated information on LTC Online Portal enhancements.
In most cases, this material supplies the information that providers routinely need to submit forms and claims. Reviewing these materials can be advantageous to help answer questions that providers may have about forms processing, this can expedite resolution in lieu of calling Provider Claims Services or TMHP.
Questions about how to download or locate specific training materials may be referred to TMHP at 1/800-626-4117, Option 1. |
| Secure PCS Mail Not Received January 1-7 |
| Information posted January 21, 2009: Due to an email server outage, DADS Provider Claims Services did not receive email sent January 1-7, 2009, to the following address: http://ausmis31.dhs.state.tx.us/cmsmail.
Please re-send any email sent to that address during the listed dates, and use the following text to notify DADS of the date the email was first sent:
Duplicate - email first sent 1/7/09. [Please replace 1/7/09 with the actual date the message initially was emailed.]
DADS apologizes for this inconvenience.
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| TMHP Scheduled System Maintenance |
| Information posted January 14, 2009: TMHP will perform extended scheduled maintenance to the Claims Engine and Long Term Care systems from 12 a.m. Sunday, January 18, 2009 until 5 a.m. Monday, January 19, 2009. Some functions will be unavailable during this time period. Click on the title to view the details. |
| Claims Deadline for LTC Services Provided to Non-Medicaid Evacuees during Hurricane Ike |
| Information posted January 16, 2009: Some providers are experiencing problems with the DADS disaster website in submitting claims related to Hurricane Ike. Because of the importance of collecting this data by January 22, 2009, DADS is asking that providers unable to submit using the disaster website, complete the attached form according to the attached instructions. Please note that one form per client must be manually completed. The form(s) should be faxed by January 22, 2009 to the attention of Candy Mata at 512/438-4380. Please contact Provider Claims Services at 512/438-2200, Option 1, with any questions regarding this message.
Click on the title to download the form. The Claim Instructions and Information Letter No. 2009-03 are posted below this article for your reference.
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| NF/Hospice Provider Tips for When to Submit an MDS PC E |
| Information posted January 13, 2009: This LTC News notice provides information to help Nursing Facility / Hospice providers determine when to submit a Minimum Data Set (MDS) Purpose Code E (PC E). Click on the title to view the information. |
| Long Term Care Information Letter No. 2009-04 |
| Information posted January 13, 2009: Cost Information Requested by January 22, 2009, for Transportation Services Provided to DADS Clients during Hurricane Ike.
Addressed to: Long Term Care Providers. Click on the title to view the information letter. |
| Long Term Care Information Letter No. 2009-03 |
| Information posted January 12, 2009: Cost Information Requested by January 22, 2009, for LTC Services Provided to Non-Medicaid Evacuees during Hurricane Ike. Addressed to: Nursing Facility Providers, Intermediate Care Facility for Persons with Mental Retardation (ICF/MR) Providers; Home and Community Support Service Agencies. Click on the title to view the information letter. |
| Instructions for Submitting Costs for NonMedicaid Services Provided during Hurricane Ike |
| Information posted January 15, 2009: Website instructions are attached to assist providers in submitting hurricane-related cost information for LTC services provided to NonMedicaid Evacuees. While these instructions are available on the DADS disaster payments website at http://cfoweb.bdm.dhs.state.tx.us/templates/ike%20template%20blank.xls, it can be useful for providers to print and preview these instructions prior to accessing the site. For details, please refer to DADS Information Letter 2009-03, Cost Information Requested by January 22, 2009, for LTC Services Provided to NonMedicaid Evacuees during Hurricane Ike. Click on the title to view the instructions.
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| LTCMI Time-out Issue – How to Prevent the Timing Out of the LTCMI |
| Information posted January 26, 2009: It is important to note that when completing the LTCMI, the form will time-out after 20 minutes of no activity. To prevent this from happening, the nursing facility has several options. Click on the title to view the options.
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| Long Term Care Information Letter No. 2009-10 |
| Information posted January 27, 2009: DADS Information Letter No. 2009-10, Online Availability of Rehabilitative/Specialized Therapy and Emergency Dental Service Request Forms, notifies Nursing Facility providers that forms used to request Rehabilitative Therapy, Specialized Therapy, or Emergency Dental services are now available online. NF providers should view the full letter for complete information. Click on the title to view the letter. |
| December 2008 |
| RUGs Q/As for Community Waivers and NF/Hospice Providers |
| Information posted December 4, 2008: As discussed in the November 2008 DADS Claims Management System (CMS) Advisory Council meeting, the attached provides answers to the most frequently received TMHP Call Center/Help Desk Nursing Facility/Hospice inquiries regarding Resource Utilization Groups (RUGs). Click on the title to view the document. |
| Long Term Care Information Letter No. 2008-176 |
| Information posted December 5, 2008: DADS Information Letter No. 2008-176: Billing for Dental Services informs HCS and TxHmL providers of the requirement effective 12/3/08 to request services and bill claims separately for dental services and anesthesiology services. Click on the title to view the Information Letter. |
| Long Term Care Information Letter No. 2008-166 |
| Information posted December 9, 2008: DADS Information Letter No. 2008-166: Nurse Aide Training Billing Reminder provides information for Nursing Facility Providers to bill for NAT classes and testing, including Attachment 1 information on NAT Bill Codes and how to complete selected fields.
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| Software Updates to the TMHP LTC Online Portal |
| Information posted December 8, 2008: Attention providers: Software updates to the TMHP LTC Online Portal will be released on December 5, 2008. Items affecting Nursing Facilities (NF)/Hospice Providers and Community Services (CS) Providers are addressed by this update. Click on the title for more information.
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| TMHP LTC Online Portal Releases Since Sept. 1, 2008 |
| Information posted December 8, 2008: Click on the title for information regarding software updates released to the TMHP Online Portal since September 1, 2008. |
| Medical Records Requests for PERM Review |
| Information posted December 5, 2008: In 2008, the Centers for Medicare & Medicaid Services (CMS) began the Payment Error Rate Measurement (PERM) review process in Texas to measure the accuracy of payments in Medicaid and the Children's Health Insurance Program (CHIP). Claims are randomly selected for review by Livanta LLC, the CMS Documentation Database Contractor. Click on the title to view the details. |
| Long Term Care Information Letter No. 2008-178 |
| Information posted December 11, 2008: DADS Information Letter No. 2008-178, Service Authorization Notification for Durable Medical Equipment (DME), notifies ICR/MF Service Group 6 (SG-6) Providers that DADS is eliminating the fax notification when service authorization(s) have been approved for DMEs effective December 11, 2008. Providers should view service authorization approvals and updates by requesting a Medicaid Eligibility Service Authorization Verification (MESAV) through TexMedConnect. SG-6 providers should view the full letter for complete information. Click on the title to view the letter. |
| Long Term Care Information Letter No. 2008-177 |
| Information posted December 11, 2008: DADS Information Letter No. 2008-177, Service Authorization Notification for Emergency Dental Services, notifies Nursing Facility Providers that DADS is eliminating the fax notification when service authorization(s) have been approved for Emergency Dental Services effective December 11, 2008. Providers should view service authorization approvals and updates by requesting a Medicaid Eligibility Service Authorization Verification (MESAV) through TexMedConnect. NF providers should view the full letter for complete information. Click on the title to view the letter. |
| LTC Online Portal Updates |
| Information posted December 31, 2008: Recent enhancements to the LTC Online Portal will result in the following changes: 1. On the Form Status Inquiry (FSI) search page, the form status options will now present in alphabetical order
2. The portal can now accept birth dates prior to 1900. If a provider has an MDS form that they have been unable to submit due to the portal not accepting a birth date from the 1800s, the provider will need to submit a modification to the State MDS database for the MDS form so it will be pulled into the LTC Online Portal again. A suggested modification is to change field AT3 (Reason for Modification) on the MDS Correction Request Form = e (other error). Once the modified form is in the LTC Online Portal, the provider will need to submit the LTCMI in order to complete the submission.
