| February 2010 |
 | FQHC and RHC Providers Claims For PCCM Clients Require Referring Provider Effective April 1, 2010 |
| Information posted February 4, 2010: Effective April 1, 2010, Federally Qualified Health Center (FQHC) and rural health clinic (RHC) providers must submit the referring provider’s National Provider Identifier (NPI) on claims for outpatient hospital or professional services that are provided to a PCCM client for whom they are not the primary care provider. If the referring provider’s NPI is not submitted on a claim for outpatient hospital or professional services that were provided to a PCCM client for whom they were not the primary care provider, the claim will be denied. Click on the title to view the details. |
 | Medicaid Reimbursement for Medicare and MAP secondary claims |
| Information posted February 5, 2010: Reminder: Texas Medicaid reimburses certain claims for dual-eligible clients enrolled in Medicare or Medicare Advantage Plans (MAP).Click on the title to view the details. |
| Update to “Reimbursement Rates for Some Diagnostic Radiology Services Procedure Codes..” |
| Information posted February 5, 2010: This is an update to an article that was posted on this website on January 15, 2010. The article incorrectly indicated that effective February 19, 2010, for dates of service on or after January 1, 2010, reimbursement rates would change for some diagnostic radiology services procedure codes. The updated information is that reimbursement rates for some diagnostic radiology services procedure codes were effective January 1, 2010, and others will become effective on March 1, 2010. Click on the title to view the reimbursement rates table.
|
| OFL Updated for Some Radiology Procedure Codes |
| Information posted February 5, 2010: TMHP has identified an issue that impacts the Online-Fee Look-Up (OFL) and the static fee schedules and some radiology procedure codes. Effective January 15, 2010, the OFL has been updated and the missing procedure codes can now be accessed. Click on the title to view a table of the affected codes. |
| Therapeutic Radiopharmaceutical Benefits to Change for Texas Medicaid |
| Information posted February 5, 2010: Effective for dates of service on or after April 1, 2010, therapeutic radiopharmaceutical benefits will change for Texas Medicaid. Click on the title to view the details. |
| Prior Authorization Requirements to Change for Some Unlisted Procedure Codes Effective April 1, 2010 |
| Information posted February 5, 2010: Effective for dates of service on or after April 1, 2010, prior authorization requirements will change for some unlisted procedure codes. Click on the title to view the details. |
| Update to “Stem Cell Transplants Benefits to Change for the CSHCN Services Program” |
| Information posted February 5, 2010: This is an update to the article published on the TMHP website at www.tmhp.com, on January 22, 2010, titled, “Stem Cell Transplants Benefits to Change for the CSHCN Services Program.” Click on the title to view the details. |
| Update to “Reimbursement Rates for Some Musculoskeletal System Surgery Services Procedure Codes..." |
| Information posted February 5, 2010: This is an update to an article that was posted on this website on January 15, 2010. The article incorrectly indicated that effective February 19, 2010, for dates of service on or after January 1, 2010, reimbursement rates would change for some musculoskeletal services procedure codes. The updated information is that reimbursement rates for some musculoskeletal system services procedure codes were effective January 1, 2010, and others will become effective on March 1, 2010. Click on the title to view the reimbursement rates table.
|
| January 2010 |
| Update to “Taxonomy Codes Updated” |
| Information posted January 12, 2010: This is an update to an article that first appeared on the December 28, 2009, Remittance and Status (R&S) Report, and to a web article that was published on this website on December 23, 2009, titled “Taxonomy Codes Updated.” The article indicated that January 1, 2010, was the effective date for the most recent taxonomy code updates. The effective date has changed to January 11, 2010. Click on the title to view the complete corrected article. |
| EFT Payments Delayed Due to Bank Holiday |
| Information posted January 12, 2010: Monday, January 18, 2010, is Dr. Martin Luther King Jr. Day Day, which is a bank holiday. As a result, electronic funds transfer (EFT) payments will be delayed by one business day. Providers receiving EFT payments can expect funds by Friday, January 22, 2010. For more information, call the TMHP Contact Center at 1-800-925-9126 or the TMHP-CSHCN Contact Center at 1-800-568-2413.
|
| Renal Dialysis Services Criteria to Change for Texas Medicaid |
| Information posted January 15, 2010: Effective for dates of service on or after March 1, 2010, benefit criteria for renal dialysis services will change for Texas Medicaid. Click on the title to view the details. |
| Reimbursement Rates for Sign Language Procedure Code to Change |
| Information posted January 15, 2010: Effective February 19, 2010, for dates of services on or after January 1, 2010, reimbursement rates for sign language or oral interpretive services procedure code T1013 with modifier U1 or UA will change for Texas Medicaid. The reimbursement rate for procedure code T1013 with modifier U1 will be $73.60. The reimbursement rate for procedure code T1013 with modifier UA will be $14.75. Affected claims with dates of service from January 1, 2010, through February 18, 2010, will be reprocessed, and payments will be adjusted accordingly. No action on the part of the provider is required.
For more information, call the TMHP Contact Center at 1-800-925-9126.
|
| Reimbursement Rates for Some Diagnostic Radiology Services Procedure Codes to Change |
| Information posted January 15, 2010: Effective February 19, 2010, for dates of services on or after January 1, 2010, reimbursement rates for some diagnostic radiology services procedure codes will change for Texas Medicaid. Affected claims with dates of service from January 1, 2010, through February 18, 2010, will be reprocessed, and payments will be adjusted accordingly. No action on the part of the provider is required. Click on the title to view the details.
|
| Reimbursement Rates for Some Musculoskeletal System Surgery Services Procedure Codes to Change |
| Information posted January 15, 2010: Effective February 19, 2010, for dates of services on or after January 1, 2010, reimbursement rates for some musculoskeletal system surgery services procedure codes will change for Texas Medicaid. Affected claims with dates of service from January 1, 2010, through February 18, 2010, will be reprocessed, and payments will be adjusted accordingly. No action on the part of the provider is required. Click on the title to view the details.
|
| Reimbursement Rates for Some Radiopharmaceutical Services Procedure Codes to Change |
| Information posted January 15, 2010: Effective February 19, 2010, for dates of service on or after January 1, 2010, reimbursement rates for some radiopharmaceutical services procedure codes will change for Texas Medicaid. Affected claims with dates of service from January 1, 2010, through February 18, 2010, will be reprocessed, and payments will be adjusted accordingly. No action on the part of the provider is required. Click on the title to view the details. |
| Reimbursement Rates for Some Respiratory System Surgery Services Procedure Codes to Change |
| Information posted January 15, 2010: Effective February 19, 2010, for dates of services on or after January 1, 2010, reimbursement rates for some respiratory system surgery services procedure codes will change for Texas Medicaid. Affected claims with dates of service from January 1, 2010, through February 18, 2010, will be reprocessed, and payments will be adjusted accordingly. No action on the part of provider is required. Click on the title to view the revised reimbursement rates.
|
| Reimbursement Rates for Some Nuclear Medicine Services Procedure Codes to Change |
| Information posted January 15, 2010: Effective February 19, 2010, for dates of services on or after January 1, 2010, reimbursement rates for some nuclear medicine services procedure codes will change for Texas Medicaid. Affected claims with dates of service from January 1, 2010, through February 18, 2010, will be reprocessed, and payments will be adjusted accordingly. No action on the part of provider is required. Click on the title to view the details.
|
| Reimbursement Rates for Some Radiology Services Procedure Codes to Change |
| Information posted January 15, 2010: Effective February 19, 2010, for dates of services on or after January 1, 2010, reimbursement rates for some radiology (portable X-ray) services procedure codes will change for Texas Medicaid. Affected claims with dates of service from January 1, 2010, through February 18, 2010, will be reprocessed, and payments will be adjusted accordingly. No action on the part of provider is required. Click on the title to view the details.
|
| Nonsolid Organ Transplant Benefits to Change for Texas Medicaid |
| Information posted January 15, 2010: Effective for dates of service on or after February 1, 2010, benefits for stem cell transplant services will change for Texas Medicaid. Click on the title to view the details.
|
| Consultation Procedure Codes to Remain a Benefit for Texas Medicaid and the CSHCN Services Program |
| Information posted January 15, 2010: Effective January 1, 2010, Medicare eliminated payment for Current Procedural Terminology (CPT) consultation procedure codes, including inpatient, office, and outpatient consultations, but excluding telemedicine consultation G-codes.
Click on the title for more information. |
| Critical Care Services Benefit to Change |
| Information posted January 15, 2010: Effective for dates of service on or after March 1, 2010, benefit criteria for critical care services will change for the Children with Special Healthcare Needs (CSHCN) Services Program. Click on the title to view the details. |
| Limitations Change for Some Laboratory Services Procedure Codes |
| Information posted January 15, 2010: Effective February 25, 2010, for dates of service on or after January 1, 2009, the limitations for some laboratory services procedure codes changed for Texas Medicaid and the Children with Special Health Care Needs (CSHCN) Services Program. Affected claims will be reprocessed, and payments will be adjusted accordingly. No action on the provider is required. Click on the title to view the details.
|
| Reimbursement Rates for DME, Medical, and Surgery Procedure Code Changes for CSHCN Services Program |
| Information posted January 15, 2010: Effective for dates of services on or after February 1, 2010, reimbursement rates for some durable medical equipment (DME) services, medical services, surgery and assistant surgery services will change for the Children with Special Health Care Needs (CSHCN) Services Program. Click on the title to view the details.
|
| Reimbursement Rates for Procedure Code H1010 to Change |
| Iformation posted January 15, 2010: Effective February 19, 2010, for dates of services on or after January 1, 2010, reimbursement rates for family planning services procedure code H1010 will change for Texas Medicaid. For clients who are birth through 20 years of age, the reimbursement rate for procedure code H1010 will be $11.46 (0.40 relative value unit [RVU], $28.640 conversion factor). For clients who are 21 years of age or older, the reimbursement rate will be $10.91 (0.40 relative value unit [RVU], $27.276 conversion factor). Affected claims for dates of service from January 1, 2010, through February 18, 2010, will be reprocessed, and payments will be adjusted accordingly. No action on the part of the provider is required.
For more information, call the TMHP Contact Center at 1-800-925-9126.
|
| Physical, Occupational, and Speech Therapy for CCP Clarification |
| Information posted January 15, 2010: This is a clarification to a banner message that first appeared on the November 13, 2009, Remittance and Status (R&S) Report, and to a web article that was posted on this website on November 9, 2009, titled “Physical, Occupational, and Speech Therapy for CCP Update.” This message clarifies the authorization and claims processes for procedure code 97535. Click on the title to view the details. |
| Postexposure Prophylaxis for Rabies to Be a Benefit of the CSHCN Services Program |
| Information posted January 15, 2010: Effective for dates of service on or after February 1, 2010, postexposure prophylaxis for rabies (procedure codes 90375, 90376, and 90675) will be a benefit of the Children with Special Health Care Needs (CSHCN) Services Program. Click on the title to view the details. |
| Blood Pressure Device Benefits to Change for the CSHCN Services Program |
| Information posted January 15, 2010: Effective for dates of service on or after February 1, 2010, benefits for blood pressure device will change for the Children with Special Health Care Needs (CSHCN) Services Program. Click on the title to view the details.
|
| THSteps-CCP Blood Pressure Device Benefits to Change |
| Information posted January 15, 2010: Effective for dates of service on or after February 1, 2010, blood pressure device benefits will change for the Texas Health Step-Comprehensive Care Program (THSteps-CCP). Click on the title to view the details.
|
| Texas Medicaid Sleep Studies Benefits to Change |
| Information posted January 15, 2010: Effective for dates of service on or after February 1, 2010, sleep study benefits will change for Texas Medicaid. Click on the title to view the details.
|
| Updates to Services Provided to PCCM Clients by FQHCs and RHCs |
| Information posted January 6, 2010: Effective March 1, 2010, FQHC and RHC providers that provide gynecological services to PCCM clients must submit claims with an encounter code and modifier GY in the claim details. Click on the title to view the details. |
| Facility Requests for Nonemergency Ambulance Prior Authorization |
| Information posted January 8, 2010: Effective with dates of service on or after January 1, 2010, all faxed nonemergency prior authorization requests must be submitted with the Nonemergency Ambulance Prior Authorization Request Form, which is available in the file library of this website. Click on the title to view the details. |
| Renal Dialysis Services Criteria to Change for Texas Medicaid |
| Information posted January 8, 2010: Effective for dates of service on or after March 1, 2010, benefit criteria for renal dialysis services will change for Texas Medicaid. Click on the title to view the details. |
| Circumcision Benefit Criteria to Change for the CSHCN Services Program |
| Information posted January 8, 2010: Effective for dates of service on or after March 1, 2010, benefit criteria for circumcisions will change for the Children with Special Health Care Needs (CSHCN) Services Program. Click on the title to view the details. |
| Renal Dialysis Services Criteria to Change for the CSHCN Services Program |
| Information posted January 8, 2010: Effective for dates of service on or after March 1, 2010, benefit criteria for renal dialysis services will change for the Children with Special Health Care Needs (CSHCN) Services Program. Click on the title to view the details. |
| Critical Care Services Benefit to Change for the CSHCN Services Program |
| Information posted January 8, 2010: Effective for dates of service on or after March 1, 2010, benefit criteria for critical care services will change for the Children with Special Health Care Needs (CSHCN) Services Program. Click on the title to view the details. |
| January Webinars for PET Scan and Cardiac Nuclear Imaging Prior Authorization Changes |
| Information posted January 8, 2010: Reminder: TMHP and MedSolutions will offer web-based, interactive presentations (i.e., “webinars”) in January 2010 to provide additional education and to answer questions about the MedSolutions prior authorization process for positron emissions tomography (PET) scans and cardiac nuclear imaging services. This prior authorization process will be effective for dates of service on or after February 1, 2010. The webinars will be instructor-led events that are conducted through WebEx Meeting. Attendees use their personal computer and telephone to participate. Click on the title to view the details. |
| CSHCN Services Program Reimbursement Rates for DME, Medical, and Surgery Procedure Codes to Change |
| Information posted January 8, 2010: Effective for dates of services on or after February 1, 2010, reimbursement rates for some durable medical equipment (DME) services, medical services, surgery and assistant surgery services will change for the Children with Special Health Care Needs (CSHCN) Services Program. Click on the title to view the details. |
| Adult Preventative Care Benefits to Change |
| Information posted January 8, 2010: Effective for dates of service on or after January 1, 2010, adult preventative care is a benefit of Texas Medicaid. Click on the title to view the details. |
| CSHCN Provider Bulletin No. 73 |
| Information Posted January 22, 2010: The February 2010 CSHCN Provider Bulletin No. 73 is now available. Click the title to view the bulletin |
| Update to “2009 HCPCS 1Q and 2Q New Benefits for Some Medical Procedure Codes |
| Information posted January 22, 2010: This is an update to an article that was published on this website on December 11, 2009, titled “2009 HCPCS First and Second Quarter New Benefits for Some Medical Procedure Codes.” The article did not list all of the diagnosis restrictions for procedure code C9249. Click on the title to view the complete, corrected article. |
| Reimbursement Rates Change for Some Surgery Services Procedure Codes |
| Information posted January 22, 2010: Effective January 22, 2010, for dates of services on or after June 1, 2008, the reimbursement rates for the following surgery services procedure codes will change for Texas Medicaid and the Children with Special Health Care Needs (CSHCN) Services Program: 11055, 11056, 11057, 11719, and G0127. Affected claims with dates of service on or after June 1, 2008, will be reprocessed, and payments will be adjusted accordingly. No action on the provider is required. Click on the title to view the details. |
| Stem Cell Transplants Benefits to Change for the CSHCN Services Program |
| Information posted January 22, 2010: Effective for dates of service on or after February 1, 2010, benefits will change for the Children with Special Health Care Needs (CSHCN) Services Program stem cell transplant services. Click on the title to view the details. |
| Reminder: New PCCM Inpatient/Outpatient Authorization Form Required Effective March 1, 2010 |
| Information posted January 22, 2010: Effective for dates of service on or after March 1, 2010, only the updated Primary Care Case Management (PCCM) Inpatient/Outpatient Authorization Form will be accepted, and all authorization requests received using the previous version of the form will not be processed and will be returned to providers. Click on the title to view the details. |
| Postexposure Prophylaxis for Rabies to Be a Benefit of Texas Medicaid |
| Information posted January 22, 2010: Effective for dates of service on or after February 1, 2010, postexposure prophylaxis for rabies (procedure codes 90375, 90376, and 90675) will be a benefit of Texas Medicaid. Click on the title to view the details. |
| February 2010 Long Term Care Provider (LTC) Bulletin No. 41 |
| Information posted January 27, 2010: The February 2010 Long Term Care (LTC) Provider Bulletin No. 41 is now available for download from the TMHP.com file library.
|
| March-April 2010 Texas Medicaid Bulletin No. 228 |
| Information posted January 27, 2010: The March-April 2010 Texas Medicaid Bulletin No. 228 is now available. Click the title to view the bulletin.
|
| New Circumcision Procedure Codes for the CSHCN Services Program |
| Information posted January 29, 2010: Effective for dates of service on or after March 1, 2010, the Children with Special Health Care Needs (CSHCN) Services Program will implement reimbursement rates for circumcision procedure codes 54150 and 54160. Click on the title to view the details. |
| Correction to Radiation Therapy Information in TMPPM |
| Information posted January 29, 2010: This is a correction to the 2009 Texas Medicaid Provider Procedures Manual section 36.4.45, “Radiation Therapy,” on page 36-117. The section indicates some incorrect places of service. Click on the title to view the correct places of service.
|
| Radiology Procedure Codes Being Reinstated for NP, CNS, PA, and Radiation Treatment Center Providers |
| Information posted January 29, 2010: Effective February 11, 2010, for dates of service on or after July 1, 2009, some radiology procedure codes will be updated for nurse practitioner (NP), clinical nurse specialist (CNS), physician assistant (PA), and radiation treatment center providers in the office, inpatient hospital, or outpatient hospital setting. Click on the title to view the details.
|
| Women’s Health Program (WHP) Providers and Performance of Elective Abortions |
| Information posted January 29, 2010: Effective September 1, 2005, Section 32.048(h), Human Resources Code, prohibits the payment of Women’s Health Program (WHP) funds to providers that perform elective abortions. Click on the title to view the details. |
| Billing for Influenza A and B Testing |
| Information posted January 29, 2010: Providers that test clients for influenza A and influenza B on the same date of service and use procedure code 87804 to bill for each test must submit two separate details on the claim submission. Modifier 91 must be added to the second test to indicate a repeated clinical laboratory test billed more than once per day. Although the different strains of influenza require different tests, each test is billed using the same procedure code, so the second test is considered a repeated test.
For more information, call the TMHP Contact Center at 1-800-925-9126 or the TMHP-CSHCN Services Program Contact Center at 1-800-568-2413.
|
 | 2010 Claims Filing Deadline Calendar Now Available for Medicaid and CSHCN Services Program Providers |
| Information posted January 29, 2010: The 2010 claims filing deadline calendar is now available for Medicaid and the Children with Special Health Care Needs (CSHCN) Services Program providers. Click on the title to view the calendar.
|
| 2009 HCPCS Second and Third Quarter New Benefits for Some Medical and DME Procedure Codes |
| Information posted January 29, 2010: Effective for dates of service on or after January 1, 2010, procedure codes C9250, C9360, C9361, and C9362, from the second and third quarter 2009 Healthcare Common Procedure Coding System (HCPCS) updates are benefits of Texas Medicaid. Affected claims will be reprocessed, and payments will be adjusted accordingly. No action on the part of the provider is required. Click on the title to view the details. |
| December 2009 |
| 2010 CSHCN Services Program Provider Manual to be Available in June |
| Information posted December 31, 2009: The 2010 CSHCN Services Program Provider Manual will be mailed to providers and will be available on this website in June 2010. The 2010 CSHCN Services Program Provider Manual will include policies with implementation and effective dates through January 1, 2010, as well as the 2010 Healthcare Common Procedure Coding System (HCPCS) annual updates. New policy implementations and updates effective after January 1, 2010, will be published in the CSHCN Services Program Provider Bulletin.
For more information, call the TMHP-CSHCN Services Program Contact Center at 1-800-568-2413.
|
| Online Provider Lookup Enhancements Coming in March |
| Information posted December 31, 2009: Enhancements to the Online Provider Lookup (OPL) will be implemented on March 1, 2010. Click on the title to view the details. |
| Texas Medicaid Reimbursement Rates to Change for Some Durable Medical Equipment |
| Information posted December 1, 2009: Effective January 4, 2010, for dates of services on or after January 1, 2010, reimbursement rates will change for some durable medical equipment (DME) procedure codes. Click on the title to view the details. |
| CSHCN Newsletter for Families |
| Information posted December 2, 2009: The January 2010 CSHCN Newsletter for Families (English and Spanish) is now available for download from the TMHP.com file library. |
| Reimbursement Rates for Specific Procedure Codes Will Change for Texas Medicaid and PCCM Programs |
| Information posted December 3, 2009: Effective January 4, 2010, for dates of services on or after January 1, 2010, reimbursement rates for some durable medical equipment (DME) services, radiology, and medical services and surgery will change for Texas Medicaid and the Primary Care Case Management (PCCM) Programs. Affected claims for dates of service from January 1, 2010, through January 3, 2010, will be reprocessed, and payments will be adjusted accordingly. No action on the provider is required. Click on the title to view the new reimbursement rates table.
|
| Documentation Requirement Update for Psychological and Neuropsychological Testing Services |
| Information posted December 4, 2009: Effective December 1, 2009, the documentation requirements for psychological and neuropsychological testing services that are performed by a psychiatrist, psychologist, or a licensed professional associate (LPA) have changed. Providers are no longer required to maintain the original testing material in the client’s medical record; however, providers must maintain the original testing material so that it is readily available for retrospective review by the Health and Human Services Commission (HHSC). Click on the title to view the details. |
| Claims Reprocessing for Certain Surgical Procedure Codes |
| Information posted December 4, 2009: TMHP has identified an issue that affects claims submitted by physicians and dentists with dates of service from February 1, 2008, through April 1, 2009, and certain surgical procedure codes in the office, inpatient hospital and outpatient hospital settings. Click on the title to view a list of the affected procedure codes. |
| 2010 Texas Medicaid Provider Procedures Manual to be Available in May 2010 |
| Information posted December 4, 2009: The 2010 Texas Medicaid Provider Procedures Manual will be mailed to providers and be available on the TMHP website at www.tmhp.com in late May 2010 rather than in January 2010. The 2010 Texas Medicaid Provider Procedures Manual will have a new format, which will make it easier for providers to access the information they need. The 2010 manual will include policies that are implemented and in effect as of January 1, 2010. New policies and policy updates that become effective after January 1, 2010, will be published in the bimonthly Texas Medicaid Bulletin.
For more information, call the TMHP Contact Center at 1-800-925-9126.
|
| Benefit Update for Obstetrics Services |
| Information posted December 4, 2009: Effective for dates of service on or after December 1, 2009, benefit criteria for obstetrics services have changed for Texas Medicaid. Click on the title to view the details. |
| Provider Identifiers to be Terminated After 24 Months of No Claim Activity |
| Information posted December 4, 2009: Beginning April 26, 2010, payment denial codes will be applied to Texas Provider Identifiers (TPIs) that have had no claim activity for a period of 24 months or greater. The TPI will be considered inactive and cannot be used to submit claims. Click on the title to view the details.
|
| Billing and Prior Authorization for Procedure Code 90378 |
| Information posted December 4, 2009: TMHP has identified an issue that impacts claims submitted with procedure code 90378 and dates of service on or after October 1, 2009. These claims might have been denied in error. Affected claims received between October 1, 2009, and December 11, 2009, will be reprocessed, and payments will be adjusted accordingly. No action on the part of the provider is required. Click on the title to view additional information about procedure code 90378. |
| Some R&S Reports Not Available for Immediate Download |
| Information posted December 7, 2009: TMHP has identified an issue that affects this week's Remittance & Status (R&S) Report Adobe portable document format (PDF) files. Some R&S reports have been delayed; however, all R&S reports will be available for download from this website by 3 p.m. on Monday, December 7, 2009. For more information, call the TMHP EDI Helpdesk at 1-888-863-3638. |
| Procedure Codes D0150 and D0180 Claims Reprocessing |
| Information posted December 11, 2009: This is a follow-up to a banner message that first appeared in the October 30, 2009, Remittance and Status (R&S) Report about reprocessing of claims for procedure code D0150 or D0180. During initial reprocessing, some claims did not have the appropriate cutbacks applied for limitation audits, resulting in radiographic services that were paid in error. Affected claims will be processed again to determine the correct payment amount, and payments will be adjusted accordingly. No action on the part of the provider is required.
