- I am an audiologist or otologist currently enrolled as a PACT provider. How do Texas Medicaid and the Children with Special Health Care Needs (CSHCN) Services Program enroll providers?
- I am not currently a Medicaid provider. Do I need to complete an application to become a Medicaid provider? Do I need to become a Medicare provider before enrolling in Medicaid?
- Once I have enrolled as a Medicaid provider, do I have to enroll with the CSHCN Services Program?
- Does an audiologist at a regional daycare need to be associated with an ENT to become a Medicaid provider?
- To whom do I send prior authorization requests and claims after services have been rendered?
- Currently, clients must have suspected or identified permanent hearing loss to be eligible for PACT services. Who will be eligible for hearing services under Texas Medicaid and the CSHCN Services Program?
- Under PACT, clients choose a provider, submit an application for services through this provider, and receive services upon approval. How do clients receive hearing services benefits under Texas Medicaid and the CSHCN Services Program?
- Will children of Texas be fit with hearing aids by any Medicaid-enrolled or CSHCN Services Program-enrolled hearing aid provider?
- Currently, I submit authorization requests, vouchers, and other forms to PACT. What forms will TMHP require for hearing services?
- How do I file claims with TMHP?
- What are the advantages of using TexMedConnect to file claims electronically?
- How do I find information about the status of claims submitted to TMHP?
- Is there someone I can contact directly with questions once the PACT transition has occurred?
- Where can I find more information about the PACT transition?
- How Are Texas Medicaid and the CSHCN Services Program Different From PACT?
Q: I am an audiologist or otologist currently enrolled as a PACT provider. How do Texas Medicaid and the Children with Special Health Care Needs (CSHCN) Services Program enroll providers?
A: Texas Medicaid and the CSHCN Services Program enroll audiologists, hearing aid fitters and dispensers, otologists, and otorhinolaryngologists (ENTs) as separate provider types. Each provider type is given a unique provider number with which to bill.
Note: ENTs are enrolled as physicians under these two programs.
back to top
Q: I am not currently a Medicaid provider. Do I need to complete an application to become a Medicaid provider? Do I need to become a Medicare provider before enrolling in Medicaid?
A: The answer depends on what provider type you are. To become a Medicaid provider, all provider types must complete the Texas Medicaid Provider Enrollment Application and receive a Texas Provider Identifier (TPI) with confirmation from TMHP that they are enrolled. All providers also must have a National Provider Identifier (NPI) to enroll with Texas Medicaid. All providers must be enrolled with the correct provider type associated with the services rendered in order to be considered for reimbursement.
- Audiologists must first be enrolled as Medicare providers.
- Hearing aid providers are not required to be Medicare providers before they enroll as Medicaid providers. Providers of hearing aids can enroll as a facility or as an individual under the hearing aid provider type.
back to top
Q: Once I have enrolled as a Medicaid provider, do I have to enroll with the CSHCN Services Program?
A: To be considered for reimbursement of services provided to CSHCN Services Program clients, Medicaid providers must also enroll with the CSHCN Services Program. To become a CSHCN Services Program provider, you must first be enrolled with Texas Medicaid. Since both Medicaid and CSHCN Services Program clients are currently referred to PACT providers, The Texas Medicaid & Healthcare Partnership (TMHP) encourages all PACT providers to enroll with both Medicaid and the CSHCN Services Program. Providers are encouraged to use the Provider Enrollment on the Portal application on www.tmhp.com to enroll into Texas Medicaid. Providers enroll into the CSHCN Services Program using a paper application which is also available on the TMHP home page.
back to top
Q: Does an audiologist at a regional daycare need to be associated with an ENT to become a Medicaid provider?
A: No. Audiologists do not need to be associated with any other provider type.
back to top
Q: To whom do I send prior authorization requests and claims after services have been rendered?
A: For dates of service on or after September 1, 2009, TMHP will be the new administrator of hearing services benefits for Texas Medicaid and the CSHCN Services Program following the transition from PACT. TMHP receives and processes all prior authorization requests and claims and notifies providers of all policy updates periodically through banner messages, web articles, and bulletin articles.
back to top
Q: Currently, clients must have suspected or identified permanent hearing loss to be eligible for PACT services. Who will be eligible for hearing services under Texas Medicaid and the CSHCN Services Program?
A: Clients of any age with demonstrated medical necessity are eligible. Providers may refer to the Hearing Services website on www.tmhp.com for medical necessity criteria.
back to top
Q: Under PACT, clients choose a provider, submit an application for services through this provider, and receive services upon approval. How do clients receive hearing services benefits under Texas Medicaid and the CSHCN Services Program?
Qualified clients enroll with Texas Medicaid and/or the CSHCN Services Program as applicable. Once enrolled, clients are eligible for all services that are benefits of the program with which they are enrolled, including medical, dental, hearing, vision, and so forth.