Questions regarding these enhancements should be directed to the TMHP LTC General Inquiry phone line at 1-800-626-4117, option 1.
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| April 2008 |
| TDHconnect Will be Discontinued May 24, 2008 |
| Information posted April 4, 2008: Effective May 24, 2008, full NPI compliance will be implemented and the contingency period will end. TDHconnect will be discontinued at this time. When full NPI compliance is implemented, all electronic transactions (e.g., claims filing, authorization requests, eligibility verifications, and claim status inquiries) must be processed using NPIs and not legacy Provider Numbers. Providers that have not reported their NPI and related data to DADS will experience rejection or denial of paper and electronic claims, forms, and other transactions.
Providers will be required to complete electronic transactions through either [1] TexMedConnect (the online TMHP replacement for TDHconnect) or [2] third-party billers that submit files on the provider’s behalf. All electronic transactions submitted through TDHconnect will be rejected.
For more information, call the TMHP Contact Center at 1-800-925-9126.
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| Claims Engine and Long Term Care Systems Maintenance Scheduled For April 13, 2008. |
| Information posted April 4, 2008: TMHP will perform scheduled maintenance to the claims engine and long term care (LTC) systems on April 13, 2008, from 6:00 p.m. until 11:59 p.m. Some functions will be unavailable during this time period. Click on the title to view the details. |
 | RUG (Resource Utilization Group) Training Available Beginning April 1, 2008 |
| Information posted April 1, 2008: This RUG training replaces the existing Texas Index of Level of Effort (TILE) training offered by Texas State University. All nurses responsible for completing assessments are required to complete this training before their RUG assessments will be accepted to authorize services. Implementation of RUG methodology is scheduled September 1, 2008. Please see Information Letter #08-02 (on this page) for additional information about the TILEs to RUGs transition. Please also watch for additional communications regarding the training and transition.
For additional information, click on the title of this article to visit Texas State University's Continuing Education Website.
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| January 2008 |
| UPDATE: Planned DADS Payment System Downtime |
| Information posted January 23, 2008: This is to notify you that the Health and Human Services Accounting System (HHSAS) upgrade remains on schedule as planned. Refer to the January 11, 2008, DADS Information Letter No. 07-126, Final Notice of Tentatively Planned DADS Payment System Downtime for All Provider Payments, regarding dates affecting your Provider Type. Providers are encouraged to monitor this site for further updates and should continue to submit claims as usual.
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| Long Term Care Information Letter No. 07-125 |
| Information posted January 25, 2008: Information letter regarding Office of Inspector General Review of Personal Assistance Services. Click on the title to link to the Information Letter. |
| 2008 |
| RUG Update Information for LTC Community Waivers Providers |
| Information posted August 22, 2008: The following RUG Update Information is being posted for LTC Community Waivers Providers.
Medical Determination on Significant Changes: This is to clarify that Medical Necessity (MN) determinations will not be done on MN & LOC significant changes submitted by Waiver Program providers through the LTC Online Portal effective September 1, 2008.
Physician’s Signature Required: Providers are being reminded that although the current MN and LOC Assessment form does not include a place for a physician signature, a physician’s signature is required on all initial MN and LOC assessments.
BC1 RUG Value: BC1 RUG Value is considered to be a default value. Default RUG BC1 is assigned because the system is unable to calculate actual RUG based on the assessment submitted. Community Service waivers have 14 days to correct an assessment or inactivate the form and submit a new one. |
 | Long Term Care Information Letter No. 07-68 |
| Information posted July 20, 2008: Implementation Of Verification of Nurse Licensure with the Texas Board of Nursing (TBON) of Nurses signing the Client Assessment, Review and Evaluation (CARE) Form 3652-A. This Information Letter is for Nursing Facilities, Community Based Alternatives (CBA) Home and Community Support Services Agencies (HCSSA), Hospice Providers, Program of All Inclusive Care for the Elderly (PACE) Providers, and Consolidated Waiver Program (CWP) Providers.
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| NPI is Here! - TDHconnect Will be Discontinued May 24, 2008 |
| Information posted May 8, 2008: The attached reminder has been posted on the DADS News & Alerts webpage. Click on the title for the complete notice. |
| System Downtime Schedule for May 24, 2008 |
| Information posted May 15, 2008: Due to the completion of the National Provider Identifier (NPI) implementation on May 23, 2008, system maintenance for the Texas Medicaid & Healthcare Partnership (TMHP) claims processing system is scheduled for Saturday, May 24, 2008, 12 a.m. to 8 p.m. During system maintenance some applications related to the claims engine will be unavailable. Click on the title to view the details.