For more information, call the TMHP Contact Center at 1-800-925-9126 or the TMHP-CSHCN Contact Center at 1-800-568-2413.
|
| Benefit Changes for Family Planning Titles V and XX Services |
| Information posted December 11, 2009: Effective for dates of service on or after December 7, 2009, benefit criteria for family planning services for Title V and XX have changed for Texas Medicaid. Click on the title to view the details.
|
| Genetic Services Benefit Criteria to Change for Texas Medicaid |
| Information posted December 11, 2009: Effective for dates of services on or after February 1, 2010, benefit criteria for genetic services will change for Texas Medicaid. Click on the title to view the details. |
| Non-Specific Patient Education Procedure Code Will No Longer Be a Benefit of Texas Medicaid |
| Information posted December 11, 2009: Effective February 1, 2010, procedure code S9445 will no longer be a benefit of Texas Medicaid for medical services. Providers should refer to the Current Procedural Terminology (CPT) Code book for a more specific procedure code.
For more information, call the TMHP Contact Center at 1-800-925-9126.
|
| 2009 HCPCS First and Second Quarter New Benefits for Some Medical Procedure Codes |
| Information posted December 11, 2009: Effective for dates of service on or after October 1, 2009, some medical services procedure codes for 2009 first and second quarter Healthcare Common Procedure Coding System (HCPCS) became new benefits of Texas Medicaid for clients of all ages. Affected claims will be reprocessed, and payments will be adjusted accordingly. No action on the part of the provider is required. Click on the title to view the details. |
| Radio TMHP: Radiology Services Episode |
| Information posted December 11, 2009: Beginning December 18, 2009, TMHP Radio will feature a frequently-asked-question (FAQ) segment that will provide details of the transition for positron emission tomography (PET) scans and the new requirement for cardiac nuclear imaging. These changes will affect services rendered to clients who are enrolled as fee-for-service or Primary Care Case Management (PCCM) clients. The changes will not affect services rendered to Children with Special Health Care Needs (CSHCN) Services Program clients or clients enrolled with managed care organizations (MCOs). Click on the title to view the details. |
| Error with Online Provider Enrollment Resolved |
| Information posted December 14, 2009: TMHP has resolved the issue that affected providers using the online Provider Enrollment Portal to enroll in Texas Medicaid or the Children with Special Health Care Needs (CSHCN) Services Program. Providers can now use Online Provider Enrollment as intended. TMHP regrets any inconvenience providers may have experienced. |
| Authorization Requests for PET and Cardiac Nuclear Imaging Services |
| Information posted December 11, 2009: Effective for dates of service on or after February 1, 2010, the prior authorization process and some benefits will change for outpatient diagnostic positron emission tomography (PET) and cardiac nuclear imaging services. Click on the title to view the details.
|
| TMHP Scheduled System Maintenance |
| Information posted December 17, 2009: TMHP will perform scheduled maintenance to the claims engine and Long Term Care (LTC) systems on Sunday, January 10, 2010, from 6:00 p.m. until midnight. 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. |
| Coinsurance and Deductible Reimbursement for Non-Contracted MAPs |
| Information posted December 17, 2009: Beginning January 4, 2010, TMHP will process claims with dates of service on or after January 1, 2008, for coinsurance and deductibles for dual-eligible clients who are enrolled in a Medicare Advantage Plan (MAP) that is not contracted with HHSC. Click on the title to view the details. |
| New Web Page for Medicare/Medicaid Dual-Eligible Claims |
| Information posted December 17, 2009: TMHP has noted that some providers are submitting claims for Medicare dual-eligible clients incorrectly, which is causing a high number of claim denials and delaying reimbursement. To help providers file Medicare claims correctly, TMHP has added a web page to this website. This web page includes links to the forms needed to submit claims for Medicare (Parts A and B) and Medicare Advantage Plan (MAP) (Medicare Part C) claims. The web page also includes instructions for completing the forms and a link to the list of the MAP providers that are contracted with HHSC. Click on the title to view this new web page. |
| Behavioral Health Form Change Update |
| Information posted December 18, 2009: This is an update to a banner message that first appeared on the November 13, 2009, Remittance and Status (R&S) Report and an article that was published on the TMHP website at www.tmhp.com on November 6, 2009, titled “Behavioral Health Form Changes.” Click on the title to view the details. |
| FMAP Rate Increases |
| Information posted December 18, 2009: Effective for dates of service on or after October 1, 2009, the Federal Medical Assistance Percentage (FMAP) has increased from 69.85 percent to 70.94 percent as part of the federal stimulus package passed by Congress. This change is effective for the first quarter of FFY 2010 as published by the Centers for Medicare & Medicaid Services (CMS). Affected claims will be reprocessed, and payments will be adjusted accordingly. No action on the part of the provider is required.
FMAP is the federal government’s contribution to states for Medicaid expenditures and is used for Medicaid fee-for-service and managed care. The FMAP change affects only providers that certify expenses and are paid only the federal share of their claims.
For more information, call the TMHP Contact Center at 1-800-925-9126.
|
| Correction to “Reimbursement Rates for Specific Procedure Codes Will Change…” |
| Information posted December 18, 2009: This is a correction to an article that was published on this website on December 3, 2009, titled “Reimbursement Rates for Specific Procedure Codes Will Change for Texas Medicaid and PCCM Programs.” The article included procedure codes that have not completed rate hearings and one procedure code that is not a benefit. Additionally, Relative Value Units (RVUs) were missing from the medical services, surgery, and assistant surgery procedure codes. Click on the title to view the details.
|
| Coinsurance and Deductible Reimbursement for Non-Contracted MAPs |
| Information posted December 18, 2009: Beginning January 4, 2010, TMHP will process claims with dates of service on or after January 1, 2008, for coinsurance and deductibles for dual-eligible clients who are enrolled in a Medicare Advantage Plan (MAP) that is not contracted with HHSC. Click on the title to view the details
|
| Updated List of Drugs Requiring NDC for Reimbursement |
| Information posted December 18, 2009: Effective for dates of services on or after February 1, 2010, procedure codes J1566, J0207 and J1040 must be submitted with an 11-digit National Drug Code (NDC). If these procedure codes are submitted on a claim without the NDC number, the claim will be denied, even if it was prior authorized. Click on the title to view an updated list of procedure codes that require the NDC number on claims. |
| Benefit Update for Botulinum Toxin Type A (Botox) |
| Information posted December 18, 2009: Effective for dates of service on or after February 1, 2010, benefit criteria for Botulinum Toxin Type A (Botox) will change for Texas Medicaid and the Children with Special Health Care Needs (CSHCN) Services Program.
Effective February 1, 2010, procedure code J0587 will have a billing quantity limit of 150 units. Providers must bill Botox drugs using procedure code J0587 for the amount of the injection per 100 units used. For example, a provider administering 2,500 units must bill a quantity of 25 quantity units. Any claim billed in excess of 150 billing quantity units will be denied with explanation of benefits (EOB) 00103 (services exceed allowed benefit limitations).
For more information, call the TMHP Contact Center at 1-800-925-9126 or the TMHP-CSHCN Services Program Contact Center at 1-800-568-2413.
|
| Taxonomy Codes Updated |
| Information posted December 23, 2009: Texas Medicaid & Healthcare Partnership (TMHP) has updated the taxonomy codes that are associated with provider types and specialties and are displayed during the National Provider Identifier (NPI) Online Attestation process. Click on the title to view the details. |
| Changes to the Personal Care Services Benefit |
| Information posted December 23, 2009: Eligible Texas Medicaid clients who are enrolled in a waiver program through the Department of Aging and Disability Services (DADS) may also receive personal care services (PCS) as long as the services that are provided through the waiver program do not duplicate the PCS. Also, effective January 15, 2010, the U8 modifier for procedure code T1019, which is used by Consumer Directed Services agencies (CDSA) to submit claims for the monthly administrative fee, must be prior authorized. Click on the title to view the details. |
| Batch File Submission and Retrieval Temporarily Unavailable |
| Information posted December 29, 2009: Providers are currently unable to submit or retrieve electronic data interchange (EDI) or TMHP Portal batch files; however, providers can still submit claims and retrieve information interactively through TexMedConnect. TMHP is aware of the issue and is working to resolve it as quickly as possible. Additional information will be posted when it is available. |
| Efforts Underway to Increase THSteps Checkups for Migrant Farm Workers and Their Families |
| Information posted December 31, 2009: The Texas Medicaid & Healthcare Partnership (TMHP) is working closely with the Health and Human Services Commission (HHSC) to educate migrant farm workers and their children about services covered by Medicaid and the importance of receiving timely Texas Health Steps (THSteps) medical and dental checkups. The children of migrant farm workers were identified as needing additional assistance because of unconventional living conditions, migratory work patterns, unhealthy working conditions, poverty, poor nutrition, lack of education, and illiteracy--all factors that contribute to poor health. Efforts are underway to increase the number of children who receive their THSteps medical and dental checkups on time. Click on the title to view the details. |
| Update to “Out-of-State Providers Who Perform Services to Migrant Farm Workers” |
| Information posted December 31. 2009: This is an update to an article that was published in the July/August 2009 Texas Medicaid Bulletin, No. 224, titled "Out-of-State Providers Who Perform Services to Migrant Farm Workers.” Effective for dates of service on or after April 1, 2009, out-of-state and border-state providers do not need a referral from a client’s primary care provider when they render services to Primary Care Case Management (PCCM) clients who are 20 years of age or younger and are either migrant farm workers or the children of migrant farm workers. Providers that submit claims for services rendered to these clients must include modifier UC with each procedure code they bill. For PCCM clients who are 21 years of age or older, primary care provider referrals are still required on claims for services rendered by out-of-state and border-state providers.
For more information, call the TMHP Contact Center at 1-800-925-9126. |
| Revised Provider Enrollment Applications to Be Available February 1, 2010 |
| Information posted December 31, 2009: This is an update to an article that was posted on the TMHP website at www.tmhp.com on November 13, 2009, titled “Revised Provider Enrollment Applications to Be Available January 1, 2010.” The availability date of the revised enrollment applications has changed to February 1, 2010, to align with changes to Provider Enrollment on the Portal (PEP). Click on the title to view the details.
|
| CSHCN Services Program Clients Removed From Waiting List |
| Information posted December 31, 2009: The Children with Special Health Care Needs (CSHCN) Services Program is pleased to announce that it has removed 80 people from the Program’s waiting list. Click on the title to view the details. |
| HCPCS Special Bulletin Now Available |
| Information posted December 31, 2009: Click the title to view the HCPCS Special Bulletin. |
| November 2009 |
| Correction to the January 2009 Inpatient and Outpatient Behavioral Health Services Special Bulletin |
| Information posted November 1, 2009: This is a correction to the January 2009 Inpatient and Outpatient Behavioral Health Services Special Bulletin, No. 1. The diagnosis code tables on pages 26 through 30 in the bulletin have been revised to include all of the appropriate codes. In addition, the procedure code table on page 30 of the bulletin has been revised to include all of the appropriate codes. Click on the title to view the details.
|
| Medicaid Ambulance Nonemergency Prior Authorization Request Form |
| Information posted November 3, 2009: TMHP has identified an issue with the “Nonemergency Ambulance Prior Authorization Request” form. The provider information section of the form is gray, and faxed authorizations are often illegible.
A revised ambulance prior authorization form has been posted on this website in the file library. Also, as an alternative to faxing the authorization form, providers may request ambulance authorizations electronically through this website.
Providers should fax only the revised ambulance prior authorization form, since faxing the authorization form that contains the gray portion will likely cause a delay in processing.
For more information, call the TMHP Contact Center at 1-800-925-9126. Click on the title to view the form.
|
| Behavioral Health Form Changes |
| Information posted November 6, 2009: Effective for dates of service on or after January 1, 2010, the Extended Outpatient Psychotherapy/Counseling Request Form will be revised. In addition, a new Psychological/Neuropsychological Testing Request Form will be created, and providers will be required to use this form to request prior authorization for psychological and neuropsychological testing. Click on the title to view the details. |
| Correction to THSteps PCS Reimbursement Rates Have Changed |
| Information posted November 6, 2009: This is a correction to an article that was published on this website on June 26, 2009, and in the November/December 2009 Texas Medicaid Bulletin, No.226, titled “THSteps PCS Reimbursement Rates Have Changed.” The article listed an incorrect reimbursement rate for procedure code T1019 with modifier U6. Effective for dates of service on or after August 1, 2009, the correct reimbursement rate for procedure code T1019 with modifier U6 is $2.92. The correction to the reimbursement rate for procedure code T1019 with modifier U6 does not apply to School Health and Related Services (SHARS) PCS.
For more information, call the TMHP Contact Center at 1-800-925-9126.
|
| Osteopathic Manipulative Treatment (OMT) Benefits to Change |
| Information posted November 6, 2009: Effective for dates of service on or after January 1, 2010, benefit criteria for osteopathic manipulative treatment (OMT) will change for Texas Medicaid. Click on the title to view the details.
|
| WHP Certification Form Deadline Extension |
| Information posted November 6, 2009: This is an update to an article that was published on the TMHP website at www.tmhp.com on June 29, 2009 and in the September/October 2009 Texas Medicaid Bulletin, No. 225 titled “Women’s Health Program (WHP) Providers and Performance of Elective Abortion.”
On June 22, 2009, a WHP Certification Form was mailed to billing providers who delivered family planning services to WHP clients in 2008 and 2009. Providers were given until September 18, 2009 to respond. The Texas Health and Human Services Commission (HHSC) has extended the deadline for submission of the certification form until November 30, 2009. TMHP may place a payment hold on all Medicaid fee-for-service claims filed by, or on behalf of, any billing provider who fails to respond by this date.
For more information, call the TMHP Contact Center at 1-800-925-9126.
|
| Reprocessing Claims with WHP Procedure Codes |
| Information posted November 6, 2009: TMHP has identified an issue that impacts claims submitted by Women’s Health Program (WHP) providers or family planning providers for dates of service on or after April 1, 2009 and the following procedure codes: 00851, 58340, 58611, 58615, 58670, 74000, 74010, 81005, 87252, 99001, 99243, E1399, or Q0111. These claims might have been processed incorrectly.
Affected claims will be reprocessed, and payments will be adjusted accordingly. No action on the part of the provider is necessary.
Additionally, claims with dates of service on or after January 1, 2010, and procedure code 58600 will no longer be payable to family planning providers in the office setting (place of service [POS] 1).
For more information, call the TMHP Contact Center at 1-800-925-9126.
|
| Revised Documentation Criteria for Home Health Glucose Testing Equipment and Supplies |
| Information posted November 6, 2009: Effective for dates of service on or after November 1, 2009, the documentation requirements for obtaining glucose testing equipment and supplies for home health services have changed for Texas Medicaid. Click on the title to view the details. |
| Reprocessing of Claims for Clients with Presumptive Eligibility |
| Information posted November 6, 2009: TMHP has identified an issue that impacts claims submitted for services provided to clients with presumptive eligibility (PE) and maternity diagnosis codes. Claims might have been denied in error with an explanation of benefits (EOB) message that indicated the services were not payable to clients determined to be presumptively eligible. Affected claims will be reprocessed, and payments will be adjusted accordingly. No action by the provider is necessary. Click on the title to view the affected diagnosis codes with their corresponding dates of service. |
| Update to “Physical, Occupational, and Speech Therapy Benefits to Change for CCP” |
| Information posted November 6, 2009: This is an update to an article that was posted on this website on July 10, 2009, titled “Physical, Occupational, and Speech Therapy Benefits to Change for CCP.” The article did not include procedure code 97535 as payable for speech therapy. Click on the title to view the details. |
| Peramivir EAU authorized by FDA October 23, 2009 |
| Information posted November 10, 2009: On October 23, 2009, the U.S. Food and Drug Administration (FDA) announced that it has issued an emergency use authorization (EUA) for the investigational antiviral drug Peramivir intravenous (IV) in certain adult and pediatric patients who are admitted to a hospital with confirmed or suspected 2009 H1N1 influenza infection. This is in response to a request from the U.S. Centers for Disease Control and Prevention (CDC). Click on the title to view the details. |
| CSHCN Services Program Benefits to Change for Outpatient Behavioral Health Services |
| Information posted November 10, 2009: Effective for dates of service on or after January 1, 2010, benefit criteria for outpatient behavioral health services will change for the Children with Special Health Care Needs (CSHCN) Services Program. Click on the title to view the details.
|
| Update to Home Health Skilled Nursing (SN) Services Benefits |
| Information posted November 16, 2009: This is an update to the 2009 Texas Medicaid Provider Procedures Manual Section 24.4.1, “Home Health Skilled Nursing (SN) Services.” Effective November 25, 2009, for dates of service on or after October 1, 2009, skilled nursing visits will not be approved for the sole purpose of instructing the client on the use of the subcutaneous injection port device. Any necessary instruction for the use of the device must be performed as part of the office visit with the prescribing physician.
|
| Subcutaneous Injection Port Device to Be a Benefit |
| Information posted November 16, 2009: Effective November 25, 2009, for dates of service on or after October 1, 2009, the subcutaneous injection port device will be a benefit of Texas Medicaid. Click on the title to view the details. |
| Texas Medicaid and CSHCN Services Program Hearing Services Quick Reference Guides |
| The Texas Medicaid and CSHCN Services Program Hearing Services Quick Reference Guides, which summarize hearing services benefits, are resources for Texas Medicaid and CSHCN Services Program providers of hearing services. Click on the title to view the quick reference guides.
|
| Cardiac Rehabilitation Services to Be a Benefit |
| Information posted November 16, 2009: Effective November 25, 2009, for dates of service on or after October 1, 2009, cardiac rehabilitation services will be a benefit of Texas Medicaid. Click on the title to view the details. |
| Revised Provider Enrollment Applications to Be Available January 1, 2010 |
| Information posted November 13, 2009: Beginning January 1, 2010, revised enrollment applications for each of the state health-care programs will be available for providers on this website. The revisions to the applications reflect enhancements that are being made to Provider Enrollment on the Portal (PEP). Click on the title to view the details. |
| Correction to Reimbursement Rate Changes for Ambulance Services |
| Information posted November 12, 2009: This is a correction to an article that was published in the November/December 2009 Texas Medicaid Bulletin, No 226 titled “Reimbursement Rate Changes for Ambulance Services.” The article listed some incorrect procedure code reimbursement rates. Click on the title to view the correct rates.
|
| EFT Payments Delayed Due to Bank Holiday |
| Information posted November 9, 2009: Wednesday, November 11, 2009, is Veterans Day, which is a bank holiday. As a result, electronic funds transfer (EFT) payments will be delayed by one business day. Providers receiving EFT payments can expect funds by Friday, November 13, 2009. For more information, call the TMHP Contact Center at 1-800-925-9126 or the TMHP-CSHCN Contact Center at 1-800-568-2413.
|
| Online Fee Lookup and Static Fee Schedule Note Codes Correction |
| Information posted November 20, 2009: TMHP has identified an issue with note codes 15 and 16 that appear in the Online Fee Lookup (OFL) and static fee schedules on this website. Note codes 15 and 16 displayed incorrect note messages.
The following are the correct note messages: Note code 15: “Displayed fee reflects reimbursement for the service rendered in a non-facility location.” Note code 16: “Displayed fee reflects reimbursement for the service rendered in a facility location.”
The note messages have been corrected in both the OFL and the static fee schedules.
For more information, call the TMHP Contact Center at 1-800-925-9126 or the TMHP-CSHCN Services Program Contact Center at 1-800-568-2413.
|
| Cardiac Rehabilitation Services to Be a Benefit |
| Information posted November 20, 2009: Effective November 25, 2009, for dates of service on or after October 1, 2009, cardiac rehabilitation services will be a benefit of Texas Medicaid. Click on the title to view the details.
|
| Subcutaneous Injection Port Device to Be a Benefit |
| Information posted November 20, 2009: Effective November 25, 2009, for dates of service on or after October 1, 2009, the subcutaneous injection port device will be a benefit of Texas Medicaid. Click on the title to view the details.
|
| Update to Home Health Skilled Nursing (SN) Services Benefits |
| Information posted November 20, 2009: This is an update to the 2009 Texas Medicaid Provider Procedures Manual section 24.4.1, “Home Health Skilled Nursing (SN) Services.” Effective November 25, 2009, for dates of service on or after October 1, 2009, skilled nursing visits will not be approved for the sole purpose of instructing the client on the use of the subcutaneous injection port device. Any necessary instruction for the use of the device must be performed as part of the office visit with the prescribing physician.
|
| Update to Closure of Wounds Services |
| Information posted November 20, 2009: Effective November 25, 2009, for dates of service on or after October 1, 2009, benefit criteria for closure of wounds will change for Texas Medicaid. Click on the title to view the details.
|
| Screening, Brief Intervention, and Referral to Treatment Benefit for Texas Medicaid |
| Information posted November 20, 2009: Effective November 25, 2009, for dates of service on or after October 1, 2009, screening, brief intervention, and referral to treatment (SBIRT) will be a benefit of Texas Medicaid. Click on the title to view the details.
|
| TMHP Closed November 26-27, 2009 and December 24-25, 2009; Claims Filing Deadline Extended |
| Information posted November 20, 2009: TMHP will be closed November 26, 2009, and November 27, 2009, for the Thanksgiving holiday and December 24, 2009, and December 25, 2009, for the Christmas holiday. Because of these closures, claims filing deadlines will be extended until the next business days--Monday, November 30, 2009, and December 28, 2009--as outlined in the 2009 Texas Medicaid Provider Procedures Manual, page 5-8, and the 2009 CSHCN Services Program Provider Manual, page 5-4.
During the holidays, providers can access the Automated Inquiry System (AIS) or use this website to obtain eligibility or claim status information.