Clients may receive services from licensed providers who are enrolled with Texas Medicaid or the CSHCN Services Program as applicable. The policy that defines applicable services is found in the following TMHP publications:
- Provider manuals
- Bulletins
- Banner messages
- The Remittance and Status (R&S) Report
- Articles on the TMHP website at www.tmhp.com
After rendering a service, providers may submit claims to TMHP for reimbursement. Prior authorization is required only for certain services as indicated in TMHP publications, including the 2009 Texas Medicaid Provider Procedures Manual and the 2009 CSHCN Services Program Provider Manual.
back to top
Q: Will children of Texas be fit with hearing aids by any Medicaid-enrolled or CSHCN Services Program-enrolled hearing aid provider?
A: Clients with abnormal hearing screens must be referred to a Texas Medicaid-enrolled or CSHCN Services- Program enrolled audiologist or physician who provides audiology services. Clients who are 20 years of age or younger with abnormal screening results will be referred to a Texas Medicaid or CSHCN Services Program provider who is experienced with the pediatric population and who offers auditory services.
back to top
Q: Currently, I submit authorization requests, vouchers, and other forms to PACT. What forms will TMHP require for hearing services?
A: Providers submit procedure codes and diagnosis codes on the appropriate claim form or the electronic equivalent to TMHP to receive reimbursement for hearing services rendered. Prior authorization is required only for certain services or for services that exceed benefit limitations and must be requested before the service is performed and before the claim is filed.
For more information about billing requirements and claims filing, refer to Chapter 5 of the 2009 Texas Medicaid Provider Procedures Manual and Chapter 5 of the 2009 CSHCN Services Program Provider Manual. Refer to Chapter 23 of the 2009 Texas Medicaid Provider Procedures Manual and Chapter 19 of the 2009 CSHCN Services Program Provider Manual for more detailed information about hearing services policy and procedures.
back to top
Q: How do I file claims with TMHP?
A: TMHP accepts electronically filed claims and claims submitted through the mail on paper forms approved by the Centers for Medicare and Medicaid Services (CMS).
To file claims electronically, providers use the TexMedConnect system. TexMedConnect is a free, web-based claims submission application provided by TMHP through the TMHP website at www.tmhp.com . Providers can use TexMedConnect for claims submission, eligibility requests, claims status inquiries, appeals, and viewing the R&S Report online.
Paper claims are mailed to the following address:
Texas Medicaid & Healthcare Partnership
Claims
PO Box 200555
Austin , TX 78720-0555
back to top
Q: What are the advantages of using TexMedConnect to file claims electronically?
- Speed - You can know what is happening to claims in less than 24 hours and receive reimbursement for approved claims in less than one week. You can submit individual requests interactively and receive immediate responses.
- Cost-effectiveness- TMHP offers free workshops for TexMedConnect. Billing and many other topics, as well as reference materials and manuals are located on the TMHP website at www.tmhp.com .
- Data Security- TMHP uses Virtual Private Network (VPN) and Secure Socket Layer (SSL) connections, just like the government, banks, and other financial institutions to ensure maximum security of all transmitted data.
- Accuracy - TexMedConnect lets providers know right away when they make a mistake, which leads to fewer rejected or denied claims. Rejected claims are returned with messages that explain what is wrong, so providers can correct and resubmit the claim quickly.
- Availability - Electronic services are available day and night, from home, the office, or anywhere a computer is available to connect.
- Record keeping and research are easy - TexMedConnect not only sends and receives claims, it also houses the Electronic R&S Report, performs claim status inquiries, and archives claims. TexMedConnect can also generate and print reports on everything sent, received, or archived by the system.
back to top
Q: How do I find information about the status of claims submitted to TMHP?
A: TMHP provides weekly R&S reports to give providers detailed information about the status of claims submitted to TMHP. The R&S Report also identifies accounts receivable established as a result of overpayment. Providers are responsible for reconciling their records to the R&S Report to determine which payments and denials have been received.
For more information about the R&S Report, including field explanations and interpretation, see the 2009 Texas Medicaid Provider Procedures Manual, section 5.10 .
back to top
Q: Is there someone I can contact directly with questions once the PACT transition has occurred?
A: The TMHP Contact Center and the TMHP-CSHCN Services Program Contact Center are also available from 7:00 a.m. to 7:00 p.m. Central Time at the following telephone numbers:
Texas Medicaid: 1-800-925-9126
CSHCN Services Program: 1-800-568-2413
The TMHP Provider Relations Department has a staff of Austin and field-based representatives who furnish a variety of services and activities that inform and educate providers about Texas Medicaid and the CSHCN Services Program. For a list of provider relations field representatives and their contact numbers, visit the Provider Relations web page .
Provider relations representatives are responsible for provider education through planned events and problem identification and resolution. Educational workshops are offered throughout the year to keep providers informed of the latest policies, claim processing procedures, and federal and state regulations that affect Texas Medicaid and the CSHCN Services Program. For a list of upcoming workshops, visit http://www.tmhp.com/C18/workshops/default.aspx
back to top
>Q: Where can I find more information about the PACT transition?
A: You can find information about the PACT transition at the following locations:
back to top
Q: How Are Texas Medicaid and the CSHCN Services Program Different From PACT?
Information posted June 8, 2009: All services that are currently available through PACT will be available through Texas Medicaid and the Children with Special Health Care Needs (CSHCN) Services Program to appropriately-enrolled providers.
Click here to view the administrative differences between PACT, Texas Medicaid, and the CSHCN Services Program.
back to top