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| TILEs to RUGs Transition Preparation - Updating the MDS Software for NFs & Hospices |
| Information posted May 5, 2008: Starting May 1, 2008, Nursing Facility and Hospice providers have the option to add the Medicaid (Resource Utilization Group) RUG Grouper to their Minimum Data Set (MDS) software. If providers choose to add the Medicaid RUG Grouper at this time, the resulting RUG value will be based on the Case Mix Index (CMI) default set, and may not provide the most accurate RUG value for Texas. Click on the title for more information. |
| TMHP Scheduled System Maintenance |
| Information posted May 30, 2008: TMHP will perform scheduled system maintenance to the claims engine and long term care (LTC) systems on June 8, 2008, from 6:00 p.m. until 11:59 p.m. Some functions will be unavailable during this time period. Click on the title to view the details. |
| Claims Engine and Long Term Care Systems Maintenance Scheduled For January 13, 2008. |
| Information posted January 9, 2008: TMHP will perform scheduled maintenance to the claims engine and long term care (LTC) systems on January 13, 2008, from 6:00 p.m. until 11:59 p.m. Some functions will be unavailable during this time period. Click on the title to view the details. |
| February LTC Bulletin Telephone Number Corrections |
| Information posted January 29, 2008: The Evercare Integrated Care Management (ICM) Customer Services telephone numbers were incorrectly listed in the February LTC Bulletin under “ICM Contacts” on page 6. The article should have stated, “Please note that for information regarding LTSS service authorizations for ICM, providers should contact Evercare at 1-866-915-6474 (voice) or 1-888-685-8480 (TDD).” All other contact information in the article is correct as published. |
| Claims Engine and Long Term Care Systems Maintenance Scheduled For February 10, 2008 |
| Information posted February 4, 2008: TMHP will perform scheduled maintenance to the claims engine and long term care (LTC) systems on February 10, 2008, from 6:00 p.m. until 11:59 p.m. Some functions will be unavailable during this time period. Click on the title to view the details. |
| Long Term Care ICM Information Letters |
| Information posted February 20, 2008: The following DADS Information Letters have been published regarding ICM implementation of Integrated Care Management (ICM) in the Dallas and Tarrant Service Areas for ICM, Community Based Alternatives (CBA), Primary Home Care (PHC), and Day Activity and Health Services (DAHS) Providers in the ICM Service Areas. Both information letters require action by ICM program providers as detailed in each information letter. Click on the title for links to the two information letters. |
| TMHP Scheduled System Maintenance |
| Information posted March 3, 2008: TMHP will perform scheduled system maintenance to the claims engine and long term care (LTC) systems on March 9, 2008, from 6:00 p.m. until 11:59 p.m. Some functions will be unavailable during this time period. Click on the title to view the details. |
| Full TexMedConnect Functionality Restored |
| Information posted March 5, 2008: TMHP has resolved the issue that had impacted the Pending Batch function of Long Term Care TexMedConnect, and full functionality has been restored. Providers can access all claims they had previously saved to batch. TMHP apologizes for any inconvenience that providers experienced while this issue was resolved. |
| Long Term Care Information Letter No. 07-126 |
| Information posted January 11, 2008: Information letter reminding all LTC providers of payment system (Health and Human Services Administrative System) tentative downtime. Click on the title for links to the Information Letter. |
| NPI Contingency Period Extended Through May 23, 2008 |
| Information posted February 20, 2008: The state of Texas contingency period for National Provider Identifier (NPI) compliance has changed and will not end on February 29, 2008. The Health and Human Services Commission (HHSC) and the Texas Medicaid & Healthcare Partnership (TMHP) have extended the NPI contingency period through May 23, 2008. This change is effective for all HHSC agencies, including the Texas Department of Aging and Disability Services (DADS), and affects all providers including Long Term Care (LTC) / Long Term Services and Supports (LTSS) providers. Click on the title to view the details. |
| Long Term Care TexMedConnect Pending Batch Function Temporarily Disabled |
| Information posted March 4, 2008: TMHP has identified an issue that impacts users of Long Term Care TexMedConnect who have attempted to perform a Pending Batch function. Users who click on the Pending Batch link have experienced a delayed loading response time and an overall slowness of the application. As a result of this issue, TMHP has temporarily disabled the Pending Batch function for Long Term Care TexMedConnect. All other functionality of Long Term Care TexMedConnect is enabled and performing correctly. TMHP is working to correct this issue and apologizes for any inconvenience. Please refer to this webpage for updates on the status of this issue. |
| Long Term Care Information Letter No. 2008-46 |
| Information posted April 11, 2008: Information letter regarding Daily Claims Processing for ICF/MR Service Group 6 Providers. Click on the title to link to the Information Letter. |
| New TILEs to RUGs Information Resources Available Now |
| Information posted May 21, 2008: A new TILES to RUGS website is available on the DADS homepage (click on "TILEs to RUGs" in the Quick Links column on the right-hand side of the page). The new site provides answers to frequently-asked questions, revised forms and Minimum Data Set assessment instruments, links to other useful sites, and more. Providers are encouraged to email any questions not answered on this site to: RUGS@dads.state.tx.us. Click on the title to go to the DADS homepage.
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| August 2008 Long Term Bulletin No. 35 |
| Information posted July 31, 2008: The August 2008 Long Term Bulletin No. 35 is now available. Click the title to view the bulletin.
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| CMS Advisory Council Meeting Minutes Now Available |
| Information posted June 20, 2008: The minutes of the May 14, 2008, meeting of the CMS Advisory Council are now available. Click on the title to view the minutes. Providers are reminded that they can view the minutes of past meetings by clicking on the CMS Advisory Council Meeting Minutes link in the main column on this webpage. |
| Workshops Schedules Affected Due to Hurricane Dolly |
| Information posted July 22, 2008: The Long Term Care workshops scheduled for Corpus Christi on July 23, 2008 (LTC RUG for Community Waiver) and July 24, 2008 (LTC TexMed Connect) will go on as scheduled.
The Long Term Care TexMed Connect workshops scheduled for Harlingen on July 22 and McAllen on July 23 have been cancelled and rescheduled. Providers registered for the workshops were automatically registered for the new dates. Click on the title to view the details.
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| CBA PAS Minimum Wage Increase |
| Information posted July 29, 2008: During the week of July 21, 2008, the minimum wage rate increase for CBA Personal Assistance Services (PAS) Level 20 was inadvertently increased by 40¢ for the period of September 1, 2007, through July 31, 2008. Effective the weekend of August 2, 2008, this increase will be changed back to the correct amount for this time period. The correct minimum wage increase will be effective as of August 1, 2008, as announced in DADS Information Letter No. 08-102: Payment Rates for the Texas Department of Aging and Disability Services (DADS) Community Programs. Click on the title to view Information Letter No. 08-102.
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| CMS Advisory Council Minutes Now Available |
| Information posted March 11, 2008: The minutes of the February 13, 2008 meeting of the CMS Advisory Council are now available. Click on the title to view the minutes. Providers are reminded that they can view the minutes of past meetings by clicking on the CMS Advisory Council Meeting Minutes link in the main column on this webpage |
| Fiscal Year-end Cutoff Processing |
| Information posted August 8, 2008: DADS has published Information Letters 2008-66; 2008-67; and 2008-68, Cutoff Dates for Miscellaneous Claims and Year-end Closeout Processing, to inform providers of important August 2008 processing cutoff dates. Please refer to the appropriate letter for details: #2008-66 is addressed to Community Services, Nursing Facility and Therapy Providers; #2008-67 pertains to ICF/MR SG5 Providers; #2008-68 supplies dates for ICF/MR SG6 Providers.
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| Claims Engine and Long Term Care Systems Maintenance Scheduled For August, 2008 |
| Information posted August 1, 2008: TMHP will perform scheduled maintenance to the Claims Engine and Long Term Care systems on August 10, 2008, from 6:00 p.m. until 11:59 p.m. Some functions will be unavailable during this time period. Click on the title to view the details.
* Interactive Eligibility Verification through AIS, the TMHP website, TexMedConnect, or EDI.
* Interactive Claims Submission through TexMedConnect or EDI.
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| Labor Day Holiday |
| Information posted August 28, 2008: TMHP will observe the Labor Day holiday on September 1, 2008. The LTC help desk staff will be available to assist providers beginning September 2, 2008 at 7:00 A.M. Please refer to the LTC RUG training materials on tmhp.com and the Frequently Asked Questions document at http://www.dads.state.tx.us/providers/TILEStoRugs/ .
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| Duplicate LTC Electronic Remittance and Status (R&S) Reports |
| Information posted August 5, 2008: Long Term Care Third-Party Submitters may notice duplicate copies of their August 2, 2008, LTC Electronic Remittance and Status (R&S) report available in their folder. These additional copies can be ignored.