For more information, call the TMHP Contact Center at 1-800-925-9126 or the CSHCN Services Program Contact Center at 1-800-568-2413.
|
| TMHP Scheduled System Maintenance |
| Information posted November 23, 2009: TMHP will perform scheduled system maintenance to the claims engine and Long Term Care (LTC) systems on Sunday, December 6, 2009, from 6:00 p.m. until midnight. 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. |
| January/February 2010 Texas Medicaid Bulletin No. 227 |
| Information posted November 24, 2009: The January/February 2010 Texas Medicaid Bulletin No. 227 is now available. Click the title to view the bulletin.
|
| October 2009 |
| Revised PCCM Inpatient/Outpatient Authorization Form |
| Information posted October 30, 2009: A revised Primary Care Case Management (PCCM) Inpatient/Outpatient Authorization Form is now available. Click on the title to view the details |
| Correction to the January 2009 Inpatient and Outpatient Behavioral Health Services Special Bulletin |
| Information posted October 30, 2009: This is a correction to the January 2009 Inpatient and Outpatient Behavioral Health Services Special Bulletin, No. 1. The diagnosis code tables on pages 26 through 30 in the bulletin have been revised to include all of the appropriate codes. In addition, the procedure code table on page 30 of the bulletin has been revised to include all of the appropriate codes. Click on the title to view the details.
|
| 2009-2010 Seasonal Influenza Vaccination Information |
| Information posted October 2, 2009: Seasonal flu vaccine is available for all Texas Medicaid clients. Click on the title to view the details.
|
| Update to “Pharmacists and Pharmacies May Enroll in Texas Medicaid to Administer Immunizations” |
| Information posted October 8, 2009: This is an update to an article published on this website on September 25, 2009, titled “Pharmacists and Pharmacies May Enroll in Texas Medicaid to Administer Immunizations.” Pharmacists who participate in Medicaid must adhere to all state and federal regulations, including the Texas Occupations Code, Section 554.052, “Immunization and Vaccinations; Physician Supervision.” In addition, pharmacists and pharmacies that are enrolled in Medicaid for the administration of vaccines must adhere to all State Board of Pharmacy licensing, certification, and scope-of-practice requirements Click on the title to view the complete, updated article.
|
| Administration Fee for H1N1 Vaccinations to Be Reimbursed for Texas Medicaid |
| Information posted October 7, 2009: Texas Medicaid, in collaboration with the Texas Department of State Health Services (DSHS), is reimbursing the administration fee for the pandemic H1N1 flu vaccine when it is administered to Texas Medicaid clients of all ages in the office setting. The effective date is October 1, 2009. Providers should monitor the primary state website for information about the pandemic at www.TexasFlu.org. Click on the title to view the details. |
| November CSHCN Bulletin No. 72 |
| Information posted October 1, 2009: The November 2009 CSHCN Provider Bulletin No. 72 is now available. Click the title to view the bulletin. |
| Update to “CSHCN Reimbursement for H1N1 Vaccination Administration” |
| Information posted October 16, 2009: This is an update to an article published on this website on October 9, 2009, titled “CSHCN Reimbursement for H1N1 Vaccination Administration”. The Children with Special Health Care Needs (CSHCN) Services Program is reimbursing the administration fee for the pandemic H1N1 flu vaccine when it is administered to CSHCN Services Program clients of all ages in the office setting. In order to be reimbursed for the administration of the H1N1 flu vaccine, providers have a choice of procedure codes to submit for the administration of the vaccine. Click on the title to view the details. |
| Claims Reprocessing of Procedure Code 57295 |
| Information posted October 16, 2009: TMHP has identified an issue with claims that were submitted by physicians, ambulatory surgical centers, and hospitals with dates of service from January 1, 2006, through October 6, 2009, and procedure code 57295. Claims that were submitted with procedure code 57295 and diagnosis codes other than 25520, 25541, or 25542 may have been denied in error. Effective for dates of service on or after January 1, 2006, procedure code 57295 is no longer diagnosis-restricted.
Affected claims will be reprocessed, and payments will be adjusted accordingly. No action on the part of the provider is necessary.
|
| Online Fee Lookup and Static Fee Schedules Updated to Include Missing Cardiac-Related Procedure |
| Information posted October 16, 2009: TMHP has identified an issue with the online fee lookup and static fee schedules on this website. Procedure codes 93541, 93542, 93543, 93544, and 93545, which were missing from the online fee lookup and the static fee schedules for physicians or ambulatory surgical centers from July 1, 2009, through October 5, 2009, have been added as of October 6, 2009.
For more information, call the TMHP Contact Center at 1-800-925-9126.
|
| Tamiflu and Relenza Are Benefits of Texas Medicaid and the CSHCN Services Program |
| Information posted October 27, 2009: Effective for dates of service on or after October 1, 2009, antiviral medications zanamivir inhalation powder (Relenza) and oseltamivir phosphate (Tamiflu) are benefits of Texas Medicaid and the Children with Special Health Care Needs (CSHCN) Services Program for clients of all ages when provided by a physician, advance practice nurse, or physician assistant in the office setting. Click on the title to view the details. |
| Recoupment of IMD Claims |
| Information posted October 21, 2009: Reminder: Institute for Mental Disease (IMD) services and any associated professional services are not a benefit of Texas Medicaid if they are provided to clients who are from 21 through 64 years of age and residents of an IMD facility.
Beginning October 26, 2009, TMHP will begin to recoup claims that were paid to providers in error for services provided to Medicaid clients who were from 21 through 64 years of age and residents of an IMD facility.
Affected claims will be reprocessed, and payments will be adjusted accordingly. Adjustments will be reflected on providers’ Remittance and Status (R&S) Reports. No action on the part of providers is required.
For more information, call the TMHP Contact Center at 1-800-925-9126.
|
| Benefit Update for THSteps Preventive Dental Services |
| Information posted October 29, 2009: Effective for dates of services on or after November 1, 2009, benefit criteria for Texas Health Steps (THSteps) preventive dental services will change for Texas Medicaid. Click on the title to view the details. |
| Phototherapy Devices Benefit Criteria to Change for Texas Medicaid |
| Information posted October 2, 2009: Effective for dates of service on or after November 1, 2009, benefit criteria for phototherapy devices will change for Texas Medicaid. Click on the title to view the details. |
| Extended Health-Care Coverage for Some Foster Care Youth Clients |
| Information posted October 2, 2009: Senate Bill 10, Section 17, 80th Legislature, Regular Session, 2007 has directed the Health and Human Services Commission (HHSC) to extend health-care coverage to some former foster care youth clients enrolled in an institution of higher education. Click on the title to view the details.
|
| 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. |
 | CSHCN Reimbursement Rates for Some Medical and Laboratory Procedure Codes to Change |
| Information posted October 23, 2009: Effective for dates of service on or after November 1, 2009, reimbursement rates for some medical and laboratory procedure codes will change for the Children with Special Health Care Needs (CSHCN) Services Program. Click on the title to view the details.
|
| Prior Authorization of Palivizumab (Synagis) Through the TMHP Website to Cease |
| Information posted October 23, 2009: Effective October 30, 2009, prior authorization requests for palivizumab (Synagis) will no longer be completed through the TMHP website at www.tmhp.com. Providers may fax prior authorization requests for palivizumab to the TMHP-CCP Prior Authorization Department at 1-512-514-4212 using the revised Texas Medicaid Palivizumab (Synagis) Prior Authorization Request Form, which is available in the Providers Forms section of this website and on page 57 of the November/December 2009 Texas Medicaid Bulletin, No. 226. For more information, call the TMHP Contact Center at 1-800-925-9126. Click on the title to view the form.
|
| Medicaid Ambulance Services Benefit to Change |
| Information posted October 23, 2009: Effective for dates of service on or after November 1, 2009, the ambulance services criteria will change for Texas Medicaid. Click on the title to view the details. |
| Diabetic Equipment and Supplies Home Health Updated Article |
| Information posted October 30. 2009: This is an update to an article published on this website on October 23, 2009, titled “Texas Medicaid Diabetic Equipment and Supplies Home Health Benefits to Change.”
The article was removed from this website, because changes to the diabetic equipment and supplies Home Health benefit have not been finalized. Providers should disregard the previously published article and monitor future provider notifications for updates.
For more information, call the TMHP Contact Center at 1-800-925-9126.
|
| Certification of Funds Letters Delayed |
| Information posted October 15, 2009: The Certification of Funds (COF) statements for School Health and Related Services (SHARS) providers for the fourth quarter (July 1 through September 30) for federal fiscal year 2009, which were scheduled to be mailed on the week of October 5, 2009, have been delayed. These statements will be mailed the week of November 2, 2009.
Each quarter, SHARS providers are required to certify the amount they were reimbursed during the previous fiscal quarter. TMHP mails quarterly COF statements to all SHARS providers after the end of each quarter in the federal fiscal year (October 1 through September 30). Each COF statement is accompanied by a letter. SHARS providers must return the signed and notarized letter to TMHP within 25 calendar days of the date printed on the letter, which will certify the funds for the fourth quarter that were listed on the statement accompanying the letter.
For more information, call the TMHP Contact Center at 1-800-925-9126. |
| Reimbursement Rates for Blood Product Procedure Codes to Change for the CSHCN Services Program |
| Information posted October 23, 2009: Effective for dates of services on or after November 1, 2009, reimbursement rates for blood product procedure codes will change for the Children with Special Health Care Needs (CSHCN) Services Program. Click on the title to view the details. |
| Providers and Excluded Entities |
| Information psoted October 23, 2009: The Health and Human Services Office of Inspector General (HHS-OIG) restricts individuals and entities with exclusions on file from participation in all federal health-care programs. These restrictions include receiving reimbursement for items or services furnished, ordered, or prescribed. Click on the title to view the details. |
| Revised PCCM Inpatient/Outpatient Authorization Form |
| Information posted October 30, 2009: A revised Primary Care Case Management (PCCM) Inpatient/Outpatient Authorization Form is now available. Click on the title to view the details
|
| Prior Authorization Criteria for Manual Wheelchairs to Change |
| Information posted October 30, 2009: Effective for dates of service on or after November 1, 2009, prior authorization criteria for manual wheelchairs will change for Texas Medicaid. Click on the title to view the details. |
| Correction to Scheduled System Maintenance for November 1, 2009 |
| Information posted October 30, 2009: This is a correction to an article that was posted on this website on October 21, 2009 titled “Scheduled System Maintenance for November 1, 2009.” The article contained an incorrect time. The following is the correct information: TMHP will perform scheduled system maintenance to the claims engine and Long Term Care (LTC) systems on Sunday, November 1, 2009, from 12:00 a.m. until 3:00 a.m. 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. |
| CSHCN Services Program Reimbursement Rate to Change for Cochlear Implants |
| Information posted October 30, 2009: Effective for dates of service on or after November 1, 2009, the Children with Special Health Care Needs (CSHCN) Services Program reimbursement rate for cochlear implants will change. The reimbursement rate for procedure code L8614 will change from $15,522.20 to $23,380.00 for purchased durable medical equipment. For more information, call the TMHP-CSHCN Services Program Contact Center at 1-800-568-2413.
|
| Ambulance Claims Submitted for Mileage |
| Information posted October 8, 2009: TMHP has identified an issue that impacts ambulance claims submitted with dates of service on or after September 1, 2009 through October 2, 2009, and mileage procedure code A0425 with an advanced life support (ALS) or specialty care transport (SCT) procedure code A0426, A0427, A0433, or A0434. These claims may have been denied in error with an explanation of benefits (EOB) that indicated the mileage procedure code is part of another procedure or service billed on the same day.
Effective for dates of service on or after September 1, 2009, ALS and SCT procedure codes A0398, A0426, A0427, A0433, and A0434 may be reimbursed in the independent laboratory (place of service [POS] 6), birthing center (POS 7), or other location (POS 9) setting.
Affected claims will be reprocessed, and payments will be adjusted accordingly. No action on the part of the provider is necessary.
For more information, call the TMHP Contact Center at 1-800-925-9126. |
| Claims Reprocessing for New Patient Obstetric Procedure Codes |
| Information posted October 9, 2009: The Texas Medicaid & Healthcare Partnership has identified an issue that affects claims submitted with dates of service from May 1, 2007, through October 31, 2008, and obstetrics procedure code 99201, 99202, 99203, 99204, 99205, 99341, 99342, 99343, 99344, or 99345 billed with modifier TH. These claims may have been denied incorrectly. Affected claims will be reprocessed, and payments will be adjusted accordingly. No further action on the part of the provider is necessary. Click on the title to view the details. |
| Medicare Crossover Claims Reprocessing |
| Information posted October 9, 2009: The Texas Medicaid & Healthcare Partnership (TMHP) has identified an issue that impacts crossover claims submitted through TrailBlazer (a Medicare intermediary) with the Medicare Part A, Remittance Advice (RA) and checks dated and distributed for August 18, 2008. Click on the title to view the details.
|
| CSHCN Reimbursement for H1N1 Vaccination Administration |
| Information posted October 9, 2009: The Children with Special Health Care Needs (CSHCN) Services Program is reimbursing the administration fee for the pandemic H1N1 flu vaccine when it is administered to CSHCN Services Program clients of all ages in the office setting. The effective date is October 1, 2009. Providers should monitor the primary state website for information about the pandemic at www.TexasFlu.org. |
| Update to "H1N1 Administration Fee for H1N1 Vaccinations to Be Reimbursed for Texas Medicaid" |
| Update posted October 16, 2009: Texas Medicaid, in collaboration with the Texas Department of State Health Services (DSHS), updated the information posted October 7, 2009 regarding provider registration with DSHS to receive the vaccine and provider billing of the administration of the H1N1 vaccine to TMHP. The effective date is October 1, 2009. Providers should monitor the primary state website for information about the pandemic at www.TexasFlu.org.
Click on the title for more details.
|
| Additional Reinstated Components for Some Radiology and Laboratory Procedure Codes |
| Information posted October 16, 2009: This is an update to an article that was posted on the TMHP website at www.tmhp.com on September 25, 2009, on the TMHP Code Updates – Procedure Code Review web page, titled, “Reinstated Components for Some Radiology and Laboratory Procedure Codes.” Effective October 1, 2009, for dates of service on or after July 1, 2009, the total component was reinstated for procedure codes 91030, 91052, and 91065 as a laboratory service instead of a radiology service. The total component and the professional interpretation component may be reimbursed as appropriate.
|
| PEP and OPL Enhancements |
| Information posted October 16, 2009: Beginning December 14, 2009, Provider Enrollment on the Portal (PEP) and Online Provider Lookup (OPL) will be enhanced to improve overall functionality. These enhancements will be accompanied by changes to the paper enrollment applications for each of the state health-care programs. Click on the title to view the details. |
| Correction to “2010 ICD-9-CM Updates Now Available” |
| Information posted October 16, 2009: This is a correction to an article that was posted on this website on September 25, 2009, on the TMHP Code Updates – ICD-9-CM web page, titled “2010 ICD-9-CM Updates Now Available.” The article incorrectly indicated that diagnosis codes V6107, V6108, V6123, V6124, V6125, and V6142 would be valid for Texas Medicaid counseling services procedure codes 90806, 90806 with modifier U8, 90853, 90853 with modifier U8, 90847, 90847 with modifier U8, and revenue code 513. Click on the title to view the correct information.
|
| September 2009 |
| Update to “Medicare Advantage Plan Claims Processing and Eligibility Inquiries Implementation” |
| Information posted September 1, 2009: This is an update to an article posted on this website on July 31, 2009, titled “Medicare Advantage Plan Claims Processing and Eligibility Inquiries Implementation.” The Health and Human Services Commission (HHSC) contact information to be used by Medicare Advantage Plans (MAPs) that choose not to contract with HHSC is no longer valid. When new contact information is available, it will be published in a provider notification. For more information, call the TMHP Contact Center at 1-800-925-9126. |
| Correction to DME New Benefit Procedure Code Reimbursement Rate |
| Information posted September 11, 2009: This is a correction to an article that was posted on this website on June 26, 2009, and published in the September/October 2009 Texas Medicaid Bulletin, No.225, and in the November 2009 CSHCN Services Program Provider Bulletin, No. 72, titled “DME New Benefit Procedure Code Reimbursement Rate.” The article listed an incorrect reimbursement rate for procedure code 9-K0739. Click on the title to view the details. |
| Cardiac Catheterization, Transthoracic Echocardiograms, Doppler Echocardiography Claims Reprocessing |
| Information posted September 4, 2009: Effective for dates of service on or after July 1, 2009, some benefit changes were made to procedure codes for cardiac catheterization, transthoracic echocardiograms, and doppler echocardiography. Click on the title to view the details. |
| Some Texas Medicaid Ambulance Services Reimbursement Rates Change |
| Information posted September 4, 2009: Effective for dates of service on or after September 1, 2009, Texas Medicaid reimbursement rates for some ambulance services have changed. Affected claims submitted for dates of service on or after September 1, 2009, will be reprocessed, and payments will be adjusted accordingly. No action on the part of the provider is necessary. Click on the title to view the details. |
| Reminder About Laboratory Services for Women’s Health Program Clients |
| Information posted September 4, 2009: Reminder: Clients who are enrolled under the Women’s Health Program (WHP) have limited Texas Medicaid benefits. WHP covers family planning services only. A client’s WHP status can be identified by locating “Women’s Health Program“ on the client’s Medicaid Identification Form H3087. Before ordering laboratory services, providers must verify that the services are a benefit of WHP. Click on the title to view additional information about laboratory services for WHP clients and guidelines for submitting claims for these services. |
| Update to “Tuberculosis Clinic Benefit Criteria to Change for Texas Medicaid” |
| Information posted September 4, 2009: This is an update to an article that was published on this website on August 7, 2009, titled “Tuberculosis Clinic Benefit Criteria to Change for Texas Medicaid.” Procedure code 99211 has been removed from the table of codes that must be billed within the 90 days immediately preceding the date directly observed therapy (procedure code H0033) is performed. Also, procedure code H0033 has been removed from the table of codes that must be billed on the same date of service as procedure code 99001. Click on the title to view the complete, updated article. |
| Benefit Update for Preventive Dental Services for the CSHCN Services Program |
| Information posted September 4, 2009: Effective for dates of services on or after November 1, 2009, benefit criteria for preventive dental services will change for the Children with Special Health Care Needs (CSHCN) Services Program. Click on the title to view the details. |
| Clarification of “Obstetric Services Benefits to Change” |
| Information posted September 4, 2009: This is a follow-up to an article published in the January/February 2009 Texas Medicaid Bulletin, No. 220, titled “Obstetric Services Benefits to Change.” Effective for dates of service on or after November 1, 2008, benefits for obstetric services changed for Texas Medicaid. The original article requires some clarification. Click on the title to view the details. |
| October 2009 CSHCN Newsletter for Families |
| Information posted September 19, 2009: The October 2009 CSHCN Newsletter for Families (English and Spanish) is now available for download from the TMHP.com file library. |
| Influenza Vaccination Information |
| Information posted September 18, 2009: Influenza vaccine is available through the Texas Vaccines for Children (TVFC) program free of charge for Texas Medicaid clients who are birth through 18 years of age. Influenza vaccine is a benefit of Texas Medicaid for high-risk clients of any age when the client is not covered by THSteps or TVFC, or when the vaccine is not available through TVFC. Providers are expected to follow Advisory Committee on Immunization Practices (ACIP) recommendations that relate to the prevention and control of influenza. Texas Medicaid does not require providers to enroll in TVFC; however, reimbursement for influenza vaccination administered to clients who are birth through 18 years of age is denied if the vaccine is available through TVFC, even if the provider is not enrolled in TVFC. Click on the title to view the details. |
| Pharmacists and Pharmacies May Enroll in Texas Medicaid to Administer Immunizations |
| Information posted September 25, 2009: Effective October 1, 2009, pharmacies and pharmacists can begin enrolling in Texas Medicaid to administer immunizations to Texas Medicaid clients. Click on the title to view the details. |
| Procedure Codes That Are No Longer Reimbursable to Psychologists |
| Information posted September 18, 2009: Effective for dates of service on or after August 31, 2009, certain procedure codes that are considered to be outside the scope of psychologists are no longer reimbursable to psychologists for Texas Medicaid. Click on the title to view the details. |
| FMAP and EFMAP Rate Changes |
| Information posted September 11, 2009: Effective for dates of service on or after July 1, 2009, the Federal Medical Assistance Percentage (FMAP) has increased from 68.76 percent to 69.85 percent as part of the federal stimulus package recently passed by Congress. Click on the title to view the details. |
| Verifying CSHCN Client Eligibility |
| Information posted September 18, 2009: As a result of recent difficulties with the automated eligibility files at the Department of State Health Services, some Children with Special Health Care Needs (CSHCN) clients may not have documents available to prove their current eligibility period. To verify the eligibility of these clients, providers may call the CSHCN Services Program at 1-800-252-8023. For more information, call the TMHP-CSHCN Services Program Contact Center at 1-800-568-2413.
|
| Texas Medicaid Rates Change for Some Vision-Related Services |
| Information posted September 18, 2009: Effective for dates of service on or after July 1, 2009, Texas Medicaid reimbursement rates for high-powered lenses (post-cataract), prosthetic eyes, and frames have changed. Affected claims will be reprocessed, and payments will be adjusted accordingly. No action on the part of the provider is necessary. Click on the title to view the details. |
| November/December 2009 Texas Medicaid Bulletin No. 226 |
| Information posted September 28, 2009: The November/December 2009 Texas Medicaid Bulletin No. 226 is now available. Click the title to view the bulletin.
|
| CSHCN Services Program Waiting List Information |
| Information posted September 10, 2009: The Children with Special Health Care Needs (CSHCN) Services Program has removed 175 clients from the program's waiting list. The effective date of this removal is September 1, 2009. These new clients received a gray CSHCN Eligibility Form that indicates the dates they are eligible to receive CSHCN Services Program benefits. When scheduling a client for an appointment, providers should ask the client to bring the form to the appointment so that a copy can be made for their records. For more information, call the TMHP-CSHCN Services Program Contact Center at 1-800-568-2413. |
| Update to “Palivizumab (Synagis) Prior Authorization Criteria to Change for Texas Medicaid” |
| Information posted September 11, 2009: This is an update to an article that was published on this website on August 28, 2009, titled "Palivizumab (Synagis) Prior Authorization Criteria to Change for Texas Medicaid." The article stated that the respiratory syncytial virus (RSV) season in the second region is expected to start no earlier than November 1 of each calendar year. The November 1 start date applies only to regions 1, 9, and 10.
In addition, TMHP will allow a grace period for palivizumab (Synagis) prior authorization requests and will accept requests submitted on the old form until November 1, 2009. Beginning November 1, 2009, providers must submit the revised Texas Medicaid Palivizumab (Synagis) Prior Authorization Request Form, which is available in the Provider Forms section of this website.
For more information, call the TMHP Contact Center at 1-800-925-9126. |
| Revised Texas Medicaid Vendor Drug Program Palivizumab (Synagis) Prescription Form |
| Information posted September 11, 2009: The Texas Medicaid Vendor Drug Program Palivizumab (Synagis) Prescription Form has been revised to update the client’s qualifying criteria. Details of the changes are available in an article published on this website on August 28, 2009, titled “Palivizumab (Synagis) Prior Authorization Criteria to Change for Texas Medicaid.” For more information, call the TMHP Contact Center at 1-800-925-9126. Click on the title to view the revised form. |
| Update to CSHCN Pharmacist and Pharmacy Enrollment to Administer Vaccinations |
| Information posted September 28, 2009: This is an update to an article published on this website on September 25, 2009, titled “Pharmacists and Pharmacies May Enroll in the CSHCN Services Program to Administer Immunizations.” The article indicated that providers must submit a paper enrollment application to enroll in the Children with Special Health Care Needs (CSHCN) Services Program. Pharmacies and pharmacists that wish to enroll in the CSHCN Services Program to administer immunizations may use the online provider enrollment application on this website. Click on the title to view the complete, updated article. |
| TMHP to Begin Processing Hurricane Ike Claims for Stages 2 and 3 |
| Information posted September 11, 2009: The Health and Human Services Commission (HHSC) has determined that funds are available to reimburse providers for Hurricane Ike claims for stages 2 and 3 (claims without FEMA numbers). HHSC has directed TMHP to process all Hurricane Ike stage 2 and stage 3 claims that were submitted before August 31, 2009, for dates of service from September 7, 2008, to November 7, 2008. Providers can expect to see processed claims beginning with the September 18, 2009, Remittance and Status (R&S) report. Providers should refer to the article titled “Filing Claims for Uninsured Evacuees of Hurricane Dolly and Hurricane Ike” that was posted on this website on April 24, 2009. For more information, call the TMHP Contact Center at 1-800-925-9126. |
| Texas Medicaid Rates Change for Some Vision-Related Services |
| Information posted September 18, 2009: Effective for dates of service on or after July 1, 2009, Texas Medicaid reimbursement rates for high-powered lenses (post-cataract), prosthetic eyes, and frames have changed. Affected claims will be reprocessed, and payments will be adjusted accordingly. No action on the part of the provider is necessary. Click on the title to view the details.
|
| TMHP Scheduled System Maintenance for October 11, 2009 |
| Information posted September 25, 2009: TMHP will perform scheduled maintenance to the Claims Engine and Long Term Care systems beginning at 4:00 p.m. Sunday, October 11, 2009, and ending at 3:00 a.m. Monday, October 12, 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 details about the affected applications. |
| Revisions to Medlog Reports |
| Information posted September 25, 2009:Effective November 27, 2009, TMHP will revise the Medicaid paid claims summary log (medlog) reports to provide additional information. TMHP will reformat the current medlog report and add two detailed reports. One detailed will include claims that received an 8 percent reduction for Supplemental Security Income Program (SSI) and SSI-related claims. The other detailed report will include claims that were for clients who were 20 years of age or younger on the date of service.
|
| CSHCN Services Program Rates Available in Online Fee Lookup |
| Information posted September 25, 2009: The online fee lookup (OFL) functionality on this website contains reimbursement rates for the Children with Special Health Care Needs (CSHCN) Services Program and replaces any previously published fee schedules. Providers should disregard references to fee schedules and Medicaid-allowed amounts that are listed in the 2009 CSHCN Services Program Provider Manual and use instead the OFL functionality to locate reimbursement rates. Click on the title for more information.
|
| Update and Correction to “Physical, Occupational, and Speech Therapy Benefits to Change for CCP” |
| Information posted September 25, 2009: This is an update to an article that was posted on this website on July 10, 2009, titled “Physical, Occupational, and Speech Therapy Benefits to Change for CCP.” The article did not specify information for home health agencies under the Comprehensive Care Program (CCP) and incorrectly stated that maintenance therapy was not a benefit under CCP. Click on the title to view the details. |
| HMO and PPO Copayment Claims Reprocessing |
| Information posted September 25, 2009: Reminder: TMHP has resumed processing Medicare Health Maintenance Organization (HMO) and Preferred Provider Organization (PPO) copayment claims for dates of service on or after January 1, 2008. Click on the title to view the details. |
| August 2009 |
| Update to "WHP Providers and Performance of Elective Abortion" |
| Information posted August 10, 2009: This is an update to an article that was published on the TMHP website at www.tmhp.com on June 29, 2009, and in the September/October 2009 Texas Medicaid Bulletin, No 225 titled “Women’s Health Program (WHP) Providers and Performance of Elective Abortion.” Click on the title to view the details. |
| Some CSHCN Services Program Reimbursement Rates to Change |
| Information posted August 14, 2009: Effective for dates of service on or after September 1, 2009, some reimbursement rates for the medical services, surgical, interpretation, and technical components of procedure codes will change for the Children with Special Health Care Needs (CSHCN) Services Program. Click on the title to view the details.
Article:
|
| Correction to “New AIS Eligibility Inquiry Responses Beginning August 31, 2009” |
| Information posted August 14, 2009: This is a correction to an article that was published on the TMHP website at www.tmhp.com on July 3, 2009, titled “New AIS Eligibility Inquiry Responses Beginning August 31, 2009.”
For clients with Children’s Health Insurance Program (CHIP) Perinatal coverage, the updated Automated Inquiry System (AIS) response, “Limited Medicaid coverage - CHIP Perinatal,” is not required and will not be implemented. Providers will continue to receive the current AIS response for clients with CHIP Perinatal coverage.
For more information, call the TMHP Contact Center at 1-800-925-9126.
|
| Provider Information Change (PIC) Form to Change |
| Information posted August 14, 2009: Beginning September 1, 2009, the Provider Information Change (PIC) Form will be revised to include the option for hearing services providers to indicate that they provide hearing services for children. The online PIC Form will include this option in the “Additional Services Offered” field. The paper form will include a checkbox for the new designation. Click on the title to view the details.
|
| Clinical Laboratory Procedure Code Reimbursement Rates Will Change for the CSHCN Services Program |
| Information posted August 14, 2009: Effective for dates of service on or after September 1, 2009, clinical laboratory procedure code reimbursement rates will change for the Children with Special Health Care Needs (CSHCN) Services Program. Click on the title to view the details.
|
| New Location of TMHP Medicaid Workshops in College Station |
| Information posted August 19, 2009: The upcoming TMHP workshops, Medicaid: The Basics and Medicaid: Beyond the Basics workshops scheduled for Tuesday, September 22, 2009 at the College Station Conference Center, 1300 George Bush Drive has been moved to the Hilton College Station Conference Center. Click on the title for more details. |
| 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.
|
| Updates to Certification of Funds (COF) Process |
| Information posted August 5, 2009: Effective for dates of service on or after September 1, 2009, some providers will no longer be required to certify their expenditures of state or local (nonfederal) funds on a federal fiscal year (FFY) quarterly basis. Click on the title to view the details. |
| Changes to Texas Medicaid Hearing Services Benefits to Accompany PACT Transition |
| Information posted August 20, 2009: Effective for dates of service on or after September 1, 2009, Texas Medicaid clients who are birth through 20 years of age will be eligible to receive medically necessary hearing aid devices and services through the hearing services benefit administered by TMHP. The hearing services benefits available to Texas Medicaid clients who are birth through 20 years of age will no longer be administered by Department of State Health Services (DSHS) through the Program for Amplification for the Children of Texas (PACT). TMHP currently administers the benefit for Texas Medicaid clients 21 years of age or older, so beginning September 1, 2009, TMHP will process all claims and authorization transactions for Texas Medicaid hearing services benefits. This article covers only the changes to Texas Medicaid benefits. The changes to the CSHCN Services Program benefits are covered in a separate article. Click on the title to view the details. |
| CSHCN Reimbursement Rates to Change for Physician-Administered Drugs, Vaccines and Toxoids |
| Information posted August 21, 2009: Effective for dates of service on or after September 1, 2009, reimbursement rates for physician-administered drugs, vaccines, and toxoids will change for the Children with Special Health Care Needs (CSHCN) Services Program. Click on the title to view the details
|
| PCCM Referral Form Reminder |
| Information posted August 21, 2009: Reminder: Primary Care Case Management (PCCM) providers are encouraged to use the PCCM Referral Form to refer PCCM clients to specialists. Click on the title to view details
|
| Some THSteps-CCP Personal Care Services Reimbursement Rates Have Changed |
| Information posted August 20, 2009: Effective for dates of service on or after August 1, 2009, Texas Health Steps – Comprehensive Care Program (THSteps-CCP) reimbursement rates for personal care services (PCS) have changed. Click on the title to view the details.
|
| Texas Medicaid Professional Services and DME Reimbursement Rate Change |
| Information posted August 21, 2009: Effective for dates of services on or after July 1, 2009, reimbursement rates for specific professional and durable medical equipment (DME) services have changed. Affected claims will be reprocessed, and payments will be adjusted accordingly. No action on the part of the provider is necessary. Click on the title to view the details.
|
| THSteps Preventive Care Medical Checkups Benefit to Change |
| Information posted July 24, 2009: Effective for dates of service on or after September 1, 2009, Texas Health Steps (THSteps) preventive care medical checkup criteria will change for Texas Medicaid. Click on the title to view the details. |
| Medicare Advantage Plans (MAPs) List Updated |
| Information posted August 21, 2009: The contact information has changed for some of the Medicare Advantage Plans (MAPs) that are contracted with the Texas Health and Human Services Commission (HHSC). Click on the title for the updated list of MAPs.
For more information, call the TMHP Contact Center at 1-800-925-9126.
|
| Requirements for HIV Testing of Pregnant Women to Change |
| Information posted August 21, 2009: Effective January 1, 2010, Texas state law will change for human immunodeficiency virus (HIV) testing of pregnant women. This revised law will apply to all clinicians who care for pregnant women. Click on the title to view the details |
| CSHCN Services Program Hearing Services Benefits (PACT Transition) |
| Information posted August 20, 2009: Effective for dates of service on or after September 1, 2009, the hearing services benefits for children will no longer be administered by the Department of State Health Services (DSHS) through the Program for Amplification for the Children of Texas (PACT). The hearing services for children benefit, including all claims and authorization transactions, will be administered by the Texas Medicaid & Healthcare Partnership (TMHP). Children with Special Health Care Needs (CSHCN) Services Program clients of any age will be eligible to receive medically necessary hearing aid devices and services. This article covers only the changes to CSHCN Services Program benefits. The changes to Texas Medicaid benefits are covered in a separate article. Click on the title to view the details.
|
| CSHCN Services Program Reimbursement Rates to Change for Some DME Procedure Codes |
| Information posted August 7, 2009: Effective for dates of services on or after September 1, 2009, reimbursement rates will change for some durable medical equipment (DME) procedure codes for the Children with Special Health Care Needs (CSHCN) Services Program. Click on the title to view the details.
|
| Some CSHCN Services Program Surgical Procedure Codes Reimbursement Rates to Change |
| Information posted August 7, 2009: Effective for dates of services on or after September 1, 2009, the reimbursement rates for surgery and ambulatory surgical center procedure codes 11981, 11982, and 11983 will change for the Children with Special Health Care Needs (CSHCN) Services Program. Procedure codes 11981, 11982, and 11983 with a surgery type of service will no longer be reimbursed to physicians or physician groups in an inpatient hospital setting. Procedure codes 11981, 11982, and 11983 will be reimbursable for ambulatory surgical centers in an outpatient hospital for Group 1. Click on the title to view the details.
|
| Tuberculosis Clinic Benefit Criteria to Change for Texas Medicaid |
| Information posted August 7, 2009: Effective for dates of services on or after September 1, 2009, benefit criteria for tuberculosis clinics will change for Texas Medicaid. Click on the title to view the details.
|
| 2010 ICD-9-CM Updates Coming October 1, 2009 |
| Information posted August 7, 2009: On October 1, 2009, TMHP will implement the 2010 International Classification of Diseases, Ninth Edition, Clinical Modification (ICD-9-CM) updates. Effective for dates of service on or after October 1, 2009, providers must use diagnosis codes from the 2010 ICD-9-CM, which contains the annual updates. Deleted diagnosis codes will no longer be benefits of Texas Medicaid and the Children with Special Health Care Needs (CSHCN) Services Program. Details of these changes will be available on this website beginning October 1, 2009, and will also be published in the January/February 2010 Texas Medicaid Bulletin, No. 227, and in the February 2010 CSHCN Services Program Provider Bulletin, No. 73. For more information, call the TMHP Contact Center at 1-800-925-9126 or the TMHP-CSHCN Services Program Contact Center at 1-800-568-2413.
|
| Update to "WHP Providers and Performance of Elective Abortion" |
| Information posted August 12, 2009: This is an update to an article that was published on the TMHP website at www.tmhp.com on June 29, 2009, and in the September/October 2009 Texas Medicaid Bulletin, No 225 titled “Women’s Health Program (WHP) Providers and Performance of Elective Abortion.”
Click on the title to view the details. |
| Clinical Laboratory Procedure Codes Claim Reprocessing |
| Information posted August 14, 2009: TMHP has identified an issue that impacts claims submitted by nurse practitioners (NPs), clinical nurse specialists (CNSs), and physician assistants (PAs) with dates of service from July 1, 2009, through August 11, 2009, and some clinical laboratory procedure codes in the office setting. Click on the title to view the details.
|
| Palivizumab (Synagis) Prior Authorization Criteria to Change for Texas Medicaid |
| Information posted August 28, 2009: Effective for dates of service on or after September 1, 2009, prior authorization criteria for palivizumab (Synagis) will change for Texas Medicaid. The prior authorization criteria changes will incorporate the most recent American Academy of Pediatrics RedBook recommendations for palivizumab. Click on the title to view the details. |
| Online Resources for Providers to Assist Clients Who Need Eligibility Information |
| Information posted August 28, 2009: Providers can access several online resources to assist clients who need eligibility information. Click on the title to view details about the information available at these resources and links to their websites. |
| CSHCN Services Program Providers Encouraged to Verify Address and Telephone Numbers |
| Information posted August 28, 2009: Clients and other providers will soon be able to search for Children with Special Health Care Needs (CSHCN) providers by name and physical location through the online provider lookup (OPL) tool on the TMHP website. TMHP encourages CSHCN Services Program providers to verify as soon as possible that their addresses and telephone numbers on file with TMHP are current and accurate. Click on the title to view the details.
|
| Reminder About Submitting Provider Complaints |
| Information posted August 28, 2009: Providers have the right to submit a complaint to the TMHP Complaints Resolution Department to express any dissatisfaction with Primary Care Case Management (PCCM). Providers can also use the complaint process when the relationship between provider and client has become unsatisfactory to one or both parties. Click on the title to view the details.
|
| 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. |
| July 2009 |
| Correction to “Correction to Non-Clinical Laboratory Procedure Codes Reimbursement Rates…” Article |
| Information posted July 24, 2009: This is a correction to an article that was published on this website on April 10, 2009, and in the July/August 2009 Texas Medicaid Bulletin, No 224 titled “Correction to Non-Clinical Laboratory Procedure Codes Reimbursement Rates Will Change for the Texas Medicaid Program." The article included some procedure codes that were discontinued with the 2009 Healthcare Common Procedure Coding System (HCPCS) update.
Effective for dates of service on or after January 1, 2009, the following procedure codes were discontinued: I/T-93731, I/T-93732, 5/I/T 93733, I/T-93734, I/T-93735, and I/T-93736.
Providers should refer to the “Current Procedural Terminology (CPT)”, for billing purposes.
For more information, call the TMHP Contact Center at 1-800-925-9126.
|
| Certification of Funds Statements Delayed |
| Information posted July 21, 2009: The Certification of Funds (COF) statements for School Health and Related Services (SHARS) providers for the third quarter (April 1 through June 30) for federal fiscal year 2009, which were scheduled to be mailed on July 3, 2009, have been delayed. These letters will be mailed the week of July 20, 2009. Each quarter, SHARS providers are required to certify their reimbursement amounts during the previous fiscal quarter. TMHP mails the quarterly COF statements to all SHARS providers after the end of each quarter in the federal fiscal year (October 1 through September 30). Providers will have 25 calendar days from the date printed on the letter to return the signed and notarized letter to TMHP, which will certify the funds for the third quarter that were listed on the statement accompanying the letter.
For more information, call the TMHP Contact Center at 1-800-925-9126.
|
| Online Fee Lookup Computer Based Training is Now Available |
| Information posted July 24, 2009: The online fee lookup (OFL) computer based training (CBT) is now available for providers to use for Texas Medicaid and the Children with Special Health Care Needs Services (CSHCN) Program. Click on title to view the details.
|
| Behavioral Health Services Performed by Licensed Psychological Associates to Be a Benefit |
| Information posted July 24, 2009: Effective for dates of service on or after August 31, 2009, behavioral health services performed by a licensed psychological associate (LPA) who is licensed by the Texas State Board of Examiners of Psychologists (TSBEP) will be a benefit of Texas Medicaid when certain conditions are met. As a result, claims filing for certain behavioral health services will be affected. In addition, effective for dates of service on or after August 31, 2009, the documentation requirements for psychological and neuropsychological testing will expand. Click on the title to view the details. |
| Static Texas Medicaid Fee Schedules to Be Updated |
| Information posted July 24, 2009: TMHP has identified an issue that impacts some of the static Texas Medicaid fee schedules posted on this website July 5, 2009. TMHP will update the affected fee schedules and repost them. Providers will be notified in a future article when the revised fee schedules are available for access.
For accurate and up-to-date fees, providers may use the Online Fee Lookup, which is updated daily.
|
| CSHCN Services Program Benefits to Change for Doctor of Dentistry Services As a Limited Physician |
| Information posted July 24, 2009: Effective for dates of service on or after September 1, 2009, benefit criteria for doctor of dentistry as a limited physician will change for the Children with Special Health Care Needs (CSHCN) Services Program. Click on the title to view the details. |
| Signature Requirements for Authorization and Prior Authorization Forms |
| Information posted July 24, 2009: Reminder: Authorization and prior authorization request forms submitted to TMHP must be signed and dated by the medical or dental provider or supplier treating the client. If indicated on the form, an authorized representative’s signature is acceptable. All signatures and dates must be hand-written and current. Computerized or stamped signatures are not permitted. Alterations to dates and signatures, such as cross-outs or white-outs, are not allowed. Submitted forms without an original hand-written signature and date will be rejected. Providers must keep the original, signed forms in the client’s medical record as documentation. For more information, call the TMHP-CSHCN Services Program Contact Center at 1-800-568-2413.
|
| Medicare Advantage Plan Claims Processing and Eligibility Inquiries Implementation |
| Information posted July 31, 2009: Beginning August 29, 2009, TMHP will process certain claims for dates of service on or after January 1, 2008, for clients enrolled in a Medicare Advantage Plan (MAP) for Medicare Qualified Medicaid Beneficiary (MQMB) clients. Eligibility inquiry responses on TexMedConnect and the TMHP Electronic Data Interchange (EDI) will be updated to provide Medicare Part C eligibility dates and contract identification (ID) numbers for clients enrolled in a MAP. Click on the title to view the details. |
| Family Planning Preventive Services Procedure Codes Claims Reprocessing |
| Information posted July 31, 2009: TMHP has identified issues that impact Women’s Health Program (WHP) and family planning Titles V, XIX, and XX claims submitted on and after July 1, 2009. Claims with counseling or preventive services procedure codes 1-99401, 1-99402, and 1-99429 that were billed without modifier FP and managed care claims for family planning clients may have been denied or rejected in error. Click on the title to view the details. |
| Type of Service (TOS) Codes Information for CSHCN Services Program |
| Information posted July 24, 2009: Type of service (TOS) codes no longer appear as part of the procedure code in the CSHCN Services Program Provider Manual and are not required for billing. TOS codes are assigned by the system and will appear on Remittance and Status (R&S) Reports. For some procedure codes, providers need to include a specific modifier so the system can assign the correct TOS. Information about modifiers and their requirements is available in the relevant sections of the 2009 CSHCN Services Program Provider Manual. Click on the title to view a list of TOS codes. |
| September/October 2009 Texas Medicaid Bulletin No. 225 |
| Information posted July 27, 2009: The September/October 2008 Texas Medicaid Bulletin No. 225 is now available. Click the title to view the bulletin
|
| Changes to Texas Medicaid Hearing Services Benefits to Accompany PACT Transition |
| Information posted July 31, 2009: Effective for dates of service on or after September 1, 2009, Texas Medicaid clients who are birth through 20 years of age will be eligible to receive medically necessary hearing aid devices and services through the hearing services benefit administered by TMHP. The hearing services benefits available to Texas Medicaid clients who are birth through 20 years of age will no longer be administered by Department of State Health Services (DSHS) through the Program for Amplification for the Children of Texas (PACT). Since TMHP currently administers the benefit for Texas Medicaid clients 21 years of age or older, TMHP will process all claims and authorization transactions for Texas Medicaid hearing services benefits. This article covers only the changes to Texas Medicaid benefits. The changes to the CSHCN Services Program benefits are covered in a separate article. Click on the title to view the details. |
| CSHCN Services Program Hearing Services Benefits (PACT Transition) |
| Information posted July 31, 2009: Effective for dates of service on or after September 1, 2009, the hearing services benefits for children will no longer be administered by Department of State Health Services (DSHS) through the Program for Amplification for the Children of Texas (PACT). The hearing services for children benefit, including all claims and authorization transactions, will be administered by the Texas Medicaid & Healthcare Partnership (TMHP). Children with Special Health Care Needs (CSHCN) Services Program clients of any age will be eligible to receive medically necessary hearing aid devices and services. This article covers only the changes to CSHCN Services Program benefits. The changes to Texas Medicaid benefits are covered in a separate article. Click on the title to view the details.
|
| Updates to EDI Eligibility Inquiries |
| Information posted July 31, 2009: Beginning August 28, 2009, when providers make client eligibility inquiries through Electronic Data Interchange (EDI), the providers can receive the relationship between the client and “other insurance” policyholder as part of the response. For clients who have other insurance on the date of service, the system will display the following: “C” for child, “M” for spouse, “O” for other, “P” for parent, and “S” for self. Click on the title for additional information. |
| New Special Medical Prior Authorization Form Now Available |
| Information posted July 24, 2009: Effective immediately, providers are encouraged to use the new Special Medical Prior Authorization (SMPA) Request Form. Using the new form will result in fewer delays and denials for incomplete requests. The form also makes it easier for providers to submit all required information for special medical services. Click on the title to view the details.
|
| Supplemental Worksheets for Inpatient and Outpatient PCCM Charges |
| Information posted July 31, 2009: A letter has been sent to providers concerning a review of the Primary Care Case Management (PCCM) program reimbursement data for inpatient services and the steps needed to facilitate the review. Click on the title to view the letter.
|
| August 2009 CSHCN Provider Bulletin No. 71 |
| Information posted July 1, 2009: The August 2009 CSHCN Provider Bulletin No. 71 is now available. Click the title to view the bulletin.
|
| Children with Special Health Care Needs (CSHCN) Services Program Waiting List Information |
| Information posted July 1, 2009: The Children with Special Health Care Needs (CSHCN) Services Program has removed 158 clients from the program's waiting list. The effective date of this removal is July 1, 2009. These new clients received a gray CSHCN Services Program Eligibility Form that indicates the dates they are eligible to receive CSHCN Services Program health-care benefits. When scheduling a client for an appointment, ask the client to bring the form to the appointment so that a copy can be made for your records. For more information, call the TMHP-CSHCN Services Program Contact Center at 1-800-568-2413.
|
| Implementation of TPN Services Benefit and Prior Authorization Changes Delayed |
| Information posted July 3, 2009: Changes to benefits and prior authorization requirements for total parenteral nutrition (TPN) services, which were announced with a July 1, 2009, effective date, have been delayed until August 15, 2009. Click on the title to view the details. |
| Revised Taxonomy Codes for Hearing Aid Providers |
| Information posted July 3, 2009: TMHP has revised the taxonomy codes available to otologists and otorhinolaryngologists (ENTs), hearing aid fitters and dispensers, and audiologists who are enrolled as hearing aid providers (i.e., the provider’s enrollment letter indicates “Hearing Aid”). Click on the title to view the details. |
| TMHP to Enhance TexMedConnect |
| Information posted July 3, 2009: On August 29, 2009, TMHP will implement new features that will make it easier to navigate and enter data on TexMedConnect. Acute care providers will also be able to access more client eligibility information through the online system. Click on the title to view the details. |
| New AIS Eligibility Inquiry Responses Beginning August 31, 2009 |
| Information posted July 3, 2009: Beginning August 31, 2009, the Automated Inquiry System (AIS) eligibility inquiry responses will provide more detail about a client’s type of Medicaid coverage. Click on the title to view the details. |
| Update to Third-Party Resources Type of Coverage Codes |
| Information posted July 3, 2009: Effective August 29, 2009, TMHP will update the TexMedConnect and Electronic Data Interchange (EDI) systems with a new type of coverage code for clients who have a Medicare Advantage Plan (MAP). The eligibility verification screen will display “M” on the Other Insurance Segments if the client is enrolled in a MAP in addition to Medicaid. Click on the title to view the details. |
| Inmates of Public Correctional Institutions Ineligible for Coverage of Medicaid Services |
| Information posted July 3, 2009: Federal financial participation (FFP) is not available to reimburse providers for services provided to Texas Medicaid clients who are inmates of public correctional institutions or holding facilities (Code of Federal Regulations, Title 42, 435.1009). Click on the title to view the details. |
| Revised Texas Medicaid Fee Schedules Available July 5, 2009 |
| Information posted July 3, 2009: Beginning July 5, 2009, the revised Texas Medicaid Fee Schedules will be available on this website. Providers can request a free paper copy of a fee schedule by calling the TMHP Contact Center at 1-800-925-9126. |
| Additional Diagnosis Codes to be Valid for Bevacizumab Injection |
| Information posted July 10, 2009: Effective for dates of service on or after September 1, 2009, procedure code 1-J9035 will be eligible for reimbursement with the following additional diagnosis codes: 1910, 1911, 1912,1913,1914,1915,1916,1917,1918, or 1919. This addition applies to Medicaid clients of all ages and Children with Special Healthcare Needs (CSHCN) Services Program clients who are 21 years of age or older.