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| CMS Advisory Council Directory |
| Information posted August 13, 2008: The LTC Claims Management System Advisory Council membership list has been updated. The CMS Advisory Council meets quarterly to discuss upcoming changes and projects affecting users of the DADS Claims Management System. Notes from Council meetings are posted on TMHP.com under "CMS Advisory Council Meeting Minutes." Click on the title to access this document.
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| Attention: DADS LTC Waiver Program Providers Using Form 3652 |
| Information posted August 15, 2008: TILEs to RUGs Transition Information - DADS strongly encourages all initial assessments requiring a physician’s signature conducted on or after August 15, 2008, be completed using the new RUG MNLOC form and then submitted after September 1. DADS also recommends that other assessments (not requiring a physician’s signature) conducted on or after August 21 be completed on the RUG MNLOC form and submitted after September 1. This will prevent having to conduct duplicate assessments if the Form 3652 cannot process through TMHP for some reason.
If a Form 3652 cannot be processed before August 25 for any reason, and that is the only form that you have, then you must complete a second assessment using the RUG MNLOC form and submit that after September 1.
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| Hurricane Gustav Information for Medicaid Providers |
| Information posted September 8, 2008: DADS is providing the following provider information in response to the federal Centers for Medicare & Medicaid Services declaration that Hurricane Gustav presented a public health emergency in Texas, Louisiana, Mississippi and Alabama. Click on the title for details.
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| Reminder – Medicaid Residents |
| Information posted September 11, 2008: A Texas provider/facility evacuating a resident to another (licensed) Texas provider/facility can establish an agreement with the receiving facility for housing and care of evacuees, and for reimbursement of services the receiving facility provides to support the evacuee.
The sending facility will continue to bill and receive payment for the residents who were transferred to the receiving facility, and will be responsible for reimbursing the receiving facility for care provided. No additional Forms 3618-Resident Transaction Notice or Minimum Data Set (MDS) assessments are required from either facility.
For additional information about hurricane-related billing for Texas residents, providers can contact DADS Provider Claims Services at 1-512-438-2200, Option 1.
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| Hurricane Gustav Information for Medicaid Providers |
| Information posted September 8, 2008: DADS is providing the following provider information in response to the federal Centers for Medicare & Medicaid Services declaration that Hurricane Gustav presented a public health emergency in Texas, Louisiana, Mississippi and Alabama. Click on the title for details.
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| Additional Hurricane Ike Information about Non-Medicaid Long Term Care Residents |
| Information posted September 11, 2008: Nursing Facilities that accept evacuees with special needs [Non-Medicaid Long-Term (LTC) residents] that are directed from State or Federal officials will be paid for services provided. Click on the title for details.
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| Additional LTC Hurricane Reimbursement Information |
| Information posted September 18, 2008: The Health and Human Services Commission (HHSC) is reviewing disaster-related reimbursement options for all health and human services agencies. DADS will post instructions for billing as soon as the final approach has been determined. As previously stated, providers will be reimbursed for services provided to hurricane evacuees.
Please continue to monitor the DADS Hurricane Information website at http://www.dads.state.tx.us/hurricane/index.cfm.
Additional information about hurricane-related billing for Community Services will be published in the DADS Hurricane Information website as soon as the final approach has been determined. |
| Hurricane Information for Medicaid Providers |
| Information posted September 10, 2008: A Texas provider/facility evacuating a resident to another Texas provider/facility can establish an agreement with the receiving facility for housing and care of evacuees, and for reimbursement of services the receiving facility provides to support the evacuee.
The sending facility will continue to bill and receive payment for the residents who were transferred to the receiving facility, and will be responsible for reimbursing the receiving facility for care provided. No additional Forms 3618-Resident Transaction Notice or Minimum Data Set (MDS) assessments are required from either facility.
For additional information about hurricane-related billing for Texas residents, providers can contact DADS Provider Claims Services at 1-512-438-2200, Option 1.
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| Important: 3652-A Care Form Purpose Code P’s Not Grandfathered - New PASARR Screening Required |
| Information posted October 3, 2008: Click on the title for important details regarding Preadmission Screening and Resident Review (PASARR). |
| Attention Nursing Facilities: Retro Claims RUG Overlap |
| Information posted October 13, 2008: During the period September 1, 2008, through September 15, 2008, for clients that transitioned from a TILE to a RUG, it is possible that the claim could have retro’d if providers were first paid at a TILE level and then submitted an MDS and obtained a RUG value. As a result, the RUG overlapped a portion of the TILE segment.
In this event, the claim would have paid at the TILE level. The claim for the RUG segment that overlapped with the TILE would have denied with the EOB F0277, National Code is missing, invalid, not billable with procedure code qualifier.
Providers should check their R&S and identify denied claims with EOB F0277 and rebill, if necessary.
The system has been corrected to not deny or retro any claims.
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| Claims Engine and Long Term Care Scheduled System Maintenance |
| Information posted October 27, 2008: TMHP will perform scheduled maintenance to the Claims Engine and Long Term Care systems on November 2, 2008, from 12:00 a.m. until 2:00 a.m. This is the annual Daylight Savings Time window. Some functions will be unavailable during this time period. |
| Important TILEs Expiration Reminder Notice for Nursing Facilities |
| Information posted November 24, 2008: This is a follow-up reminder to Medicaid Nursing Facility Providers that DADS will end all TILEs (Texas Index for Level of Effort) covering dates beyond November 30th, 2008, to ensure that only RUGs (Resource Utilization Groups) are in use by December 1, 2008. Click on the title for more information. |
| CMS Advisory Council Minutes Now Available |
| Information posted December 18, 2008: The minutes of the November 12, 2008, meeting of the CMS Advisory Council are now available. Click on the title to view the minutes. Providers are reminded that they can view the minutes of past meetings by clicking on the CMS Advisory Council Meeting Minutes link in the main column on this webpage. |
| DADS Thanksgiving Processing Schedules |
| Information posted November 14, 2008: DADS has provided a calendar for the DADS Holiday Claims Processing Downtime Schedules. Click on the title to view the calendar.
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| RUGs Information for Nursing Facility Providers |
| Information posted December 15, 2008: Please review and share the following information with your staff who submit forms. This LTC News notice provides information on the top 5 reasons forms are rejecting, which causes a delay in payment. Click on the title to view the notice.
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| DADS 2008 Christmas/New Year Processing Schedules |
| Information revised December 10, 2008: Click on the title for the DADS Holiday Claims Processing Downtime Schedules calendar. |
| Important Information for Nursing Facilities – How to Prevent NF-0032 Rejections for Forms 3619 |
| Information posted December 18, 2008: To reduce occurrences of NF-0032 rejections, NF staff should use the information provided in this notice. Click on the title to view the notice. |
| Long Term Care Information Letter No. 2008-181 |
| Information posted December 31, 2008: DADS Information Letter No. 2008-181- RUGs Information Requiring Special Attention is available. Click on the title to view the letter. |
| DADS Responses to Questions Raised at December 2008 THCA Meeting |
| Information posted December 18, 2008: Addressed to nursing facilities, this notice provides DADS responses to the questions raised during the December 10, 2008, meeting of the Texas Health Care Association, Inc. (THCA) on Wednesday, December 10, 2008. Click on the title to view the referenced document.