For more information, call the TMHP Contact Center at 1-800-925-9126 or the TMHP-CSHCN Services Program Contact Center at 1-800-568-2413.
|
| Phase II of Cost Avoidance for Pharmacy Claims to be Implemented |
| Information posted July 10, 2009: Effective July 20, 2009, phase II of the cost avoidance coordination-of-benefits (COB) initiative for pharmacy claims will be implemented. Click on the title to view the details.
|
| Clinician-Directed Care Coordination Reminder for Texas Medicaid |
| Information posted July 10, 2009: Reminder: Effective for dates of service on or after January 1, 2009, benefits for clinician-directed care coordination services changed for the Texas Medicaid Program. Click on the title to view the details.
|
| Home Health Physical and Occupational Therapy Benefits to Change for Texas Medicaid |
| Information posted July 10, 2009: Effective for dates of service on or after August 31, 2009, benefit criteria for Home Health physical and occupational therapy will change for Texas Medicaid. Click on the title to view the details. |
| Physical, Occupational, and Speech Therapy Benefits to Change for Acute Services for Texas Medicaid |
| Information posted July 10, 2009: Effective for dates of service on or after August 31, 2009, the benefit criteria for physical, occupational, and speech therapy will change for acute services for Texas Medicaid. Click on the title to view the details. |
| Physical, Occupational, and Speech Therapy Benefits to Change for CCP |
| Information posted July 10, 2009: Effective for dates of service on or after August 31, 2009, the benefit criteria for physical, occupational, and speech therapy will change for the Comprehensive Care Program (CCP). Click on the title to view the details. |
| Correction to “New Benefits for Home Health Services for the CSHCN Services Program.” |
| Information posted July 10, 2009: This is a correction to an article that was published on this website on March 6, 2009, titled “New Benefits for Home Health Services for the CSHCN Services Program.” The article listed an incorrect procedure code for social work services. The correct social work services procedure code is C-G0155. For more information, call the TMHP-CSHCN Services Program Contact Center at 1-800-568-2413.
|
| Initial Reimbursement Rates for Molecular Laboratory Services for CSHCN Services Program |
| Information posted July 10, 2009: Effective for dates of services on or after September 1, 2009, the Children with Special Health Care Needs (CSHCN) Services Program will implement initial reimbursement rates for two molecular laboratory services procedure codes. Click on the title to view the details. |
| Clinician-Directed Care Coordination Services for the CSHCN Services Program |
| Information posted July 10, 2009: Reminder: Effective for dates of service on or after January 1, 2009, benefits for clinician-directed care coordination services changed for the Children with Special Health Care Needs (CSHCN) Services Program. Click on the title to view the details. |
| Changes to Outpatient SLP and Physical Medicine and Rehabilitation Benefits Delayed for CSHCN |
| Information posted July 10, 2009: The changes to benefit criteria for outpatient speech-language pathology and physical medicine and rehabilitation, which were to change for the Children with Special Health Care Needs (CSHCN) Services Program on August 1, 2009, have been delayed until August 31, 2009. Click on the title to view the details. |
| Cleft/Craniofacial Benefits to Change for the CSHCN Services Program |
| Information posted July 10, 2009: Effective for dates of service on or after September 1, 2009, benefit criteria for cleft/craniofacial services will change for the Children with Special Health Care Needs (CSHCN) Services Program. Click on the title to view the details.
|
| New Molecular Laboratory Benefits for the CSHCN Services Program |
| Information posted July 10, 2009: Effective for dates of service on or after September 1, 2009, additional molecular laboratory procedure codes may be reimbursed by the CSHCN Services Program. Click on the title to view the details. |
| Extended System Maintenance Window August 10, 2009 |
| Information posted July 15, 2009: TMHP will perform scheduled maintenance to the Claims Engine and Long Term Care systems on Sunday, August 9, 2009, from 6:00 p.m. until Monday August 10, 2009 at 3:00 a.m. 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 |
| Preventive Care Medical Checkup Benefits to Change for the CSHCN Services Program |
| Information posted July 17, 2009: Effective for dates of service on or after September 1, 2009, benefit criteria will change for preventive care medical checkups for the Children with Special Health Care Needs (CSHCN) Services Program. Click on the title to view the details. |
| Correction to “Molecular Laboratory Services Benefits Change” |
| Information posted July 17, 2009: This is a correction to an article published on this website on April 24, 2009, titled “Molecular Laboratory Services Benefits Change.” The article incorrectly stated that effective for dates of service on or after May 1, 2009, procedure code 5-S3840 would be reimbursed by the Children with Special Health Care Needs (CSHCN) Services Program. Procedure code 5-S3840 will be reimbursed by the CSHCN Services Program effective for dates of service on or after September 1, 2009. Click on the title to view the details.
|
| Prior Authorization to Change for Nonemergency Ambulance Transport |
| Information posted July 17, 2009: Effective for dates of service on or after September 1, 2009, prior authorization requirements and telephone line hours for nonemergency ambulance requests will change for Texas Medicaid. Click on the title to view the details.
|
| June 2009 |
| Scheduled System Maintenance for the TMHP Web Portal |
| Information posted June 1, 2009: Scheduled System Maintenance for the TMHP web portal is scheduled for Monday, June 1, 2009 8:00 to 9:00 p.m. During the system maintenance window, some applications related to the portal may be unavailable. TexMedConnect (Acute and Long Term Care) may have intermittent connectivity issues. Normal processing is scheduled to resume by 9:00 p.m. Click on the title to view the details. |
| July/August 2009 Texas Medicaid Bulletin No. 224 |
| Information posted June 1, 2009: The July/August 2009 Texas Medicaid Bulletin No. 224 is now available. Click the title to view the bulletin.
|
| TMHP Wants To Hear From You - Claims and Prior Authorization Surveys |
| Information posted June 1, 2009: In order to provide better service to providers, the Texas Medicaid & Healthcare Partnership (TMHP) developed two surveys to find out what providers think about the claims and prior authorization transaction processes. Click on the title to access the surveys. |
| Medical Direction Criteria for Anesthesia Reimbursement to Change |
| Information posted June 5, 2009: Effective for dates of service on or after August 1, 2009, the medical direction criteria for anesthesia reimbursement will change for Texas Medicaid. Click on the title to view the details. |
| Adding a PCCM Family Member to a Closed Primary Care Physician Panel |
| Information posted June 5, 2009: Reminder: TMHP cannot add new clients when the primary care provider has a closed panel. A client who selects the same primary care provider as another family member may be denied because of a closed panel. When this happens, clients are instructed to notify the primary care provider because TMHP can open a panel only at the request of a primary care provider. Click on the title to view details. |
| Outpatient Speech-Language Pathology Benefits to Change for the CSHCN Services Program |
| Information posted June 5, 2009: Effective for dates of service on or after August 1, 2009, benefit criteria for outpatient speech-language pathology services will change for the Children with Special Health Care Needs (CSHCN) Services Program. Click on the title to view the details. |
| Physical Medicine and Rehabilitation Benefits to Change |
| Information posted June 5, 2009: Effective for dates of service on or after August 1, 2009, benefit criteria for physical medicine and rehabilitation will change for the Children with Special Health Care Needs (CSHCN) Services Program. 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, 6:00 p.m. until June 15th, 2009, 2:00 a.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 & 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. |
| 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 on the title to view the administrative differences between PACT, Texas Medicaid, and the CSHCN Services Program.
|
| Evaluation and Management Procedure Code Limitation Changes |
| Information posted June 19, 2009: TMHP identified an issue that impacts claims submitted with dates of service on or after May 1, 2007, through June 30, 2009, and some evaluation and management (E/M) procedure codes. Click on the title to view the details. |
| TPN Prior Authorizations to Be Extended |
| Information posted June 19, 2009: TMHP will be extending prior authorizations for Total Parenteral Nutrition (TPN) to August 14, 2009. This extension affects existing prior authorizations for TPN services using procedure codes 1-S9364, 1-S9365, 1-S9366, 1-S9367, and 1-S9368 that end on June 30, 2009. Providers will be receiving a prior authorization letter from TMHP about the extension. For new prior authorizations that are requested before August 15, 2009, providers will need to request services through August 14, 2009. For more information, call the TMHP Contact Center at 1-800-925-9126. |
| Update to Online Fee Lookup Will Be Available to Texas Medicaid and CSHCN Services Program Providers |
| Information posted June 19, 20090: This is an update to an article that was published on the TMHP website on May 8, 2009, titled “Online Fee Lookup Will Be Available to Texas Medicaid and CSHCN Services Program Providers.” Click on title to view details.
|
| Women’s Health Program (WHP) Providers and Performance of Elective Abortions |
| Information posted June 19, 2009: As of September 1, 2005, Section 32.0248(h) of the Human Resources Code prohibits the Health and Human Services Commission (HHSC) from paying Women’s Health Program (WHP) funds to a provider that performs elective abortions. To enable HHSC to comply with this requirement, a WHP Provider Certification form will be mailed on June 22, 2009, to all billing providers that have delivered WHP services during the calendar years 2008 and 2009. Click on the title to view the details.
|
| Update to Texas Medicaid Implements Molecular Laboratory Services Reimbursement Rates |
| Information posted June 19, 2009: This is an update to an article that was published on this website on May 29, 2009, titled “Texas Medicaid Implements Molecular Laboratory Services Reimbursement Rates.” Click on the title to view the complete, updated article.
|
| TMHP Radio Now Featuring Children and Pregnant Women (CPW) Program Information |
| Information posted June 19, 2009: This month, TMHP Radio will feature a conversation with Cossy Hough, Case Management Branch Manager from the Department of State Health Services (DSHS), about the Case Management for Children and Pregnant Woman (CPW) program. Click on the title to view the details.
|
| Youth Empowerment Services Waiver |
| Information posted June 19, 2009: The Health and Human Services Commission (HHSC) and the Department of State Health Services (DSHS) received federal approval in February 2009 to implement a 1915(c) Medicaid Waiver. This program, called Youth Empowerment Services (YES), allows more flexibility in the funding of intensive community-based services and supports for children with serious emotional disturbances (SED) and their families. Click on the title to view the details. |
| EDI Batch Identification Numbers to Change Effective July 31, 2009 |
| Information posted June 19, 2009: Effective July 31, 2009, the format for the 8-character batch identification number assigned to claims received through the TMHP Electronic Data Interface (EDI) Gateway will change. Click on the title to view the details. |
| Some Remittance & Status (R&S) Reports Not Available for Immediate Download |
| Information posted June 22, 2009: TMHP has identified an issue that affects some of this week’s Remittance & Status (R&S) Adobe portable document format (PDF) files, which are not available for immediate download. All R&S reports will be available for download from this website by 2 p.m. Monday, June 22, 2009. For more information, call the TMHP EDI Helpdesk at 1-888-863-3638. |
| TMHP Scheduled System Maintenance |
| Information updated June 25, 2009: TMHP will perform scheduled maintenance to the Claims Engine and Long Term Care systems on Sunday, July 12, 2009, from 6:00 p.m. until Monday, July 13, 2009 at 3:00 a.m. During the system maintenance window, some applications will be unavailable for both Acute Care and Long Term Care systems. |
| Correction and Clarification for CDTF Services |
| Information posted June 26, 2009: This is a correction and clarification to information that was published in the January 2009 Inpatient and Outpatient Behavioral Health Services Special Bulletin, No. 1, about chemical dependency treatment facility (CDTF) services. Click on the title to view the details. |
| New DME Procedure Code Benefit |
| Information posted June 26, 2009: Effective for dates of service on or after July 1, 2009, procedure code 9-K0739 will be a new benefit of both Medicaid and the Children with Special Health Care Needs (CSHCN) Services Program. The reimbursement rate for procedure code 9-K0739 will be $13.21, which will be payable for clients of all ages. Click on the title to view the details.
|
| Incorrect PAF Form in CD Edition of the 2009 CSHCN Services Program Provider Manual |
| Information posted June 26, 2009: TMHP has identified an issue with the compact disc (CD) edition of the 2009 CSHCN Services Program Provider Manual. The CSHCN Services Program Physician/Dentist Assessment Form (PAF) published in the CD edition of the manual, was not the correct version of the form. The correct form, with a revision date of April 2008, is included in the print edition of the manual and in the file library of this website.
For more information, call the TMHP-CSHCN Services Program Contact Center at 1-800-568-2413.
|
| Correction to Telephone Numbers for CSHCN Services Program Regions 9 and 10 |
| Information posted June 26, 2009: This is a correction to a website article that was published on this website on June 19, 2009, titled “2009 CSHCN Manual Correction to Telephone Numbers for Regions 9 and 10.” Click on the title to view the details.
|
| May 2009 |
| Issue with Duplicate Medicare Payments on Professional Claims |
| Information posted May 1, 2009: TMHP has identified an issue that impacts professional claims that are duplicates of professional claims filed to Medicare, i.e., crossover claims. Professional claims with dates of service on or after January 1, 2004 that are duplicates of professional crossover claims may have been paid in error. Affected claims will be reprocessed, and payments will be adjusted accordingly. No action on the part of the provider is necessary. As a reminder, public health programs available to clients with Medicaid such as Medicare and Tricare are considered a third-party resource (TPR) as defined in the Texas Medicaid Provider Procedures Manual, section 4.10 titled “Third-Party Resources (TPR)“ on page 4-15 and Title 1 Texas Administrative Code (TAC) §358.215. Click on the title to view the details.
|
| Corrected Modifiers for RHC Texas Health Steps (THSteps) Claims |
| Information posted May 1, 2009: This is a correction to an article published on this website on April 17, 2009, titled, “Clarification of RHC Claims Filing Requirements and Family Planning Changes.” The manual and the article include incorrect information about how Texas Health Steps (THSteps) medical services should be billed when performed in the RHC setting. Click on the title to view the details.
|
| New Women’s Health Program (WHP) Benefit for the Occlusive Sterilization System |
| Information posted May 1, 2009: This is a clarification to an article that was posted on this website on April 10, 2009, titled “Update to ‘Women’s Health Program and Family Planning Benefits and Claims Filing Criteria to Change’.” The article, which indicates that procedure code 9-E1399 is a benefit for Women’s Health Program (WHP) clients, should have included WHP billing instructions. Click on the title to view the details. |
| Revised Provider Forms in Upcoming 2009 CSHCN Services Program Provider Manual |
| Information posted May 1, 2009: TMHP has revised all of the forms found in the 2008 CSHCN Services Program Provider Manual. The updated forms will be available on this website in May and will be published in the 2009 CSHCN Services Program Provider Manual. Forms that are available through the TMHP fax-back option will also be updated. The fax-back option is available through the Automated Inquiry System (AIS) at 1-800-568-2413. Click on the title to view the details.
|
| Updated Personal Care Services (PCS) Prior Authorization FAQs |
| Information posted May 1, 2009: This is an update to an article that was published on this website on March 20, 2009, titled “Personal Care Services (PCS) Prior Authorization FAQs.” Question # 4 on the frequently asked questions (FAQs) has been updated. The revised FAQ can be found on the “Alberto N. Related Information” topic web page on this website and will be published in the July/August 2009 Texas Medicaid Bulletin, No. 224. Click on the title to view the details. |
| TMHP Scheduled System Maintenance |
| Information posted May 1, 2009: TMHP will perform scheduled maintenance to the Claims Engine and Long Term Care systems on Sunday, May 10, 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. |
| Family Planning Claims Reprocessing for Clients with Retroactive Title XIX Eligibility |
| Information posted May 5, 2009: TMHP has identified an issue that impacts claims that were reimbursed under the Family Planning Titles V or XX program with dates of service from May 11, 2007 through August 28, 2008. Claims for clients who received retroactive Title XIX eligibility for that period of time will be recouped, and then the claims will be reimbursed under the Title XIX program.
A provider’s Titles V or XX Remittance and Status (R&S) Report will show that the Title V or XX claim was adjusted, an accounts receivable was set up, and the adjusted claim will appear as paid on the provider’s Title XIX R&S Report. Individual providers will be contacted by the Texas Department of Health Services (DSHS) if recoupment of outstanding fiscal year 2007 and fiscal year 2008 Title V or Title XX accounts receivables is necessary.
For more information, call the TMHP Contact Center at 1-800-925-9126.
|
| TMHP Closed May 25, 2009; Claims Filing Deadline Extended |
| Information posted May 21, 2009: As outlined in the 2009 Texas Medicaid Provider Procedures Manual, page 5-8, and the 2009 CSHCN Services Program Provider Manual, page 5-5, claims filing deadlines will be extended for the Memorial Day holiday, May 25, 2009. Because TMHP will be closed in observance of this holiday, claims filing deadlines will be extended until the next business day, Tuesday, May 26, 2009.
Providers will be able to access the automated inquiry system (AIS) or use this website to obtain eligibility or claim status information on Memorial Day.
For more information, call the TMHP Contact Center at 1-800-925-9126 or the CSHCN Services Program Contact Center at 1-800-568-2413.
|
| CMS Medicaid Integrity Group Conducting Audits of Some Providers |
| Information posted May 18, 2009: Texas Medicaid is being audited by the Centers for Medicare & Medicaid Services Medicaid Integrity Group (CMS-MIG). CMS-MIG will assess claims for payment for items or services submitted by Texas Medicaid providers. A Medicaid Integrity Contractor (MIC), Health Management System (HMS), may ask Medicaid providers for medical records documentation and other information as part of the audit. Click on the title to view the details. |
| Texas Medicaid Reimbursement Rates for Clinical Laboratory Procedure Codes Changed |
| Information posted May 22, 2009: Effective for dates of services on or after April 1, 2009, Texas Medicaid reimbursement rates for clinical laboratory procedure codes have changed. Affected claims will be reprocessed, and payments will be adjusted accordingly. No action on the part of the provider is necessary. Click on the title for more information.
|
| New Form to Release CSHCN Services Program Claims History |
| Information posted May 22, 2009: The “DSHS Form to Release CSHCN Services Program Claims History” is now available on this website. This form must be completed by a client (or parent or guardian) of the Children with Special Health Care Needs (CSHCN) Services Program or by someone, such as an attorney, who represents a CSHCN Services Program client in a third-party claim or an action for damages related to personal injuries. The form must be signed by the client, parent, or guardian. When the signed form is received, TMHP will release the CSHCN Services Program claim information that pertains to the client. A complete article on TMHP third-party liability cases was published in the 2008 August CSHCN Services Program Provider Bulletin, No. 67. For more information, call the TMHP Third-Party Resources Contact Center at 1-800-846-7307, Option 2. Click on the title to access the form.
|
| Correction to Additional Annual 2009 HCPCS Procedure Codes |
| Information posted May 22, 2009: This is a correction to a web article that was published on this website on May 8, 2009, titled “Additional Annual 2009 HCPCS Procedure Codes.” The article incorrectly indicates that the reimbursement rates for procedure codes 7-00211, and 7-00567 apply to clients of all ages. The correct information is as follows: Procedure code 7-00211 has a reimbursement rate of $269.69 for clients who are birth through 20 years of age and a reimbursement rate of $240.77 for clients who are 21 years of age or older. Procedure code 7-00567 has a reimbursement rate of $797.17 for clients who are birth through 20 years of age and a reimbursement rate of $613.62 for clients who are 21 years of age or older. Click on the title to view the complete, revised reimbursement rates table.
|
| Limitation Changes for Cytogenetics Testing Procedure Codes |
| Information posted May 8, 2009: Effective for dates of service on or after May 1, 2009, the limitations have changed for cytogenetic testing procedure codes for Texas Medicaid and the Children with Special Health Care Needs (CSHCN) Services Program. Click on the title to view the details.
|
| Updated "Drugs Requiring NDC for Texas Medicaid and CSHCN Service Program Reimbursement" List |
| Information posted May 8, 2009: Texas Medicaid and the Children with Special Health Care Needs (CSHCN) Services Program are expanding the list of procedure codes that will be denied if submitted without an 11-digit National Drug Code (NDC). Effective June 1, 2009, claims for the following additional procedure codes must be submitted with an 11-digit NDC: J9206, J2405, J1626, J9178, J3370, J1170, J9293, J9190, and J9062. If these procedure codes are submitted without NDC information, they will be denied, even if they have been prior authorized. Click on the title to view the details. |
| Online Fee Lookup Will Be Available to Texas Medicaid and CSHCN Services Program Providers |
| Information posted May 8, 2009: Effective June 26, 2009, TMHP will implement online fee lookup functionality on this website for Texas Medicaid and the Children with Special Health Care Needs (CSHCN) Services Program. Click on the title to view the details. |
| Free CME Opportunity: Medical Home Implementation Teleconference Series Scheduled Through June 2009 |
| Information posted May 8, 2009: The American Academy of Pediatrics (AAP) is hosting a free teleconference series through June 2009, to provide child health professionals with practical strategies for implementing the medical home concept in their practices. This activity is acceptable for a maximum of 1.25 AAP credits. Click on the title to view the details. |
| Additional Annual 2009 HCPCS Procedure Codes |
| Information posted May 8, 2009: On April 20, 2009, Texas Medicaid and the Children with Special Health Care Needs (CSHCN) Services Program reimbursement rates were adopted for some additional 2009 Healthcare Common Procedure Coding System (HCPCS) procedure codes, which became effective for dates of services on or after January 1, 2009. On May 23, 2009, the Children with Special Health Care Needs (CSHCN) Services Program will adopt the same rates and effective date as Texas Medicaid with the exception of procedure code 1-J1786 which will be manually priced for the CSHCN Services Program. Click on the title to view the details.
|
| Texas Medicaid to Implement Implant Services Reimbursement Rates |
| Information posted May 29, 2009: Effective for dates of services on or after July 1, 2009, Texas Medicaid will implement initial reimbursement rates for implant services procedure codes. These procedure codes will be a new benefit of Texas Medicaid. The initial reimbursement rates were adopted following a public rate hearing that was held on May 12, 2009. Click on the title to view the details. |
| Texas Medicaid to Implement Molecular Laboratory Services Reimbursement Rates |
| Information posted May 29, 2009: Effective for dates of services on or after July 1, 2009, Texas Medicaid will implement initial reimbursement rates for molecular laboratory services procedure codes. These procedure codes will be a new benefit of Texas Medicaid. The initial reimbursement rates were adopted following a public rate hearing that was held on May 12, 2009. Click on the title to view the details. |
| Updated Correction: Rates Change for Medical Services, Surgical, Interpretation and Technical Codes |
| Information posted May 29, 2009: Effective for dates of services on or after April 1, 2009, some medical services, surgical, interpretation, and technical component procedure codes reimbursement rates have changed for the Texas Medicaid Program. The reimbursement rates were adopted following a public rate hearing that was held on February 17, 2009. Claims submitted with dates of services on or after April 1, 2009, and procedure codes T-93532 and T-93641 for the technical components may have been reimbursed at an incorrect rate. Affected claims will be reprocessed, and payments will be adjusted accordingly. No action on the part of the provider is necessary. Click on the title to view the details.
|
| Family Planning Title XIX Retroactive Eligibility Claims Reprocessing |
| Information posted May 29, 2009: TMHP has identified an issue that impacts claims for providers who were reimbursed under the Family Planning Titles V or XX program with dates of service from May 11, 2007, through August 28, 2008. Title V and XX claim payments for clients who received retroactive Title XIX eligibility for that period will be recouped, and the claims will be reimbursed under the Title XIX program. Click on the title to view the details. |
| Correction to Licensing Information in Provider Manuals |
| Information posted May 29, 2009: This is a correction to the 2009 Texas Medicaid Provider Procedures Manual, section 1.1.4.11, “Copy of License/Temporary License/Certification,” on page 1-7 and the 2009 CSHCN Services Program Provider Manual, section 2.1.4.5, “Provider’s License,” on page 2-5. These sections list licensing boards from which TMHP directly receives information. The Texas State Board of Examiners of Psychologists, the Texas Board of Chiropractic Examiners (Medicaid only), and the Texas State Board of Podiatric Medical Examiners should not have been included. Click on the title to view the details.
|
| Original Signatures Required on All Prior Authorization Request Forms |
| Information posted May 29, 2009: Reminder: Prior authorization request forms with signature lines must be signed and dated by the medical or dental provider familiar with the client before the forms are submitted to TMHP. All signatures on these forms must be current, unaltered, and handwritten. Computerized or stamped signatures are not permitted. Forms that are submitted without a hand-written signature will be rejected. The form that contains the original signature must be kept in the client’s medical record for future access.
Submission of prior authorization requests via the secure pages of the TMHP website at www.tmhp.com does not replace adherence to documentation requirements outlined in the 2009 Texas Medicaid Provider Procedures Manual.
For more information, call the TMHP Contact Center at 1-800-925-9126. |
| Texas Medicaid Reimbursement Rates for Medical Services and Blood Products to Change |
| Information posted May 29, 2009: Effective for dates of services on or after July 1, 2009, Texas Medicaid reimbursement rates will change for medical services and blood products procedure codes. The reimbursement rates were adopted following a public rate hearing that was held on May 12, 2009. Click on the title to view the details.
|
| Prior Authorization Requirements for Evercare Integrated Care Management (ICM) Providers |
| Information posted May 15, 2009: This is an update to an article published on this website on April 3, 2009, titled “HHSC to End the ICM Program Contract with Evercare.” Beginning June 1, 2009, for services provided to clients who were previously enrolled in Evercare Integrated Care Management (ICM), prior authorization requirements will follow the 2009 Texas Medicaid Provider Procedures Manual. Providers should refer to specific sections in the manual for authorization information related to the service provided. Click on the title to view the details
|
| TMHP Wants To Hear From You |
| Information posted May 15, 2009: In order to provide better service to providers, the Texas Medicaid & Healthcare Partnership (TMHP) developed two surveys to find out what providers think about the claims and prior authorization transaction processes.
The surveys will be available on this website from June 1, 2009, through June 30, 2009.
For more information, call the TMHP Contact Center at 1-800-925-9126 or the CSHCN Services Program Contact Center at 1-800-568-2413.
|
 | Important: ICM Provider Transition Forum |
| Information posted May 15, 2009: Click on the title for information about the Integrated Care Management (ICM) Long-term Services and Supports Provider Forum — ICM Transition. |
| Correction to CSHCN Services Program Reimbursement Rates Change for Patient Lifts |
| Informationn posted May 15, 2009: This is a correction to an article that was published on this website on February 20, 2009, titled “CSHCN Services Program Reimbursement Rates Change for Patient Lifts.” Click on the title to view the details.
|
| Diagnosis Codes Payable for Azacitidine (Vidaza) |
| Information posted May 15, 2009: Effective for dates of service on or after June 1, 2009, procedure code J9025 is restricted to clients who are 13 years of age and older and may be billed with diagnosis codes 23872, 23873, 23874, or 23875. Procedure code J9026 may be billed with additional diagnosis codes. Click on the title to view the details. |
| Mental Health Services for FQHC Providers |
| Information posted May 15, 2009: Reminder: Federally Qualified Health Centers (FQHCs) must bill using an appropriate modifier when billing for mental health services. Click on the title to view the details.
|
| Update to Personal Care Services (PCS) |
| Informaton posted May 15, 2009: Effective for dates of service on or after June 1, 2009, Texas Medicaid providers may be eligible to receive an increased rate when they provide prior authorized personal care services (PCS) to clients with a behavioral health condition. Click on the title to view the details. |
| Correction for Procedure Code I/T-10022 Procedure Code Update |
| Information posted May 15, 2009: This is a correction to an article that was posted on this web page on March 20, 2009, titled “Correction to First Quarter Procedure Code Review.” The article incorrectly indicates that effective for dates of service on or after April 1, 2009, procedure code 10022 is no longer reimbursed for the technical or professional components. The correct information is that effective for dates of service on or after April 1, 2009, procedure code I/T-10022 is a benefit and is reimbursed as follows: I-10022 is reimbursed at $75.65, and T-10022 is reimbursed at $27.74. For more information, call the TMHP Contact Center at 1-800-925-9126.
|
| Use of Modifier FP to Change for Family Planning Services |
| Information posted May 15, 2009: Reminder: Effective for dates of service on or after July 1, 2009, the Women’s Health Program (WHP) and Titles V, XIX, and XX Family Planning will be changing the way modifier FP is used on claims for family planning services. Beginning July 1, 2009, modifier FP must be used only when billing the annual family planning examination. All other family planning services, such as evaluation and management services, laboratory services, and anesthesia services, must omit modifier FP. Claims filed incorrectly may be denied. Click on the title to view how these changes update the information in the 2009 Texas Medicaid Provider Procedures Manual.
|
| Survey About Pediatric Consultations and Referrals |
| Information posted May 11, 2009: Primary Care Physicians: Do you feel you are having difficulty communicating with subspecialists about your pediatric patients? Subspecialists: Do you need more from your communications with primary care physicians in order to properly assess and care for their referrals?
The Texas Health and Human Services Commission (HHSC)has contracted with Health Management Associates (HMA) to conduct a survey to better understand problems pediatric providers face. This effort is part of the state's initiative to improve access to specialty and subspecialty care for the pediatric Medicaid population. Click on the title to view the details. |
| Update to Rate Changes for Some Medical Services, Surgical, Interpretation, and Total Component |
| Information posted May 15, 2009: This is an update to an article that was posted on this website on March 19, 2009, and published in the 2009 May/June Texas Medicaid Bulletin, No. 223 titled “Correction to Texas Medicaid Reimbursement Rates Change for Some Medical Services, Surgical, Interpretation, and Total Component.“ Click on the title to view the details.
|
| April 2009 |
| Swine Influenza Information |
| Information posted April 27, 2009: Click on the title for information regarding the swine influenza outbreak. |
| PACT Transitioning to HHSC and DSHS-CSHCN |
| Information posted April 24, 2009: Effective September 1, 2009, the Program for Amplification for Children of Texas (PACT) will no longer be administered by the Department of State Health Services (DSHS). The hearing services benefits currently administered through PACT will be transitioned to the Health and Human Services Commission (HHSC) for Texas Medicaid benefits and DSHS-Children with Special Health Care Needs (CSHCN) Services Program for CSHCN Services Program benefits. Click on the title to view the details.
Article:
|
| Provider Enrollment and NPI Attestation Reminder |
| Information posted April 24, 2009: Enrollment and National Provider Identifier (NPI) Attestation Reminder: To enroll in the Children with Special Health Care Needs (CSHCN) Services Program, a provider must complete the required CSHCN Services Program Provider Enrollment Application and enter into a written provider agreement with the CSHCN Services Program. Click on the title to view the details.
|
| Anesthesia, Consultation, and Medical Procedure Codes Claims Reprocessing |
| Information posted April 24, 2009: TMHP has identified an issue that affects Primary Care Case Management (PCCM) claims for dates of service on or after September 1, 2007, that were billed with procedure code 7-00534, 7-00540, 3-99252, 3-99255, or 1-J1885. These claims may have been reimbursed at an incorrect rate.
Affected claims will be reprocessed, and payments will be adjusted accordingly. No action on the part of the provider is necessary. Providers should refer to the fee schedule for pricing.
For more information call the PCCM Provider Helpline at 1-888-834-7226.
|
| SDA Letters to Be Mailed by the End of May |
| Information posted April 24, 2009: By the end of May 2009, TMHP will mail letters to inpatient diagnosis-related group (DRG) hospital providers. The letters will contain the standard dollar amounts (SDAs) that will be effective for admissions on or after September 1, 2008. The letters will also contain information about the proposed changes to the SDA and DRG statistics for state fiscal year 2010. TMHP will send the letters to the attention of the Administrator or Chief Financial Officer at the mailing address on file.
For more information, call the TMHP Contact Center at 1-800-925-9126.
|
| Filing Claims for Uninsured Evacuees of Hurricane Dolly and Hurricane Ike |
| Information posted April 24, 2009: The State of Texas has received a special Social Services Block Grant from the U.S. Department of Health and Human Services that can be used, in part, to process claims related to 2008’s Hurricane Ike and Hurricane Dolly for uninsured evacuees. A Medicaid provider may be reimbursed for services rendered to a hurricane evacuee who is uninsured and is not eligible for Medicaid. Click on the title to view the details. |
| Online Provider Enrollment Systems Maintenance Scheduled For April 24, 2009 |
| Information posted April 23, 2009: TMHP will perform maintenance to the online provider enrollment system on April 24, 2009, from 7:00 p.m. until April 25, 2009, 12 midnight, Central Time. Online provider enrollment will not be available during this time period.
|
| Limited Services Offered to CSHCN Services Program Waiting List Clients Through June 30, 2009 |
| Information posted April 29, 2009: In late April 2009, the Children with Special Health Care Needs (CSHCN) Services Program mailed letters to 624 of the clients on its waiting list to inform them that they could get the full range of program health-care benefits, for a limited time, from May 1, 2009, through June 30, 2009, only. Those clients received with their letters a green “Limited Services” form that shows the dates of this coverage. Although clients may receive services during this period, they will remain on the waiting list. Click on the title to view the details. |
| Notice to Women's Health Program Providers |
| Information posted April 30, 2009: Section 32.0248, Human Resources Code, prohibits payment of Women's Health Program funds to a provider that performs or promotes elective abortions. A provider that has performed or promoted elective abortions (through either surgical or medical
methods) for any patient is ineligible to serve Women's Health Program clients and cannot be reimbursed for those services. This prohibition has been in effect since September 1, 2005. The Health and Human Services Commission will recoup Women's Health Program funds that it determines were paid to providers that have performed or promoted elective abortions. |
| Clarification to “New Process for MAPs Claims for 2005 through 2007 Dates of Service” Article |
| Information posted April 24, 2009: This is an update to an article published on this website on March 6, 2009, titled ”New Process for Medicare Advantage Plans (MAP) Claims for 2005 through 2007 Dates of Service.” The previous article and the MAP Submission Forms and Instructions direct providers to submit the original claim on forms HCFA 1500 or HCFA 1450/UB-92, which were the forms in use during the dates of service affected by the new process. In 2007, the CMS-1500 and CMS-1450-UB/04 forms replaced the HCFA forms. Providers should submit the CMS-1500 or CMS-1450-UB/04 claim forms; however, if a provider is unable to submit claims with the new claim form, TMHP will accept the HCFA forms. Click on the title to view the details.
|
| Notification/Prior Authorization for Inpatient Stay Following Scheduled Day Surgery for PCCM Clients |
| Information posted April 24, 2009: Reminder: Notification for an inpatient stay is required when a prior-authorized, scheduled outpatient day surgery for a client enrolled in Primary Care Case Management (PCCM) becomes an inpatient stay due to complications. The prior authorization for the day surgery is not valid as authorization for the inpatient stay. Refer to the 2009 Texas Medicaid Provider Procedures Manual, section 7.7.17, “PCCM Inpatient Authorization Process,” section 7.7.17.6, “Urgent and Emergent Admission,” and section 7.7.2, “Inpatient/Outpatient Prior Authorization Line” for contact telephone and fax numbers.
|
| Primary Care Providers Must Document Client’s THSteps Services Performed by Different Providers |
| Information posted April 24, 2009: Primary care providers are encouraged to complete the Texas Health Steps (THSteps) medical checkup as part of the medical home for their clients who are enrolled in Primary Care Case Management (PCCM). Providers that refer these clients to a THSteps provider for a THSteps medical checkup must document that THSteps medical checkup in their clients’ records. If a client self-refers to a THSteps provider for a THSteps medical checkup, the provider that performs THSteps medical checkup services must work in collaboration with the client’s primary care provider and provide the THSteps medical checkup results to the primary care provider to ensure continuity of care.
Primary care providers that want to become THSteps providers may enroll online on this website or they may download the Texas Medicaid Provider Enrollment Application from this website and submit it by mail.
|
| Update to Total Parenteral Nutrition (TPN) Services |
| Information posted April 1, 2009: This is an update to a banner message that first appeared on the February 13, 2009, Remittance and Status (R&S) Report concerning benefit and prior authorization changes for total parenteral nutrition (TPN) services and to a corresponding web article that was published on this website on February 6, 2009, titled “Update to Total Parenteral Nutrition (TPN) Services.” Click on the title to view the details. |
| Correction to “Benefits for Home Health Bath and Bathroom Equipment to Change” |
| Information posted April 24, 2009: This is a correction to an article that was published on this website on February 6, 2009, titled “Benefits for Home Health Bath and Bathroom Equipment to Change.” The article incorrectly stated that procedure codes J-E0243, J-E0244, J-E0245, J-E0246, J-E0160, J-E0621, J-E0625, and J-E1399 will no longer be reimbursed in any place of service to custom durable medical equipment (DME) providers. The correct information is as follows: Procedure codes J-E0243, J-E0244, J-E0245, J-E0246, J-E0160, J-E0621, J-E0625, and J-E1399 may be reimbursed to custom DME providers. For more information, call the TMHP Contact Center at 1-800-925-9126.
|
| Correction to “Correction to Rate Changes Insert in the November 2007 CSHCN Bulletin |
| Information posted April 3, 2009: This is a correction to an article that was published on this website on February 20, 2009, titled "Correction to Rate Changes Insert in the November 2007 CSHCN Services Program Provider Bulletin." The article incorrectly stated that rates for some procedure codes were updated February 24, 2009, for dates of service on or after October 1, 2007.
The rates for procedure codes 1-90810 and 1-90812 were updated on March 3, 2009, and rates for the remaining procedure codes were updated on February 26, 2009.
For more information, call the TMHP-CSHCN Services Program Contact Center at 1-800-568-2413.
|
| Correction and Update to New Dental Diagnostic Services Procedure Codes to Be THSteps Benefits |
| Information posted April 3, 2009: This is an update and a correction to a banner message that first appeared on the March 13, 2009, Remittance and Status (R&S) Report concerning diagnostic dental services procedure codes that are becoming benefits of Texas Health Steps (THSteps). The article included an incorrect procedure code D0632. The correct procedure code is D0362. In addition, the article has been updated to include prior authorization requirements. Click on the title to view the complete, revised article. |
| HHSC to End the ICM Program Contract with Evercare |
| Information updated April 3, 2009: Effective for dates of service on or after June 1, 2009, the Health and Human Services Commission (HHSC) will end the Integrated Care Management (ICM) program contract with Evercare of Texas. Click on the title to view the details. (Original post March 30, 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.
|
| Medical Transportation Verification Requirements |
| Information posted April 3, 2009: Reminder: When asked to do so, Medicaid providers are required to complete and sign authorized medical transportation forms (e.g., Form 3103, Individual Driver Registrant (IDR) Service Record, or Form 3111, Verification of Travel to Healthcare Services by Mass Transit) or provide an equivalent (e.g., provider statement on official letterhead) to attest that services were provided to a client on a specific date. The client presents these forms to the provider. Providers are not allowed to bill clients or Texas Medicaid for completing these forms. For more information, call the TMHP Contact Center at 1-800-925-9126.
|
| Some Hearing Aid Devices Claims to Be Reprocessed |
| Information posted April 3, 2009: TMHP has identified issues that affect claims billed with dates of service from December 2, 2008, through March 24, 2009, and some hearing devices and services procedure codes. Click on the title to view the details.
|
| Survey About Pediatric Consultations and Referrals |
| Information posted April 10, 2009: Two weeks ago, providers were scheduled to receive a survey asking about their views and experiences with pediatric specialty and subspecialty consultations and referrals. The Texas Health and Human Services Commission (HHSC) has contracted with Health Management Associates (HMA) to conduct this survey to understand problems pediatric providers face. This effort is part of the state’s initiative to improve access to specialty and subspecialty care for the pediatric Medicaid population. Click on the title to view the details. |
| Update to “Women’s Health Program and Family Planning Benefits and Claims Filing Criteria to Change” |
| Information posted April 10, 2009: This is an update to an article published on this website on March 20, 2009, titled, “Women’s Health Program and Family Planning Benefits and Claims Filing Criteria to Change.” The article indicated that the changes in billing modifier FP are effective July 1, 2009, for any claim or appeal filed regardless of date of service. Modifier FP changes will be effective only for dates of service on or after July 1, 2009, and will not affect services provided before the July 1, 2009, implementation date. Click on the title to view the complete, corrected article. |
| Correction to Non-Clinical Laboratory Procedure Codes Reimbursement Rates to Change |
| Information posted April 10, 2009: This is a correction to an article that was published on this website on March 23, 2009, titled “Non-Clinical Laboratory Procedure Codes Reimbursement Rates to Change for the Texas Medicaid Program." The article incorrectly listed some procedure codes that were no longer reimbursable, some procedure codes with incorrect reimbursement rates and incorrect provider types. Click on the title to view the complete, corrected article. |
| Correction to Texas Medicaid Reimbursement Rates Will Change for Some DME Procedure Codes |
| Information posted April 10, 2009: This is a correction to an article that was published on this website on March 27, 2009, titled “Texas Medicaid Reimbursement Rates Will Change for Some Durable Medical Equipment Procedure Codes.” The article incorrectly included procedure codes J-E0164 and J-E0166 as reimbursable procedure codes for Texas Medicaid. Procedure code J-E0164 and J-E0166 are no longer reimbursable procedure codes for Texas Medicaid. Click on the title to view the complete, corrected table of DME reimbursement rates that were effective April 1, 2009. |
| Claims Billed with Manufacturer’s Suggested Retail Price (MSRP) |
| Ordinarily, claims submitted must be the provider’s usual and customary fee for the services provided. The billed charges must not be higher than the fees charged to other carriers or private pay patients. This process is different when billing for durable medical equipment (DME), expendable supplies, and nutritional products that have no established fee. DME and expendable supplies other than nutritional products that have no established fee are subject to manual pricing at the documented manufacturer’s suggested retail price (MSRP) less 18 percent or at the provider’s documented invoice cost. Nutritional products that have no established fee are subject to manual pricing at the documented average wholesale price (AWP) less 10.5 percent or at the provider’s documented invoice cost. These items require prior authorization. The dollar amount billed must match the amount that was prior authorized.
For more information, call the TMHP Contact Center at 1-800-925-9126. |
| Revised HHS (Title XIX) DME/Medical Supplies Physician Order Form Mandatory |
| Information posted April 17, 2009: Effective June 1, 2009, for all dates of service, TMHP will accept only the revised Home Health Services (Title XIX) DME/Medical Supplies Physician Order Form (effective date 10/21/2008). This updates the information previously published that indicated that the old forms were going to be returned beginning April 1, 2009.Click on the title to view the details. |
| Clarification of RHC Claims Filing Requirements and Family Planning Changes |
| Information posted April 17, 2009: This is a clarification about claim billing requirements for rural health clinics (RHCs). RHCs are reimbursed for general medical services (procedure code T1015) and copayments (procedure codes CP001, CP002, CP005, or CP006) using their RHC National Provider Identifier (NPI). Providers that perform services in the RHC setting for Texas Health Steps (THSteps) medical services and family planning services for Women’s Health Program (WHP) and Titles V, XIX, and XX clients must submit claims using the provider’s (not the RHC’s) NPI and place of service 72. Click on the title to view the details.
|
| CSHCN Services Program Provider Survey |
| Information posted April 17, 2009: The Children with Special Health Care Needs (CSHCN) Services Program is conducting a survey to learn more about delivery of services for children with special needs in Texas. Click on the title to view the details. |
| Bekesy Audiometry Will No Longer Be a Benefit of Texas Medicaid or the CSHCN Services Program |
| Information posted April 10, 2009: Effective for dates of service on or after May 15, 2009, procedure code 5/I-92561 (Bekesy Audiometry) will no longer be a benefit of Texas Medicaid or the Children with Special Health Care Needs (CSHCN) Services Program.
For more information, call the TMHP Contact Center at 1-800-925-9126 or the TMHP-CSHCN Services Program Contact Center at 1-800-568-2413. |
| Updated Texas Medicaid Fee Schedules Now Available |
| Information posted April 10, 2009: Updated Texas Medicaid fee schedules are now available on this website. Providers can request a free paper copy of a fee schedule by calling the TMHP Contact Center at 1-800-925-9126. |
| Criteria for Removal of Cerumen Established |
| Information posted April 10, 2009: The Office of Inspector General has identified an issue that affects claims for removal of cerumen (procedure code 2-69210) on the same date of service by the same provider or provider group as an evaluation and management (E/M) service. Click on the title to view the details. |
| May 2009 CSHCN Provider Bulletin No. 70 |
| Information Posted April 15, 2009: The May 2009 CSHCN Provider Bulletin No. 70 is now available. Click the title to view the bulletin. |
| Molecular Laboratory Services Benefits Change |
| Information posted April 24, 2009: Effective for dates of service on or after May 1, 2009, benefits have changed for molecular laboratory services. Click on the title to view the details.
|
| Claims Reprocessing for Ambulatory Surgical Centers |
| Information posted April 24, 2009: TMHP has identified an issue that impacts ambulatory surgical center claims with dates of service on or after August 1, 2005, and procedure codes ranging from F-27599 through F-29450. Claims may have been denied in error with the explanation of benefits message, “These services are not in accordance with Medical Policy.” Affected claims will be reprocessed, and payments will be adjusted accordingly. No action on the part of the provider is necessary. Click on the title to view a list of the affected procedure codes.
|
| March 2009 |
| Reimbursement Rates Change for Some Medical Services, Surgical, Interpretation and Total Component |
| Information posted March 19, 2009: (Corrected) This is a correction to an article that was published on March 6, 2009, titled “Texas Medicaid Reimbursement Rates Change for Some Medical Services, Surgical, Interpretation and Total Component. “ The article incorrectly stated that procedure code I-62252 is a benefit of Texas Medicaid and included incorrect reimbursement rates for procedure codes 2-92979, I -92979, T-92979, and T-93621. Click on the title for the corrected information.
|
| Women’s Health Program and Family Planning Benefits and Claims Filing Criteria to Change |
| Information posted March 20, 2009: Some family planning claims filing criteria and benefits will be changing for Texas Medicaid Title XIX Family Planning, the Women’s Health Program (WHP), and Family Planning Titles V and XX. WHP claims filing criteria and benefit changes will be effective for dates of service on or after April 1, 2009. Family planning Titles V, XIX, and XX claims filing criteria and benefit changes will be effective for dates of service on or after July 1, 2009.
|
| Texas Medicaid and CSHCN to Implement Initial Reimbursement Rates for Some Mobility Aids |
| Information posted March 20, 2009: Effective for dates of services on or after April 1, 2009, Texas Medicaid and the Children with Special Health Care Needs (CSHCN) Services Program will implement initial reimbursement rates for some mobility aids procedure codes. Click on the title for details.
|
| Update to Medicaid Reimbursement Rates for Patient Lifts |
| Information posted March 20, 2009: This is an update to an article that was published on this website on December 5, 2008, titled “Texas Medicaid Reimbursement Rates Change for Patient Lifts.” Click on the title to view the details. |
| Federal Stimulus Package Increases FMAP Rate for Federal Fiscal Year 2009 Quarters 1 and 2 |
| Information posted March 23, 2009: Effective for dates of service from October 1, 2008, through December 21 2010, the Federal Medical Assistance Percentage (FMAP) has increased from 59.44% to 68.76% as part of the federal stimulus package recently passed by Congress. Click on the title to view the details.
|
| Personal Care Services (PCS) Prior Authorization FAQs |
| Information posted March 20, 2009: The TMHP Personal Care Services (PCS) Prior Authorization Frequently Asked Questions (FAQs) is now available on the Alberto N. Related Information web page of this website. Click on the title to view the document.
|
| New Benefits for Home Health Services for the CSHCN Services Program |
| Information posted March 6, 2009: Effective for dates of service on or after May 1, 2009, the Children with Special Health Care Needs (CSHCN) Services Program will implement new benefit criteria for home health services. Click on the title to view the details. |
| Texas Medicaid Initial Reimbursement Rates for Doctor of Dentistry as a Limited Physician Service |
| Information posted March 6, 2009: Effective for dates of services on or after April 1, 2009, some procedure codes for services by doctors of dentistry practicing as a limited physician will become a benefit of Texas Medicaid. The initial reimbursement rates were adopted following a public rate hearing that was held on February 17, 2009. Click on the title to view the details. |
| New Process for Medicare Advantage Plans Claims for 2005 Through 2007 Dates of Service |
| Information posted March 6, 2009: The Health and Human Services Commission (HHSC) and the Texas Medicaid & Healthcare Partnership (TMHP) are finalizing a process that will allow providers who participate in Medicare Advantage Plans (MAPs) to submit claims to TMHP for reimbursement of the coinsurance or deductible for services rendered to dual-eligible clients for dates of service from January 1, 2005, through December 31, 2007. Click on the title to view the details.
|
| Free Continuing Education Hours from THSteps |
| Information posted March 6, 2009: Ready to learn more about Texas Health Steps (Medicaid for children) and other health
care services? Take advantage of the free, online education program for health care providers developed by the Texas Department of State Health Services and the Texas Health
and Human Services Commission. This comprehensive program offers free continuing education hours, and all courses are accredited. Click on the title to view the details. |
| Texas Medicaid Reimbursement Rates to Change for Physician-Administered Drugs and Biologicals |
| Information posted March 6, 2009: Effective for dates of services on or after April 1, 2009, Texas Medicaid reimbursement rates will change for physician-administered drugs and biologicals procedure codes. For vaccines distributed through Texas Vaccines for Children (TVFC), the vaccine reimbursement rates will be in effect only if the vaccine is not available from TVFC. “Not available” is defined as a new vaccine: approved by the Advisory Committee on Immunization Practices (ACIP) that has not been negotiated or added to a TVFC contract; for which TVFC has not yet established funding: or where national supply or distribution issues limit availability. Providers will be notified when Medicaid recognizes that a vaccine meets the definition of not available. Not all vaccines are available for adults. Click on the title to view the details.
|
| 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. |
| Rate Change for Clinical Laboratory Panel Procedure Code 80047 |
| Information posted March 27, 2009: Effective March 27, 2009, the reimbursement rate for procedure code 5-80047 has changed for Texas Medicaid. Click on the title to view the details. |
| Correction to Diagnostic Dental Services Benefit Changes |
| Information posted March 27, 2009: This is a correction to articles that were published on this website on February 6, 2009, titled "Benefit Update for THSteps Dental Diagnostic Services for Texas Medicaid" and “Benefit Update for Diagnostic Dental Services for the CSHCN Services Program.” Both articles incorrectly stated that procedure code D0180 is limited to once every six months by the same provider.