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| 2007 |
| Personal Care Services Transition |
| Information posted June 8, 2007: Effective for dates of service on or after September 1, 2007, personal care services (PCS) for clients younger than 21 years of age will be provided by the Texas Health and Human Services Commission (HHSC) under the new PCS benefit. Texas Department of Aging and Disability Services (DADS) Primary Home Care clients who are younger than 21 years of age will be transitioned to the new benefit at HHSC. Clients currently enrolled in a Texas Medicaid Managed Care Organization (MCO) will receive PCS through HHSC. Click on the title to view the details. |
| Long Term Care Information Letter No. 07-53 |
| Information Letter dated June 11, 2007: For providers in the Dallas & Tarrant service areas. |
| Home Health Skilled Nursing, Private Duty Nursing, and Home Health Aide Benefits Are Changing |
| Information posted June 19, 2007: Effective for dates of service on or after September 1, 2007, benefit changes will be implemented for private duty nursing, home health skilled nursing, and home health aide services for the Texas Medicaid Program. Additional information will be provided in the upcoming 2007 Personal Care Services (PCS) Special Bulletin, No. 207. These changes do not apply to nursing services delivered by school districts in the school setting through the School Health and Related Services (SHARS) program. SHARS providers bill under the school district's Texas Provider Identifier (TPI). The policy for SHARS can be found in the 2007 Texas Medicaid Provider Procedures Manual (TMPPM), Section 42, “School Health and Related Services (SHARS),” on page 42-1. For more information, call the TMHP Contact Center at 1-800-925-9126. |
| Long Term Care Information Letter No. 07-55 |
| Information posted June 27, 2007: Long Term Care (LTC) Claim Form 1290 Requirement. |
| Long Term Care National Provider Identifier (NPI) Special Bulletin |
| Information Posted January 8, 2007: The January 2007 Special Bulletin is now available. Click the title to view the bulletin. |
| Long Term Care Information Letter No. 07-56 |
| Information posted June 27, 2007: Long Term Care (LTC)
Verification of Nurse Licensure with the Texas Board of Nurse Examiners (BNE) of Nurses signing the Client Assessment, Review and Evaluation (CARE) Form 3652-A |
| Long Term Care Information Letter No. 07-24 |
| Letter dated May 1, 2007: Minimizing Claim Rejection Information |
| Long Term Care Information Letter 07-51 |
| Information Letter dated May 18, 2007:Remittance and Status Report information. |
| Long Term Care Information Letter No. 07-25 |
| Information Letter dated April 27, 2007: National Provider Identifier (NPI) Reporting Process for DADS Providers. |
| Hospice Phone Tips for Nursing Facility & Hospice Providers |
| Information posted May 8, 2007: These tips to use before calling the TMHP Call Center/Help Desk or DADS Provider Claims Services (PCS) are also useful for making your call faster and more effective. Information is provided about when to call TMHP instead of PCS; accessing useful reports; and when providers should call the Medicaid Eligibility Worker rather than TMHP or PCS. It has been confirmed that many calls PCS receives can be resolved by accessing either a MESAV (Medicaid Eligibility/ Service Authorization Verification) or a Remittance & Status (R&S) Report. Click on the title to view the tips. |
| Long Term Care Information Letter No. 07-43 |
| Information posted June 27, 2007: Long Term Care (LTC) Integrated Care Management (ICM) Program – Service Coordination |
| Long Term Care National Provider Identifier (NPI) Special Bulletin No. 205 |
| Information Posted June 7, 2007: The Long Term Care National Provider Identifier (NPI) Special Bulletin No. 205 is now available. Click the title to view the bulletin. |
| Change to TMHP.com Sign On |
| Information posted June 8, 2007: Starting June 10, 2007, when end users access the www.tmhp.com website, a screen with a pop up end user agreement will display. Users will be required to accept the American Medical Association (AMA) end-user agreement on the use of Current Procedural Terminology, (CPT®). To accept, users must click on the indicated field of the pop up box. This agreement must be accepted every 30 days from the last date the agreement was accepted by the user for each computer accessing the TMHP website. If this end-user agreement is not accepted for a computer every 30 days, users will not be able to enter the website from that computer until the agreement has again been accepted. For additional information about AMA and CPT®, please refer to the following website: http://www.ama-assn.org/ama/pub/category/3113.html.
Providers and/or users should contact the TMHP Contact Center at 1-800-925-9126, option 1 for any assistance.
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| Claims Management Advisory Council List Updated |
| Information posted June 21, 2007: The LTC Claims Management Advisory Council membership list has been updated. The Council meets quarterly to discuss upcoming changes and projects affecting users of the DADS Claims Management System. Notes from Council meetings are posted on TMHP.com under "CMS Advisory Council Meeting Minutes." Click on the title to view the updated list. |
| ATTENTION: LTC Nursing Facilities – Completion of CARE Form 3652 |
| Information posted June 29, 2007: TMHP will no longer review the CARE Form 3652 comment section for Purpose Code E recovery dates. Dates of recovery should be entered in field 10 – Date Recipient Entered Facility, and field 11 – Date Recipient Admitted to Medicaid. The comment section will only be reviewed for additional medical information to determine medical necessity by TMHP medical staff.
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| Long Term Care Information Letters 07-27 & 07-28 |
| Information posted July 19, 2007: Miscellaneous Claims Cutoff Notice dates and associated information are posted for all providers. [Providers of Home and Community-based Services (HCS) & Texas Home Living (TxHmL) Waiver Services should refer to Letter No. 07-28]. Click on the title for links to the two information letters.
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| Long Term Care Information Letter No. 07-62 |
| Information posted July 18, 2007: New information for Nursing Facilities. Information Letter No. 07-62: Procedure Changes - Provider Claims Services (PCS) Unit. |
| Revised CARE Form 3652-A Is Now Available |
| Information posted July 19, 2007: The revised Form 3652-A (Client Assessment, Review and Evaluation) is available for immediate use. This form contains 3 new data fields required for all Forms 3652-A that TMHP receives on or after August 12, 2007, in order to comply with the requirements detailed in Information Letter No. 07-26 - Verification of Nurse Licensure with the Texas Board of Nurse Examiners (BNE) of Nurses signing the Client Assessment, Review and Evaluation (CARE) Form 3652-A. This Information Letter was posted on June 27, 2007 (see below). As noted in the Information Letter, new data fields also are being implemented in the LTC Online Portal effective August 12, 2007. Click on the title to view the form.
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| Correction to the NPI Special Bulletin for Long Term Care (LTC) Providers |
| Information posted July 23, 2007: This is a correction to the Quick Reference Guide in the June 2007 National Provider Identifier (NPI) Special Bulletin for Long Term Care (LTC) Providers, No. 205, on page 9. In the box labeled “TDHconnect/TexMedConnect Transactions,” the third bullet contains an incorrect date of July 27, 2007. The complete, corrected third bullet is, "TMHP online TexMedConnect will accept and return NPI/API only for MESAV transactions beginning 8/27/07.” For more information, call the TMHP Call Center/Help Desk at 1-800-626-4117.
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| August 2007 Long Term Care Programs (LTC) Bulletin No. 31 |
| Information posted July 27, 2007: The August 2007 Long Term Care (LTC) Programs Bulletin No. 31 is now available for download from the TMHP.com file library.