Procedure code D0180 is not limited to once every six months by the same provider; however, other limitations described in the articles do apply to procedure code D0180. The complete, corrected articles will be published in the May/June 2009 Texas Medicaid Bulletin, No. 223, and the May 2009 CSHCN Services Program Provider Bulletin, No. 70.
For more information, call the TMHP Contact Center at 1-800-925-9126 or the TMHP-CSHCN Services Program Contact Center at 1-800-568-2413.
|
| TMHP Radio Now Available on This Website |
| Information posted March 27, 2009: Radio TMHP, which is now available on this website, offers providers an opportunity to hear quarterly audio programs about a variety of special-interest topics. Click on the title to view the details:
|
| Texas Medicaid Reimbursement Rates to Change for Some Durable Medical Equipment |
| Information posted March 27, 2009: Effective for dates of services on or after April 1, 2009, Texas Medicaid reimbursement rates will change for some durable medical equipment (DME) procedure codes. Click on the title to view the details.
|
| Survey About Pediatric Consultations and Referrals |
| Information posted March 27, 2007: The Texas Health and Human Services Commission (HHSC) has contracted with Health Management Associates (HMA) to conduct a survey to understand problems pediatric providers face. This effort is part of the state’s initiative to improve access to specialty and subspecialty care for the pediatric Medicaid population. Click on the title to view the details. |
| HHSC Will End the ICM Program Contract with Evercare |
| Information posted March 30, 2009: Effective for dates of services on or after June 1, 2009, the Health and Human Services Commission (HHSC) will end the contract with Evercare of Texas for the Integrated Care Management (ICM) program. Click on the title to view the details.
|
| RSV Prophylaxis Season Update |
| Information originally posted March 5, 2009: As of March 1, 2009, the respiratory syncytial virus (RSV) season ended in most areas of the state. As a result. palivizumab (Synagis) is no longer considered medically necessary in those areas. In consultation with qualified experts, Texas Medicaid and the Children with Special Health Care Needs (CSHCN) Services Program have been monitoring RSV activity across the state. Current surveillance trends document that RSV activity has fallen below the accepted threshold for the 2009 season in most areas of the state. There are still five regions in the state where the RSV activity remains elevated. Click on the title to view a list of these regions with the corresponding zip codes. |
| May/June 2009 Texas Medicaid Bulletin No. 223 |
| Information posted March 30, 2009: The May/June 2009 Texas Medicaid Bulletin No. 223 is now available. Click the title to view the bulletin. |
| February 2009 |
| Hysteroscopy with Endometrial Ablation Reimbursement Rates to Change for CSHCN |
| Information posted February 27, 2009: Effective for dates of service on or after March 1, 2009, the Children with Special Health Care Needs (CSHCN) Services Program reimbursement rates for hysteroscopy with endometrial ablation surgery services will change. Click on the title to view the details. |
| Correction to “THSteps-CCP Mobility Aids Benefits Change” |
| Information posted February 26, 2009: This is a correction to an article that was published on this website on February 6, 2009, titled “THSteps-CCP Mobility Aids Benefits to Change.” The article incorrectly stated that procedure codes J-E0700, J-E1035, 9-E1340, and J/L-E1399 will no longer be reimbursed to custom durable medical equipment (DME) providers and seating assessments must be prior authorized.
Procedure codes J-E0700, J-E1035, 9-E1340, and J/L-E1399 may be reimbursed to custom DME providers, and seating assessments do not require prior authorization.
For more information, call the TMHP Contact Center at 1-800-925-9126.
|
| Texas Medicaid Benefits to Change for Telemedicine Services |
| Information posted February 27, 2009: Effective for dates of service on or after April 1, 2009, benefit criteria for telemedicine services will change for Texas Medicaid. Click on the title to view the details. |
| Medical Home Implementation Teleconference Series Scheduled for March 2009 through June 2009 |
| Information posted February 27, 2009: The American Academy of Pediatrics is hosting a free teleconference series that begins in March 2009 and runs through June 2009 to provide child health professionals with practical strategies for implementing the medical home concept in their practices. Click on the title to view the details.
|
| 2009 Clinical Decision Support Tool for Advanced Imaging Guide Now Available |
| Information posted February 27, 2009: The 2009 Clinical Decision Support Tool for Advanced Imaging Guide is now accessible from the “Provider Manuals and Guides” area on the homepage of this website. Click on the title to view the details.
|
| CSHCN Services Program Benefits to Change for Telemedicine Services |
| Information posted February 27, 2009: Effective for dates of service on or after April 1, 2009, benefit criteria for telemedicine services will change for the Children with Special Health Care Needs (CSHCN) Services Program. Click on the title to view the details.
|
| DSHS Laboratory Criteria Changes |
| Information posted February 27, 2009: Effective March 12, 2009, the Department of State Health Services (DSHS) Laboratory will have new specimen acceptance criteria for specimens submitted for syphilis (RPR and TPPA), HIV, and Hepatitis C testing. Click on the title to view the details. |
| Correction to “THSteps-CCP Mobility Aids Benefits to Change” |
| Information posted February 27, 2009: This is a correction to an article that was published on this website on February 6, 2009, titled “THSteps-CCP Mobility Aids Benefits to Change.” The article incorrectly stated that procedure codes J-E0700, J-E1035, 9-E1340, and J/L-E1399 will no longer be reimbursed to custom durable medical equipment (DME) providers and seating assessments must be prior authorized.
Procedure codes J-E0700, J-E1035, 9-E1340, and J/L-E1399 may be reimbursed to custom DME providers, and seating assessments do not require prior authorization.
For more information, call the TMHP Contact Center at 1-800-925-9126.
|
| TMHP Scheduled System Maintenance |
| Information posted February 27, 2009: TMHP will perform scheduled system maintenance to the claims engine and long term care (LTC) systems from 6:00 p.m. on Sunday, March 8, 2009, until 2:00 a.m. on Monday, March 9, 2009. Some functions will be unavailable during this time period. Click on the title to view the details.
|
| Update to “Correction to the 2009 HCPCS Special Bulletin, No. 221” |
| This is a correction to a message that first appeared on the February 6, 2009, Remittance and Status (R&S) Report and an article that was published on this website at on January 30, 2009, titled “Correction to the 2009 HCPCS Special Bulletin, No. 221.” The articles stated that incorrect benefit information was published in the 2009 Healthcare Common Procedure Coding System (HCPCS) Special Bulletin, No. 221, for procedure codes 5-93279, 5-93282, and 5-93289, and that these procedure codes would not be reimbursed retroactively to January 1, 2009. Procedure codes 5-93279, 5-93282, and 5-93289 will be a benefit retroactive to January 1, 2009, for Texas Medicaid and the Children with Special Health Care Needs (CSHCN) Services Program. Once the reimbursement rates are implemented, affected claims will be reprocessed and payments will be adjusted accordingly. No action on the part of the provider is necessary. Click on the title to view the complete corrected article. |
| List of Top Physician-Administered Multiple-Source Drugs Now Available |
| Information posted February 13, 2009: The Texas Medicaid and Children with Special Health Care Needs (CSHCN) Services Program Top Physician-Administered Multiple-Source Drugs List is now available on the National Drug Code (NDC) page of this website. The Texas Medicaid and CSHCN Services Program Top Physician-Administered Multiple-Source Drugs list are those physician-administered, multiple-source drugs that the U.S. Secretary of Health and Human Services has determined to have the highest dollar volume of physician-administered drugs that are dispensed through Medicaid. Click on the title to view the details. |
| Leuprolide Acetate Injection Allowable Dosage to Change |
| Information posted February 13, 2009: Effective for dates of service on or after March 1, 2009, leuprolide acetate injection procedure code 1-J9217 will be allowed for use in monthly, three-month, four-month and six-month doses instead of one every 28 days. Click on the title to view the details. |
| Update to Medicaid Reimbursement Rates for Ambulatory Surgical Centers, Dental, and DME Services |
| Information posted February 20, 2009: This is an update to a banner message that was published on the December 5, 2008, Remittance and Status (R&S) Report and a web article that was posted on this website on November 28, 2008, titled “Reimbursement Rates to Change for Ambulatory Surgical Centers, Dental, and DME Services.” The articles incorrectly listed the effective date for the procedure codes as January 1, 2009. The correct effective date is January 1, 2008. Additionally, the 2009 Healthcare Common Procedure Coding System (HCPCS) replacement procedure codes that were effective on or after January 1, 2009, for some of the durable medical equipment (DME) services were omitted from the article. Click on the title to view the complete, corrected article.
|
| 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. |
| Clarification to 2009 Texas Medicaid Provider Procedures Manual Laboratory Panel- Related Section |
| Information posted February 20, 2009: This is a clarification of the 2009 Texas Medicaid Provider Procedures Manual, section 25.3.3.11, “Hospital Laboratory Services,” on page 25-32 and section 26.4.4,”Organ or Disease Panel,” on page 26-7 for laboratory panel procedure code 80055. Click on the title to view the details. |
| Changes for Breast Cancer (BRCA) Testing |
| Information posted February 20, 2009: Effective for dates of service on or after March 1, 2009, the prior authorization guidelines and documentation requirements for breast cancer (BRCA) testing will change for gene mutation analysis (procedure codes 5-S3820, 5-S3822, and 5-S3823). The BRCA testing policy for Texas Medicaid will be revised to match national standards. Click on the title to view the details.
|
| Correction to Rate Changes Insert in the November 2007 CSHCN Services Program Provider Bulletin |
| Information posted February 20, 2009: This is a correction to the Rate Changes Insert in the November 2007 CSHCN Services Program Provider Bulletin, No. 64. The “Rate Changes for Anesthesia Services” article on page 25 and “Rate Increases for Physician and Other Professional Services” article on page 26 indicated that some procedure codes were not a benefit of the CSHCN Services Program and so were not affected by the rate change. Some of these procedure codes are benefits of the CSHCN Services Program and should have had the rate increase applied to them. Affected claims will be reprocessed, and payments will be adjusted accordingly. No action on the part of the provider is necessary.
|
| CSHCN Rate Changes for Ambulatory Surgical Centers, Dental, and DME Services |
| Information posted February 20, 2009: Effective for dates of service on or after April 1, 2008, the Children with Special Health Care Needs (CSHCN) Services Program reimbursement rates for 2008 HCPCS procedure codes have changed for ambulatory surgical centers, dental, and durable medical equipment (DME) services. Affected claims will be reprocessed, and payments will be adjusted accordingly. No action on the part of the provider is necessary. Click on the title to view the details.
|
| CSHCN Services Program Reimbursement Rates Change for Patient Lifts |
| Information posted February 20, 2009: Effective for dates of service on or after March 1, 2009, the Children with Special Health Care Needs (CSHCN) Services Program reimbursement rates will change for patient lifts procedure codes. Click on the title to view the details.
|
| Correction to Immune Globulins Limitation |
| Information posted February 20, 2009: This is a correction to the 2009 Texas Medicaid Provider Procedures Manual section 36.4.21.25, “Gamma Globulin/Immune Globulin,” on page 36-56. Additionally, TMHP has identified an issue that impacts claims billed with an immune globulin procedure code, diagnosis code 28730, and dates of service from May 1, 2006, through December 31, 2007. Click on the title to view the details.
|
| March/April 2009 Texas Medicaid Bulletin No. 222 |
| Information posted February 1, 2009: The March-April 2009 Texas Medicaid Bulletin No. 222 is now available. Click the title to view the bulletin.
|
| 2009 Provider Education Workshops and New Education Opportunities |
| Information posted February 5, 2009: In 2009, Texas Medicaid & Healthcare Partnership (TMHP) will institute several enhancements to agency-sponsored training for providers. A number of the changes are in direct response to provider suggestions. The new training schedule will include more live workshops and new technology-based opportunities, including webinars, computer-based training (CBT), and "radio" broadcasts. All training is free of charge. Click on the title for additional information.
|
| Benefit Update for Diagnostic Dental Services for the CSHCN Services Program |
| Information posted February 6, 2009: Effective for dates of service on or after April 1, 2009, benefit criteria for diagnostic dental services will change for the Children with Special Health Care Needs (CSHCN) Services Program. Click on the title to view the details.
|
| THSteps-CCP Mobility Aids Benefits to Change |
| Information posted February 6, 2009: Effective for dates of service on or after April 1, 2009, benefits for mobility aids for Texas Health Steps-Comprehensive Care Program (THSteps-CCP) will change for Texas Medicaid. Click on the title to view the details.
|
| First Quarter Procedure Code Review |
| Information posted February 6, 2009: To align with Centers for Medicare & Medicaid Services (CMS) requirements for easy access to all Medicaid fees, TMHP has completed the first quarter procedure code review. Effective for dates of service on or after April 1, 2009, provider type, place of service (POS), and type-of-service (TOS) changes have been applied to some surgical procedure codes. Provider type changes are now available in the updated fee schedules, and providers are encouraged to determine coverage changes by reviewing the fee schedules before submitting claims. Click on the title to view the details of the POS and TOS changes.
|
| First Quarter HCPCS Updates to Be Available April 1, 2009 |
| Information posted February 6, 2009: On April 1, 2009, TMHP will implement first quarter 2009 Healthcare Common Procedure Coding System (HCPCS) additions, changes, and deletions effective for dates of service on or after April 1, 2009. Click on the title to view the details.
|
| CSHCN Services Program Benefits Have Changed for Some Durable Medical Equipment (DME) |
| Information posted February 6, 2009: Effective for dates of service on or after April 1, 2009, benefit criteria for the Children with Special Health Care Needs (CSHCN) Services Program will change for some durable medical equipment (DME). Click on the title to view the details.
|
| Home Health Mobility Aids Benefits to Change |
| Information posted February 6, 2009: Effective for dates of service on or after April 1, 2009, benefit criteria for home health mobility aids will change for Texas Medicaid. Click on the title to view the details.
|
| Clarification: Claims Filing Deadline Waived for Providers in Ike Evacuation Areas |
| Information posted February 6, 2009: This is a clarification to information posted on the Hurricane Ike Provider Information web page available at www.tmhp.com and published in the November/December 2008 Texas Medicaid Bulletin, No. 219, in the article titled, “HHSC Response to Recent Hurricanes.” Click on the title to view the details. |
| Clarification: Claims Filing Deadline Waived for Providers in Ike Evacuation Areas |
| Information posted February 6, 2009: This is a clarification to an article posted to the Children with Special Health Care Needs (CSHCN) Services Program web page on September 24, 2008, titled, “CSHCN Services Program Claim Filing Deadline Waived for Services to Ike Evacuees.” Click on the title to view the details.
|
| Benefit Update for THSteps Dental Diagnostic Services for Texas Medicaid |
| Information posted February 6, 2009: Effective for dates of service on or after April 1, 2009, benefit criteria for Texas Health Steps (THSteps) dental diagnostic services will change for Texas Medicaid. Click on the title to view the details.
|
| Correction to Hearing Aid Devices Limited to Every 5 Years |
| Information posted February 6, 2009: This is a correction to a banner message that was first published on the January 16, 2009 R&S Report. The banner message indicated an incorrect limitation for monaural hearing devices effective for dates of service on or before December 1, 2008. Click on the title to view the complete, corrected article.
|
| Correction to CSHCN Services Program Reimbursement Rates Change for Office Visits by Optometrists |
| Information posted February 6, 2009: This is a correction to a message that first appeared on the December 12, 2008, Remittance and Status (R&S) Report about the Children with Special Health Care Needs (CSHCN) Services Program reimbursement rate changes for optometrists’ office visits and to an article that was published on this website on December 5, 2008, titled “CSHCN Services Program Reimbursement Rates Change for Optometrists’ Office Visits.” The article incorrectly stated that the effective date was September 1, 2007, and that claims would be reprocessed. The effective date for the new reimbursement rates was January 1, 2009.Click on the title to view the details.
|
| Benefits for Home Health Bath and Bathroom Equipment To Change |
| Information posted February 6, 2009: Effective for dates of service on or after April 1, 2009, a toilet seat lift mechanism (procedure code J-E0172) is a benefit of Texas Medicaid when prior authorized. Click on the title to view the details.
|
| Update to CSHCN Services Program Adopts Rates for More HCPCS 2008 Procedure Codes |
| Information posted February 6, 2009: This is a clarification to a banner message that first appeared on the January 9, 2009, Remittance and Status (R&S) Report, and to an article that was published on this website on January 2, 2009, titled “CSHCN Services Program Adopts Initial Rates for More HCPCS 2008 Procedure Codes.” Click on the title to view the details.
|
| Correction to Scheduled System Maintenance |
| Information posted February 6, 2009: This is a correction to an article that was published in the 2009 March/April Texas Medicaid Bulletin No. 223, about a scheduled system maintenance window on Sunday, March 8, 2009, from 12:00 a.m. until 3:00 a.m. for the daylight saving time change. This downtime window will be cancelled because it is unnecessary for the spring time change. The downtime scheduled for March 8, 2009, from 6:00 p.m. until 11:59 p.m. will still occur. Click on the title to view the correct information.
|
| Benefits to Change for Regional Anesthesia Services |
| Information posted February 6, 2009: Effective for dates of service on or after April 1, 2009, regional anesthesia services criteria will change for Texas Medicaid. Click on the title to view the details.
|
| Benefits for Services by Doctors of Dentistry Practicing as a Limited Physician to Change |
| Information posted February 6, 2009: Effective for dates of service on or after April 1, 2009, benefits for services by doctors of dentistry practicing as a limited physician will change for Texas Medicaid. Click on the title to view the details.
|
| Reminder: Benefit Changes for Hearing Devices and Related Services for Texas Medicaid |
| Information posted February 6, 2009: Reminder: Effective for dates of service on or after December 2, 2008, hearing aid device revisits must be billed using procedure code 1-92592 or 1-92593. The revisits are limited to two per calendar year performed by any provider. Procedure codes 99211 and 99212 will no longer be reimbursed for the hearing aid device revisits. Procedure codes 99211 and 99212 will be denied if submitted with the same date of service by the same provider as procedure code 92592 or 92593. Click on the title to view the complete article.
|
| Update to CSHCN Services Program Rate Changes for Nutritional Products, Equipment, and Supplies |
| Information posted February 6, 2009: Effective for dates of service on or after January 1, 2009, the Children with Special Health Care Needs (CSHCN) Services Program reimbursement rates have changed for nutritional products, equipment, and supplies. Click on the title to view the details.
|
| Update to Total Parenteral Nutrition (TPN) Services |
| Information posted February 6, 2009: Effective for dates of service on or after April 1, 2009, Texas Medicaid will implement benefit and prior authorization changes for total parenteral nutrition (TPN) services. Click on the title to view the details.
|
| 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. |
| January 2009 |
| Correction to “Restriction Changes for 2008 HCPCS Procedure Codes” |
| Information posted January 16, 2009: This is a correction to an article published in the July/August 2008 Texas Medicaid Bulletin, No. 216, titled “Restriction Changes for 2008 HCPCS Procedure Codes.” The article did not include a place of service change for procedure code 1-90772. Click on the title to view the corrected information. |
| February 2009 CSHCN Provider Bulletin No. 69 |
| Information Posted January 14, 2009: The February 2009 CSHCN Provider Bulletin No. 69 is now available. Click the title to view the bulletin.
|
| Updated Information for Outpatient Speech-Language Pathology & Physical Medicine and Rehabilitation |
| Information posted January 21, 2009: This is an update to a banner message that appeared on the January 16, 2009, Remittance and Status (R&S) Report about outpatient speech-language pathology and physical medicine and rehabilitation, the corresponding article that was published on this website January 9, 2009, titled "Update for Outpatient Speech-Language Pathology and Physical Medicine and Rehabilitation," and articles published in the February 2009 CSHCN Services Program Provider Bulletin, No. 69, titled “Change in Benefit Criteria for Outpatient Speech-Language Pathology Services” and “Change in Benefit Criteria for Physical Medicine and Rehabilitation Services.” Click on the title to view the updated information. |
| Updated Implementation Information for Physical, Occupational, and Speech Therapy |
| Information posted January 21, 2009: This is an update to a banner message that appeared on the January 16, 2009, Remittance and Status (R&S) Report about physical, occupational, and speech therapy and a corresponding article that was published on this website January 9, 2009, titled "Update for Physical, Occupational, and Speech Therapy." Click on the title to view the updated information. |
| Survey on Uncompensated Care for Hurricanes Dolly and Ike Evacuees |
| Information posted January 20, 2009: In an effort to estimate the amount of uncompensated care provided to Hurricanes Dolly and Ike uninsured evacuees, HHSC is requesting providers to complete the “Texas Hurricane-related Uncompensated Care Survey” located on this website. In order for a provider’s estimate to be included in the state’s uncompensated care estimate the survey must be completed no later than February 6, 2009. Click on the title to view the details and access the online survey. |
| Hurricane Ike Waivers Will Be Discontinued on February 1, 2009 |
| Information posted January 21, 2009: TMHP will discontinue the special waivers for services rendered to clients in ZIP codes affected by Hurricane Ike. For claims with dates of service February 1, 2009, and after, the normal requirements for primary care provider referrals, prior authorizations, and 95-day filing deadlines will be reinstated.
Click on the title for more details. |
| Hurricane Ike Filing Deadline Waiver for CSHCN Services Program Providers to Be Discontinued |
| Information posted January 22, 2009: Effective February 1, 2009, TMHP will discontinue the filing deadline waiver for services rendered to Children with Special Health Care Needs (CSHCN) Service Program clients in ZIP codes affected by Hurricane Ike. Click on the title to view the details. |
| Home Health Services (Title XIX) DME/Medical Supplies Physician Order Form Instructions Revised |
| January 23, 2009: The instructions in Section B of the Home Health Services (Title XIX) DME/Medical Supplies Physician Order Form have been revised for clarity. The revised form is available on the TMHP Website at www.tmhp.com and will be published in the 2009 March/April Texas Medicaid Bulletin, No. 222. Click on the title to view the revised form.
|
| Removal of Osteogenic Stimulator Age Restrictions |
| Information posted January 23, 2009: Effective for dates of service on or after February 1, 2009, the age restriction for procedure codes 9-E0749 and J-E0760 will be removed and these procedure codes will become payable for clients of all ages.