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| Minutes of Third Quarter CMS Advisory Council Meeting Now Available |
| Information posted August 28, 2007: The minutes of the August 8, 2007 meeting of the CMS Advisory Council are now available. Click on the title to view the minutes. Providers are reminded that they can view the minutes of past meetings by clicking on the CMS Advisory Council Meeting Minutes link in the main column on this webpage |
| Nurse Licensure Verification With the Texas Board of Nursing (TBON) |
| Information posted August 24, 2007: Effective August 12, 2007, TMHP began to verify nurse licensure with the Texas Board of Nurse Examiners (BNE) for both the Director of Nurses (DON) and the Assessor signing the Client Assessment, Review, and Evaluation (CARE) Form 3652-A for all purpose codes. TMHP will validate the first three letters of the nurses’ last name and license number for the corresponding signature date. Click on the title to view the details. |
| Long Term Care Information Letter No. 07-69 |
| Information posted September 7, 2007: Information letter regarding Minimum Wage Increase for Attendant Care Services Effective August 1, 2007. Click on the title for links to the Information Letter. |
| Attention Long Term Care Providers |
| Information posted October 8, 2007: As previosuly notified, some Long Term Care (LTC) providers have experienced an issue surrounding incomplete information on their September 8, and September 15th, 2007 remittance and status (R&S) reports. As a result providers may notice incomplete warrant information reflected. Click on the title for details. |
| Attention Long Term Care Providers |
| Information posted November 6, 2007: Two types of accounts may be created by Long Term Care providers to access the secured functions at the TMHP web site. Click the title for a discussion of the two accounts. |
| Issue Identified With Remittance and Status (R&S) Files |
| Information posted September 24, 2007: TMHP has identified an issue potentially impacting a number of Long Term Care (LTC) remittance and status (R&S) files produced on September 8, 2007 and September 15, 2007. The issue resulted in the potential for some finalized claims not to be included appropriately on the R&S. Impacted providers will be able to access the corrected LTC R&S files for September 8, 2007 and September 15, 2007 no later than October 1, 2007. Please contact TMHP at 1-800-626-4117 for any questions on the above information. TMHP is working diligently to expedite the correction and minimize any impact to the impacted providers.
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| Important Information for ICF/MR Service Group 6 providers |
| Information posted November 30, 2007: DADS apologizes for the incorrect Thanksgiving holiday processing schedule notice which is impacting payment to ICF/MR Service Group 6 providers that submitted claims on Wednesday, November 21. We regret the error and have made arrangements to issue payments for Service Group 6 claims submitted from November 21-28, 2007, so they can be paid on December 4 rather than the normal December 5 payment date. Click on the title for more details. |
| February 2008 Long Term Care Provider (LTC) Bulletin No. 33 |
| Information posted January 28, 2007: The February 2008 Long Term Care (LTC) Provider Bulletin No. 33 is now available for download from the TMHP.com file library.
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| Holiday Claims Processing Downtime Schedules |
| Information posted November 8, 2007: DADS offices close November 22-23, 2007, for Thanksgiving; December 24-26, 2007, for Christmas, and January 1, 2008, for New Year’s Day. These schedule changes will affect claim payment processing for providers that bill through TMHP Claims Management System, including Intermediate Care Facility for the Mentally Retarded (ICF/MR) Service Groups (SGs) 5 and 6. Click on the title for details.
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| Electronic Transaction Changes Effective March 1, 2008 |
| Information posted December 19, 2007: Effective March 1, 2008, electronic claims must be submitted with a National Provider Identifier (NPI) for the billing providers. If an NPI is not included or if a legacy provider identifier is submitted, the claim will be rejected. Other electronic transactions, such as eligibility verification and claim status inquiries, must also be submitted with an NPI as well. If an NPI is not included or if a legacy provider identifier is submitted, these transactions will be rejected. Click on the title to view the details. |
| Service Coordination for the Integrated Care Management Program |
| Information posted December 20, 2007: In collaboration with the Health and Human Services Commission (HHSC) and the Department of Aging and Disability Services (DADS), Evercare of Texas, LLC has integrated its disease management and service coordination clinical model designed to serve the Texas Integrated Care Management (ICM) population. This client-centered care model employs a multidisciplinary team of physicians, nurses, hospital, and operational staff to improve client health and promote self-management of chronic conditions. The model seeks to help clients move from intensive levels of intervention to more supportive ones, empowering clients to better self-manage their conditions. By incorporating applied resources and tools, the program supports treatment adherence, the physician-patient relationship, physician-directed care, and information sharing regarding treatment. Click on the title to view the details. |
| DADS Holiday Processing Schedules |
| Information posted December 4, 2007: To clarify and update the November 8, 2007, notice regarding DADS Holiday Claims Processing Downtime Schedules, the corrected calendar schedule below is being provided for your use. Click on the title for details. |
| LTC Providers Required to Report NPI for Each Contract |
| Information posted October 1, 2007: Long term care (LTC) providers are required to report a National Provider Identifier (NPI) for each contract they have with the Department of Aging and Disability Services (DADS). The NPI for each contract must be reported even if the NPI is the same for all contracts. By reporting all NPIs, providers can help prevent the interruption of payments.
Providers can verify whether all of their NPIs have been reported by visiting the DADS website at www.dads.state.tx.us/providers/hipaa/npisearch.cfm.
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| Long Term Care Information Letter No. 07-111 |
| Information posted November 13, 2007: Information letter informing all LTC providers of planned payment system (Health and Human Services Administrative System) Downtime. Click on the title for links to the Information Letter. |
| November Long Term Care Bulletin No. 32 |
| Information posted October 23, 2007: The November 2007 Long Term Care Bulletin No. 32 is now available. Click the title to view the bulletin.
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| Long Term Care Information Letter No. 07-112 |
| Information posted December 20, 2007: Information letter reminding all LTC providers of payment system (Health and Human Services Administrative System) tentative downtime. Click on the title for links to the Information Letter. |
| Long Term Care Information Letter 07-97 |
| For CBA, PHC & DAHS providers in Dallas and Tarrant service areas: Long Term Care Information Letter No. 07-97 -- Information posted 11- 5 -2007: Integrated Care Management (ICM) Program -- Service Codes and Billing Requirements Prior to Implementation. Addressed to Community Based Alternatives (CBA), Primary Home Care (PHC) and Day Activity and Health Service (DAHS) Providers. Click on the title to view the information letter.
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| Long Term Care Information Letter No. 07-110 |
| Information posted November 26, 2007: Information letter informing all LTC providers that the National Provider Identifier (NPI) Contingency Period ends March 1, 2008. Click on the title for a link to the Information Letter. |
| 2006 |
| LTC NPI Conference Calls |
| LTC providers who are unable to attend the National Provider Identifier (NPI) Implementation Workshop are invited to participate in a conference call to learn more about NPI. Callers will be prompted to provide the Conference ID number at the time of the call. Click on the title for the details for each conference call. |
| Three LTC Workshops Available in March |
| Information Posted January 9, 2006: TMHP Provider Relations representatives will present three different workshops in March: CBA Care Forms Completion, Nursing Facility Forms Completion, and TDHconnect 3.0. Click the title to view the workshop descriptions, dates, times, locations, and registration information. To register for a workshop online, click the Register for a Workshop link located on the top, right side of this webpage. |
| Medicare Rx Prescription Drug Coverage to Resume for "Dual Eligible" Individuals |
| Information Posted April 3, 2006: Effective April 1, 2006, Medicare will resume full responsibility for drug coverage for individuals who are "dual eligibles," i.e., eligible for both full Medicaid services and Medicare. Consequently, the Texas Health and Human Services Commission (HHSC) is informing pharmacists that March 31, 2006, will be the last date for which they can bill Medicaid for prescription drugs for these individuals.
Click on the title for complete details.
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| Medicare Prescription Drug Program New Urgent Information |
| Information Posted February 10, 2006: Information to help ensure your full dual eligible clients receive their Medicare RX prescription drugs is now available on the Texas Department of Aging and Disability Services (DADS) website located at www.txcares.org/medicare. |
| CARE Forms System Upgrade - Creating Portal Accounts |
| Information Posted April 18, 2006: To access the new system, providers must create a Provider Administrator account on the TMHP website at www.tmhp.com Providers may create Provider Administrator account beginning Tuesday, June 6, 2006. Providers should begin creating these accounts to ensure forms can be transmitted. Instructions for creating, maintaining, and using Provider Administrator accounts can be found in the Website Security Training Manual on the TMHP website at www.tmhp.com.
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| Attention Long Term Care Providers - CFS Software Update |
| Effective January 1, 2006 the CARE Form System Software (CFS) has been updated to version 4.0. This update is for CFS users only. Providers using third party software are not affected by this update. CFS users who have not completed the update by February 28, 2006 will be blocked from transmitting electronically until the update is completed.
Click on the title for instructions and the location of the update. |
| Corrections to the May 2006 Long Term Care Bulletin No 26: |
| Information Posted April 18, 2006: Click on the title to see corrections to the bulletin. |
| Long Term Care National Provider Identifier (NPI) Special Bulletin No. 196 |
| Information Posted May 1, 2006: The May 2006 Special Bulletin No. 196 is now available. Click the title to view the bulletin. |
| May 2006 Long Term Care Bulletin No. 26 |
| Information Posted April 10, 2006: The May 2006 Long Term Care Bulletin No. 26 is now available. Click the title to view the bulletin. |
| CARE Form System Software Upgrade Requires Third-Party Software Testing |
| Information Posted April 7, 2006: The current DOS-based Client Assessment, Review, and Evaluation CARE Form System (CFS) software administered by TMHP is being upgraded to a web-based, online system. The target for implementation is August 2006. The next system will have a web portal interface to submit forms, corrections, and retrieve status inquiries. Providers using Third Party Software must have software vendors complete testing for the new CARE Form System by August 1, 2006. If testing is not complete by August 1, 2006, providers will not be able to transmit their forms to Texas Medicaid & Healthcare Partnership (TMHP). Please email questions to careformsupport@tmhp.com. |
| Attention Hospice Providers |
| Please refer to Information Letter No. 06-44, LTC Online Portal
Transition, which states that effective August 21, 2006, Hospice providers will be able to use the LTC Online Portal to submit the Form 3071 Hospice Election/Cancellation/ Discharge and Form 3074 Physician Certification/Recertification of Terminal Illness. Additionally, it states that although the LTC Online Portal will not be implemented until August 21, 2006, Hospice Providers may now use updated Forms 3071 and 3074.
This is to clarify that until the LTC Online Portal is implemented in August, Hospice providers should continue to mail paper Forms 3071 and 3074 to Provider Claims Services. Effective August 14, 2006, providers MUST mail paper forms to TMHP at the following mailing address: TMHP LTC Unit,
P.O. Box 200765, Austin, TX 78720-0765. |
| ATTENTION LTC Providers (Does not Include Hospice Providers) |
| LTC Online Portal - Providers that Submit Paper Forms to TMHP Please refer to Information Letter No. 06-44, LTC Online Portal transition, which states that effective August 21, 2006, providers would be able to submit (via the LTC Online Portal) the CARE Form 3652; Forms 3618, 3619, 3071, 3074.
Additionally, the letter stated that the last day that providers can submit old (non-updated forms) to TMHP is August 21, 2006. This purpose of this notification is to let providers know that the last date to submit old (non-updated forms) to TMHP has been changed to Sunday, August 13, 2006. Effective Monday, August 14, 2006, providers must mail updated paper forms to TMHP at tthe following address: TMHP LTC Unit, P.O. Box 200765, Austin, TX 78720-0765. Any forms received on or after August 13, 2006 on the old form will be returned by TMHP for resubmission on the revised form.
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| Creating a New Account for the LTC Online Portal on the TMHP website |
| Information Posted on June 5, 2006: To create a new account for the LTC Online Portal, go to the TMHP website and select Account Activation. When selecting a provider type, on the Account Activation screen, there are three options to choose from. It is important that providers choose the correct option. Choosing an incorrect option would not allow providers to set up the appropriate security levels for their agency. Providers should choose the appropriate provider type as follows:
1) Acute Care - If you are an Acute Care Povider or a Hospice Acute Care Provider choose Acute Care,
2) Long Term Care - If you are a LTC Hospice Provider choose Long Term Care,
3) NF/Waiver Programs - If you are a Nursing Facility or CBA, CWP, or PACE Provider or an MDCP case manager, choose NF/Waiver Programs. |
| LTC TDHconnect Workshop in Tyler Relocated |
| Information Posted September 14, 2006: The LTC TDHconnect workshop scheduled for Wednesday, October 18, 2006, at the East Texas Medical Center Pavilion Conference Center in Tyler is being moved. TMHP has secured the same date and time at the Orneles Conference Center Ballroom at the University of Texas Health Center in Tyler. Click on the title for more details.
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| Attention LTC Providers - Paper Forms Unnecessary When Using Portal Entry |
| Information Posted September 1, 2006: It has been brought to our attention that some Nursing Facility providers are not only submitting Form 3618 and 3619 data via the LTC Online Portal, but also mailing these forms to TMHP. This is to clarify that it is unnecessary to mail paper forms when you have submitted the data via the LTC Online Portal. Data should either be entered via the Portal or mailed to TMHP. Using the Portal is the preferred method.
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| Long Term Care NPI Implementation Workshops Available in November |
| Information Posted September 27, 2006: TMHP Provider Relations representatives will present the Long Term Care National Provider Identifier (NPI) Implementation Workshop in November 2006. Click the title above to view the workshop description, dates, times, locations, and registration information. To register for a workshop online, click the Register for a Workshop link located on the top, right side of this webpage |
| Attention: LTC Providers that Use the LTC Online Portal |
| Enhancements to the LTC Online Portal took place Sunday, November 12, 2006. Click on the title to see the list of enhancements were made.
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| LTC Claims Processing During Thanksgiving Holiday |
| Information posted November 15, 2006: Claims payment processing by the Texas Department of Aging and Disability Services (DADS) Accounting and the State Comptroller will not occur on Thursday, November 23, 2006, or Friday, November 24, 2006. Normal claims processing will resume on Monday, November 27, 2006.
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| Attention LTC Hospice Providers |
| Information posted September 8, 2006 - Hospice forms submitted to the new LTC Online Portal since August 21, 2006 (Form 3071-Hospice Election / Cancellation / Discharge and Form 3074-Physician Certification / Recertification of Terminal Illness) are being received by TMHP and successfully transmitted to DADS. Click the title for more information. |
| Reminders and Highlights |
| Information posted November 27, 2006: Always remember to have your form printed and signed to verify correct information before transmitting.
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| Learn More About the LTC Online Portal |
| Information posted October 12, 2006: TMHP is offering LTC providers another opportunity to participate in conference calls to learn more about the new LTC Online Portal system. There is no need to register for these conference calls. However, the number of lines is limited, and only 100 callers will be able to participate in each call. Click on the title to review the dates and times below and select one most convenient for you. |
| Thanksgiving Processing for ICF/MR SG 5 & 6 Claims |
| Information posted November 15, 2006: For ICF/MR Service Group 6 providers, claims payment processing will occur on Wednesday, November 22, 2006, due to the Thanksgiving Holiday. Providers must enter their ICF/MR SG 6 billing claims by 5:00 p.m. on Tuesday, November 21, 2006, to ensure direct deposits during the week of November 27, 2006. For ICF/MR Service Group 5 providers, the processing schedule is unchanged: ICF/MR Service Group 5 providers must have their claims entered by 5:00 pm Monday, November 20, 2006; warrants for claims entered by that time will be available on Friday, November 24, 2006.
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| Claims Processing by TMHP for NF Services Provided - Information Letter No. 06-96 |
| Information posted December 1, 2006: Click the title to read this important information for all providers. |
| Reminders and Highlights |
| Information posted November 27, 2006: The LTC Portal offers two features to retrieve data formerly reported on the weekly status report. The first feature is called Form Status Inquiry (FSI). Using FSI, select form type and you may search using multiple search criteria. The second feature is Current Activity. You will select the vendor/contract number you wish to receive current form activity data. The report will display any form (3618, 3619, and 3652) with a status change within the last fourteen days. Both reports provide the same information formerly reported on the weekly status report. The FSI and current activity reports are also available for Hospice providers. You will select the contract number for the current activity status for forms 3071 and 3074.
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| Reminders and Highlights |
| Information posted November 27, 2006: TMHP has received forms with the incorrect century for the birth year. Please ensure the correct 4 digit century is entered for the client date of birth.
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| Attention (LTC) Hospice Providers |
| Information Posted August 22, 2006: Form 3071-Recipient Election/Cancellation/Discharge Notice requires a three digit numeric county code be entered in field 12, County Code, before the form can be processed. Click on the title to view the list of county codes. |
| LTC Claims Processing during Christmas and New Year’s Holidays |
| Information posted on December 15, 2006 - Due to the upcoming holidays, Long Term Care (LTC) claim payment processing by the Texas Department of Aging and Disability Services (DADS) Accounting and the State Comptroller will not occur on December 25-26, 2006 or January 1, 2007. Routinely, it takes a minimum of four business days from the time a claim has been submitted until a payment is issued. However, due to the holiday processing schedules, providers should allow an additional two days for payments to be issued. Questions should continue to be addressed to the TMHP Call Center/Help Desk toll-free at 1-800-626-4117 or 1-800-727-5436; local Austin calls should be made to 1-512-335-4729. Check warrant/claim status at the Comptroller’s website: https://ecpa.cpa.state.tx.us and choose the State-to-Vendor-Payment Info-Online-Search link. |
| ICF/MR Holiday Processing Information |
| Information posted December 14, 2006: Payment for ICF/MR Service Group 5 claims submitted by 5:00 pm, Tuesday, December 26, 2006, should be issued the week of January 1, 2007. Payment for ICF/MR Service Group 5 claims submitted by 5:00 pm, Monday, January 1, 2007, should be issued the week of January 8, 2007. Payment for ICF/MR Service Group 6 claims submitted by 5:00 pm, Wednesday, December 27, 2006, should be issued the week of January 1, 2007. Payment for ICF/MR Service Group 6 claims submitted by 5:00 pm, Wednesday, January 3, 2007, should be issued the week of January 8, 2007 |
| New NPI Information |
| Information posted 11/9/2006: Are you drowning in NPI questions? Information Letter No. 06-89 was mailed to providers in October, and is available online, detailing how to submit your NPI to DADS. In addition, DADS has developed a list of the top ten frequently asked questions and their responses. To see the answers and a list of valuable resources, click on the title to go to http://www.dads.state.tx.us/business/hipaa/index.html. |
| 2005 |
| Hurricane Assistance |
| Texas Department of Aging and Disability Services website provides hurricane assistance information for providers. Visit http://www.dads.state.tx.us/Katrina/index.cfm for more information.
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| Info 05-11[1] |
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| Info 05-34[1] |
| LTC Information Letter 05-34 |
| Long Term Care Providers: Katrina Waiver and Claims Processing Information for Health Care Providers |
| The Department of Aging and Disability Services (DADS) has posted an information letter titled Waiver and Claims Processing Information for Health Care Providers to the DADS website. The information letter provides information on how to bill for services provided to Katrina evacuees. Please note that this website also includes Frequently Asked Questions regarding reimbursement for LTC Services and Support under the Katrina Waiver. Providers are encouraged to check this website daily for updates.
Click on the title for links to this information. |
| Attention: LTC Providers |
| Claims payment processing by TDADS Accounting and the State Comptroller will NOT occur on Monday, December 26, 2005, due to Christmas Holidays.
Claims payment processing will occur as normally scheduled the remainder of the week including Monday, January 2, 2006.
Attention: ICF/MR Providers (Service Group 6)
Claims payment processing will occur as normally scheduled on
Thursdays, December 22, 2005; December 29, 2005 and January 5, 2006. |
| Nursing Facilities Postponed Rita |
| Due to Hurricane Rita, TMHP Provider Relations is postponing the October 19, 2005, "Nursing Facilities Form 3618, 3619, and 3652" workshop scheduled to be held in Beaumont, Texas. Providers registered for this workshop will be automatically registered for the new date. The new date will be published at www.tmhp.com as soon as a date is determined. TMHP Provider Relations apologizes for the inconvenience. For more information, call the TMHP LTC Helpdesk at 1-800-626-4117.
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| Attention Long Term Care Providers (Including both Legacy DHS and MHMR Providers) |
| Subject: Transportation Costs Related to Hurricane Rita Evacuations. The Department of Aging and Disability Services (DADS) is pursuing the possibility of paying private for-profit providers for non-reimbursed transportation costs provided to Hurricane Rita clients. These costs are those not reimbursed by FEMA and/or not already included as part of the contract rate. While DADS does not have the funds to reimburse providers for these costs, we will seek to obtain funds from FEMA to pass to providers who have documented transportation expenses. Click on the title to view the details. |
| LTC TDHconnect Workshops Available in August and October |
| The Texas Medicaid & Healthcare Partnership (TMHP) is presenting LTC TDHconnect Workshops in your area! Click the title to view the workshop description, dates, times, locations, and registration information. To register for a workshop online, click the Register for a Workshop link located on www.TMHP.com. |