For more information, call the TMHP Contact Center at 1-800-925-9126.
|
| New Process Related to Claims for Clients with Third-Party Insurance |
| Information posted January 23, 2009: On September 27, 2008, TMHP implemented a new process to forward electronic institutional claims to AIM Healthcare Services Inc. (AIM) for research to determine whether a client has other insurance. Beginning February 2009, if AIM determines a client has other, valid insurance for an institutional claim's date of service, AIM will forward the claim to the other insurance carrier on behalf of the provider. Click on the title to view the details of this new process including claim types that are exempt from forwarding. |
| TMHP Scheduled System Maintenance |
| Information posted January 29, 2009: TMHP will perform scheduled system maintenance to the claims engine and long term care (LTC) systems on February 8, 2009, from 6:00 p.m. until 2:00 a.m. Some functions will be unavailable during this time period. Click on the title to view the details.
|
| National Drug Code Data Claims Update |
| Information posted January 27, 2009: Effective January 30, 2009, claims submitted for professional, outpatient, and family planning services that include physician-administered prescription drug procedure codes will no longer require the National Drug Code (NDC) unit of quantity or the NDC unit of measurement codes. Click on the title to view the details. |
| CSHCN Services Program Rates to Change for Casting, Splinting, and Strapping Services |
| Information posted January 30, 2009: Effective for dates of service on or after March 1, 2009, the Children with Special Health Care Needs (CSHCN) Services Program reimbursement rates will change for casting, splinting, and strapping services for surgery, assistance surgery, and ambulatory surgical centers. Click on the title to view the details. |
| Correction to the 2009 HCPCS Special Bulletin, No. 221 |
| Information posted January 30, 2009: This is a correction to the 2009 Healthcare Common Procedure Coding System (HCPCS) Special Bulletin, No. 221. The bulletin indicates incorrect benefit information for the following procedure codes: 1-93279, 1-93282, 1-93289, 1-99460, 1-99462, 1 99463, 1-99464, and 1-99466. Click on the title to view the details. |
| TMHP Scheduled System Maintenance |
| Information posted January 2, 2009: TMHP will perform scheduled system maintenance to the claims engine and long term care (LTC) systems on January 11, 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. |
| CHIP Perinatal Labor and Delivery-Related Professional Services Claims Reprocessing. |
| Information posted January 2, 2009: Effective November 1, 2008, Texas Medicaid & Healthcare Partnership (TMHP) no longer processes claims for Children’s Health Insurance Program (CHIP) Perinatal labor and delivery-related professional services. Click on the title to view the details. |
| Update to Total Parenteral Nutrition (TPN) Services |
| Information posted January 2, 2009: Effective April 1, 2009, Texas Medicaid will implement benefit and prior authorization changes for total parenteral nutrition (TPN) services. Click on the title to view the details. |
| Update to Article About IMD Provider Submitting Client Information on the TMHP Website |
| Information posted January 2, 2009: This is an update to a banner message that was published on December 19, 2008, and an article that was posted on the TMHP website at www.tmhp.com on December 12, 2008, about Institution for Mental Diseases (IMD) providers that must inform TMHP about clients who reside in their facilities before submitting inpatient claims for those clients. Click on the title to view the details. |
| CSHCN Services Program Adopts Initial Rates for Additional HCPCS 2008 Procedure Codes |
| Information posted January 2, 2009: On January 1, 2008, the Texas Medicaid & Healthcare Partnership (TMHP) has applied the annual 2008 Healthcare Common Procedure Coding System (HCPCS) updates effective for dates of service on or after January 1, 2008. Click on the title to view the details. |
| Children with Special Health Care Needs (CSHCN) Services Program Waiting List Information |
| Information posted January 7, 2009: The Children with Special Health Care Needs (CSHCN) Services Program has removed 314 clients from the program's waiting list. The effective date of this removal is January 1, 2009. These new clients received a gray CSHCN Services Program Eligibility Form that indicates the dates they are eligible to receive CSHCN Services Program health care benefits. When scheduling a client for an appointment, ask the client to bring the form to the appointment so that a copy can be made for your records. For more information, call the TMHP-CSHCN Services Program Contact Center at 1-800-568-2413.
|
| CSHCN Services Program Benefit Changes for Drug Procedure Codes J1645, J1650, and J1652 |
| Information posted January 9, 2009: Procedure codes J1645, J1650, and J1652 will be reimbursable in office, home, nursing home and outpatient settings. Effective February 1, 2009, procedure codes 1-J1645, 1-J1650, and 1-J1652 will be payable in the office, home, nursing home, and outpatient hospital setting for nurse practitioners, clinical nurse specialists, physicians, and physician groups. Procedure codes 1-J1645, 1-J1650, and 1-J1652 will also be payable to hospitals in an outpatient hospital setting.
For more information, call the TMHP-CSHCN Services Program Contact Center at 1-800-568-2413.
|
| New CSHCN Reimbursement Rates for Nutritional Products, Equipment, and Supplies |
| Information posted January 9, 2009: Effective for dates of service on or after January 1, 2009, the Children with Special Health Care Needs (CSHCN) Services Program has implemented reimbursement rates for nutritional products, equipment, and supplies. Click on the title to view the details. |
| Update for Outpatient Speech-Language Pathology and Physical Medicine and Rehabilitation |
| Information posted January 9, 2009: This is an update to a banner message that appeared on the November 14, 2008, Remittance and Status (R&S) Report about outpatient speech-language pathology and physical medicine and rehabilitation and to web articles that were published on this website on November 7, 2008, titled, “Outpatient Speech-Language Pathology Benefits to Change for the CSHCN Services Program,” and “Physical Medicine and Rehabilitation Benefits to Change for the CSHCN Services Program.” Click on the title to view the details. |
| Unit Calculations for Billing Drugs |
| Information posted January 9, 2009: Reminder: Providers that request reimbursement for drugs must bill the number of units based on the number of Healthcare Common Procedure Coding System (HCPCS) units actually administered. Providers should refer to the HCPCS procedure code description for the unit amount to calculate the number of units to be billed. Click on the title to view the details. |
| Update for Physical, Occupational, and Speech Therapy |
| Information posted January 9, 2009: This is an update to a banner message that appeared on the November 14, 2008, Remittance and Status (R&S) Report about physical, occupational, and speech therapy and to articles that were published on this website on November 7, 2008, titled, “Physical, Occupational, and Speech Therapy Benefits to Change for CCP,” “Home Health Physical and Occupational Therapy Benefits to Change for Texas Medicaid,” and “Physical, Occupational, and Speech Therapy Benefits to Change for Acute Services for Texas Medicaid.” Click on the title to view the details. |
| TMHP Scheduled System Maintenance |
| Information posted January 13, 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.
|
| December 2008 |
| Claims for Medicare Advantage Dual-Eligible Clients |
| Information posted December 22, 2008: The Health and Human Services Commission (HHSC) and Medicare Advantage Plans (MAPs) are continuing their efforts to resolve the issues with outstanding crossover claims for cost share and copayment amounts for services rendered from January 1, 2005, through December 31, 2007. Click on the title to view the details. |
| Optometry and Ophthalmology Claims Reprocessing for PCCM Providers |
| Information posted December 23, 2008: TMHP has identified an issue affecting non-surgical claims submitted by optometrists and ophthalmologists with dates of service on or after September 1, 2007, for Primary Care Case Management (PCCM) clients. These claims may have been inappropriately denied because of a missing primary care provider referral. Primary care provider referrals are not required for routine vision services. Affected claims will be reprocessed beginning on January 12, 2009. Payments will be adjusted accordingly. No action on the part of the provider is necessary. For more information, call the TMHP Contact Center at 1-800-925-9126.
|
| Correction to “Immunization Procedure Code Rate Changes for CSHCN” |
| Information posted December 23, 2008: This is a correction to an article that was published on this website on August 22, 2008, and in the November 2008 CSHCN Services Program Provider Bulletin, No. 68, titled “Immunization Procedure Code Rate Changes for CSHCN. " Click on title to view the details. |
| Type of Service Codes Removed from 2009 Texas Medicaid Provider Procedures Manual |
| Information posted December 23, 2008: The 2009 Texas Medicaid Provider Procedures Manual will not include type of service (TOS) codes as part of a procedure code. Providers should refer to the Texas Medicaid fee schedules that are available on the TMHP website at www.tmhp.com to determine all payable types of service codes for procedure codes that are a benefit of Texas Medicaid. Providers can also refer to the Texas Medicaid Provider Procedures Manual, Chapter 5 “Claims Filing” for TOS code descriptions.
For more information, call the TMHP Contact Center at 1-800-925-9126.
|
| PCCM-Enrolled FQHCs and RHCs Must Report Medical Staff Changes to TMHP |
| Information posted December 23, 2008: Effective February 1, 2009, Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs) that are enrolled in Primary Care Case Management (PCCM) must inform TMHP of all changes to their medical staff so that the PCCM Provider Directory can be properly updated. An accurate and up-to-date provider listing gives PCCM clients access to all of the staff members of these providers. FQHCs and RHCs must complete the Primary Care Case Management Federally Qualified Health Centers or Rural Health Clinics Medical Staff Update Form, which is available on the TMHP website at www.tmhp.com. The form can be faxed to the PCCM Contract and Credentialing Department at 1 888 235 8399. For more information, call the TMHP Contact Center at 1-800-925-9126. Click on the title to view the form. |
| HCPCS Special Bulletin Now Available |
| Information posted December 31, 2008: Click the title to view the HCPCS Special Bulletin.
|
| Inpatient and Outpatient Behavioral Health Services Benefits to Change |
| Information posted December 5, 2008: Texas Medicaid will implement benefit changes for behavioral health services.
Effective for dates of service on or after January 1, 2009, Texas Medicaid will implement benefit changes for inpatient and outpatient behavioral health services. Details of these changes will be available on this website on December 12, 2008, in the January 2009 Inpatient and Outpatient Behavioral Health Services Special Bulletin, No. 1. For more information, call the TMHP Contact Center at 1-800-925-9126. |
| 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. |
| Texas Medicaid to Implement Revised Reimbursement Rates for Intestinal Transplants |
| Information posted December 5, 2008: Effective for dates of service on or after January 1, 2009, Texas Medicaid will implement revised reimbursement rates for intestinal transplants following a public rate hearing on November 17, 2008. Click on the title to view the details. |
| CSHCN Services Program Reimbursement Rates Change for Optometrists’ Office Visits |
| Information posted December 5, 2008: Effective for dates of service on or after September 1, 2007, the Children with Special Health Care Needs (CSHCN) Services Program reimbursement rates have changed for optometrists’ office visits. Claims submitted with dates of service on or after September 1, 2007, will be reprocessed, and payments will be adjusted accordingly. No action on the part of the provider is necessary. Click on the title to view the details. |
| January/February 2009 Texas Medicaid Bulletin No. 220 |
| Information posted December 5, 2008: The January/February 2009 Texas Medicaid Bulletin No. 220 is now available. Click the title to view the bulletin.
|
| Texas Medicaid Reimbursement Rates Change for Patient Lifts |
| Information posted December 5, 2008: Effective for dates of service on or after December 1, 2008, Texas Medicaid reimbursement rates have changed for patient lifts following a public rate hearing on November 25, 2008. Click on the title to view the details. |
| Texas Medicaid to Revise Developmental and Neurological Assessment and Testing Reimbursement |
| Information posted December 5, 2008: Effective for dates of service on or after January 1, 2009, Texas Medicaid will implement revised reimbursement rates for developmental and neurological assessment and testing following a public rate hearing on November 17, 2008. Click on the title to view the details. |
| Hysteroscopy with Endometrial Ablation Surgery Services Reimbursement Rates to Change |
| Information posted December 5, 2008: Effective for dates of service on or after January 1, 2009, Texas Medicaid reimbursement rates for hysteroscopy with endometrial ablation surgery services will change following a public rate hearing on November 17, 2008. Click on the title to view the details. |
| January 2009 Inpatient and Outpatient Behavioral Health Services Special Bulletin, No. 1 |
| Information posted December 12, 2008: Click on the title to view the Inpatient and Outpatient Behavioral Health Services Special Bulletin.
|
| TMHP Scheduled System Maintenance |
| Information posted December 10, 2008: TMHP will perform scheduled system maintenance to the claims engine and long term care (LTC) systems on December 14, 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. |
| THSteps Medical Checkups Periodicity Schedule Updated |
| Information posted December 12, 2008: The Texas Health Steps (THSteps) Medical Checkups Periodicity Schedule has been updated. Click on the title to view the details. |
| Correction to “Billing Criteria to Change for Women’s Health Program Laboratory Services” |
| Information posted December 12, 2008: This is a correction to an article published on this website on November 14, 2008, titled, “Billing Criteria to Change for Women’s Health Program Laboratory Services.” The article did not include procedure code 5/I-86703. Click on the title to view the complete, corrected article. |
| 2009 CSHCN Services Program Provider Manual to Be Available in May 2009 |
| Information posted December 12, 2008: The 2009 Children with Special Health Care Needs (CSHCN) Services Program Provider Manual will be mailed to providers and made available on the TMHP website at www.tmhp.com in May 2009 rather than in January as in previous years. The CSHCN Services Program has revised the production and mailing dates to be able to include policies with an implementation and an effective date through January 1, 2009 and the 2009 Healthcare Common Procedure Coding System (HCPCS) annual updates. New policy implementations and updates effective after January 1, 2009 will be published in each quarterly edition of the CSHCN Services Program Provider Bulletin.
For more information, call the TMHP-CSHCN Services Program Contact Center at 1-800-568-2413. |
| IMD Providers Requested to Inform TMHP of Clients Residing in Their Facility |
| Information posted December 12, 2008: Beginning January 30, 2009, Institution for Mental Diseases (IMD) providers will be able to enter client information and the admission and discharge dates on the secured portion of this website. At that time, IMD providers will be requested to inform the Texas Medicaid & Healthcare Partnership (TMHP) of the Medicaid clients who are residing in their facilities before submitting inpatient claims for those clients. Click on the title to view the details. |
| Maternity Service Clinics Reimbursement Rates to Change for Texas Medicaid |
| Information posted December 12, 2008: Effective for dates of service on or after January 1, 2009, Texas Medicaid reimbursement rates for maternity service clinics will change following a public rate hearing that was held on November 17, 2008. Click on the title to view the details. |
| Updated Texas Medicaid Provider Forms |
| Information posted December 19, 2008: The Texas Medicaid & Healthcare Partnership (TMHP) has revised some of the Texas Medicaid provider forms found in the 2008 Texas Medicaid Provider Procedures Manual. Click on the title to view the details. |
| Benefit Changes for Drug Procedure Codes J1645, J1650, and J1652 |
| Information posted Dacember 19, 2008: Effective February 1, 2009, procedure codes 1-J1645, 1-J1650, and 1-J1652 will be payable in the office, home, nursing home, and outpatient hospital settings for nurse practitioners, clinical nurse specialists, physicians, physician assistants, and physician groups. Procedure codes 1-J1645, 1-J1650, and 1-J1652 will also be payable to hospitals in an outpatient hospital setting. For more information, call the TMHP Contact Center at 1-800-925-9126.
|
| November 2008 |
| Update to CSHCN Services Program Adoption of 2007 HCPCS Codes for Ambulatory Surgical Centers |
| Information posted November 28, 2008:The Children with Special Health Care Needs (CSHCN) Services Program adopts HCPCS codes for ambulatory surgical centers. Click on the title to view the details. |
| TMHP Closed December 24-26, 2008; Claims Filing Deadline Extended |
| Information posted November 20, 2008: Claims filing deadlines will be extended for the Christmas holidays. Click on the title to view the details. |
| Thanksgiving and Christmas Holidays to Delay EFT Payments |
| Information posted November 21, 2008: The Thanksgiving and Christmas holidays will delay Electronic Funds Transfer (EFT) payments by one business day. Providers receiving EFT payments can expect funds to be deposited by Friday, November 28th, 2008, after the Thanksgiving holiday and Friday, December 26th, 2008, after the Christmas holiday.
For more information, call the TMHP Contact Center at 1-800-925-9126 or the TMHP-CSHCN Services Program Contact Center at 1-800-568-2413.
|
| Correction to CSHCN Services Program Reimbursement Rate Changes for Clinical Laboratory, Anesthesia |
| Information posted November 28, 2008: This is a correction to a website article posted on November 7, 2008, titled “CSHCN Reimbursement Rates to Change for Clinical Laboratory, Anesthesia Services and Dental Services.“ The effective date was incorrectly stated as January 1, 2009. The correct effective date is January 1, 2007. Click on the title to view the complete, corrected article. |
| Correction for Texas Medicaid Bulletin and HCPCS Special Bulletin Issue Numbering |
| Information posted November 28, 2008: The issue numbers for the March/April 2009 Texas Medicaid Bulletin and the 2009 Healthcare Common Procedure Coding System (HCPCS) Special Bulletin have changed. Click on the title to view the details. |
| Medicaid Reimbursement Rates to Change for Hearing Services Procedure Codes |
| Information posted November 28, 2008: Effective for dates of service on or after December 2, 2008, Texas Medicaid reimbursement rates will change for hearing services procedure codes. The rate changes were adopted following a public rate hearing on November 17, 2008. Click on the title to view the details. |
| Reimbursement Rates to Change for Ambulatory Surgical Centers, Dental, and DME Services |
| Information posted November 28, 2008: Effective for services on or after January 1, 2009, Texas Medicaid reimbursement rates for 2008 HCPCS procedure codes will change for ambulatory surgical centers, dental, and durable medical equipment (DME) services. The new reimbursement rates were adopted following a public rate hearing on November 17, 2008. Affected claims will be reprocessed, and payments will be adjusted accordingly. No action on the part of the provider is necessary. Click on the title to view the details. |
| Casting, Splinting and Strapping Services Rates to Change |
| Information posted November 28, 2008: Effective for dates of service on or after January 1, 2009, Texas Medicaid reimbursement rates will change for casting, splinting, and strapping services for surgeons, assistance surgeons, and ambulatory surgical centers following a public rate hearing on November 17, 2008. Click on the title to view the details. |
| Texas Medicaid Fee Schedules Revised |
| Information posted November 4, 2008: TMHP has revised some of the current Texas Medicaid fee schedules that are posted on this website. Click on the title to view details. |
| Texas Comptroller to Complete Overpayment Audit |
| Information posted November 6, 2008: During the 79th Texas Legislature, Regular Session 2005, a requirement for a centralized overpayment recovery audit program for Texas was established. As a result of the legislation, the Texas Comptroller is required to complete an overpayment audit and recover any funds that may have been incorrectly paid to Medicaid providers. Click on the title to view the details. |
| Outpatient Speech-Language Pathology Benefits to Change for the CSHCN Services Program |
| Information posted November 7, 2008: Effective for dates of service on or after January 1, 2009, benefit criteria for outpatient speech-language pathology services will change for the Children with Special Health Care Needs (CSHCN) Services Program. Click on the title to view the details. |
| Home Health Physical and Occupational Therapy Benefits to Change for Texas Medicaid |
| Information posted November 7, 2008: Effective for dates of service on or after January 1, 2009, benefit criteria for Home Health physical and occupational therapy will change for Texas Medicaid. Click on the title to view the details. |
| Physical, Occupational, and Speech Therapy Benefits to Change for CCP |
| Information posted November 7, 2008: Effective for dates of service on or after January 1, 2009, the benefit criteria for physical, occupational, and speech therapy will change for the Comprehensive Care Program (CCP). Click on the title to view the details. |
| Family Planning Diagnosis Codes Expanded for the Annual Examination |
| Information posted November 7, 2008: Effective for dates of service on or after January 1, 2009, some claims filing criteria have changed for Texas Medicaid Title XIX family planning services. Click on the title to view the details. |
| Providers to Be Notified When They Have an Invalid Address |
| Information posted November 7, 2008: Beginning January 1, 2009, the Texas Medicaid & Healthcare Partnership (TMHP) will implement a system enhancement that will notify providers when they have an invalid address on file with TMHP. Account administrators who log onto their accounts on this website will be notified when they have an invalid address on file for any of the Texas Provider Identifiers (TPIs) associated with their National Provider Identifier (NPI). Click on the title to view the details. |
| Correction to Article “THSteps Therapeutic Dental Services Reimbursement Rate Change” |
| Information posted November 7, 2008: This is a correction to an article published in the November/December 2008 Texas Medicaid Bulletin, No. 219, and on this website on August 29, 2008, titled “THSteps Therapeutic Dental Services Reimbursement Rate Change.” The article incorrectly listed procedure code D9920. The correct procedure code is D9220. The reimbursement rate for procedure code D9220 has increased only for those providers who are dental anesthesiology specialists. Click on the title to view the complete, revised article. |
| Physical Medicine and Rehabilitation Benefits to Change for the CSHCN Services Program |
| Information posted November 7, 2008: Effective for dates of service on or after January 1, 2009, benefit criteria for physical medicine and rehabilitation will change for the Children with Special Health Care Needs (CSHCN) Services Program. Click on the title to view the details. |
| Intestinal Transplants to be a Benefit of Texas Medicaid |
| Information posted November 7, 2008: Effective for dates of service on or after January 1, 2009, intestinal transplants are a benefit of Texas Medicaid. Click on the title to view the details. |
| Physical, Occupational, and Speech Therapy Benefits to Change for Acute Services for Texas Medicaid |
| Information posted November 7, 2008: Effective for dates of service on or after January 1, 2009, the benefit criteria for physical, occupational, and speech therapy will change for acute services for Texas Medicaid. Click on the title to view the details. |
| CSHCN Services Program to Implement New Rates for Augmentative Communication Devices |
| Information posted November 7, 2008: Effective for dates of services on or after December 30, 2008, the Children with Special Health Care Needs (CSHCN) Services Program will implement new reimbursement rates for augmentative communication device (ACD) procedure codes. Click on the title to view the details. |
| Casting, Splinting, and Strapping Benefits to Change for Texas Medicaid |
| Information posted November 7, 2008: Effective for dates of service on or after January 1, 2009, casting, splinting, and strapping benefits will change for Texas Medicaid. Click on the title to view the details. |
| Claim Details for Services Must Match Prior Authorization Letter Information |
| Information posted November 7, 2008: Providers submitting claims for services for which prior authorization has been obtained must follow certain guidelines as a condition of reimbursement. Click on the title to view the details. |
| New Medicaid Benefits Announced for Developmental and Neurological Assessment and Testing |
| Information posted November 7, 2008: Effective for dates of service on or after January 1, 2009, aphasia assessment, developmental screening and testing, and neurobehavioral assessment are benefits of Texas Medicaid. Click on the title to view the details. |
| CSHCN Reimbursement Rates to Change for Clinical Laboratory, Anesthesia Services and Dental Services |
| Information posted November 7, 2008: Effective for dates of service on or after January 1, 2009, the Children with Special Health Care Needs (CSHCN) Services Program will implement new reimbursement rates for clinical laboratory, anesthesia services, and dental services procedure codes. Click on the title to view the details. |
| CSHCN Services Program Adopts Rates for 2007 HCPCS Codes for Ambulatory Surgical Centers |
| Information posted November 7, 2008: The Children with Special Health Care Needs (CSHCN) Services Program has adopted rates for reimbursement to ambulatory surgical centers for some 2007 Healthcare Common Procedure Coding Systems (HCPCS) codes that were effective January 1, 2007. Click on the title to view the details. |
| TMHP System Maintenance |
| Information posted November 10, 2008: TMHP will perform maintenance to the Claims Engine and Long Term Care systems on November 16, 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.
|
| Benefits to Change for Hearing Devices and Related Services for Texas Medicaid |
| Information posted November 14, 2008: Effective for dates of service on or after December 2, 2008, benefit criteria for hearing devices and services will change for Texas Medicaid. Click on the title to view the details. |
| Billing Criteria to Change for Women’s Health Program Laboratory Services |
| Information posted November 14, 2008: Effective for dates of service on or after January 1, 2009, some claims filing criteria will change for Women’s Health Program (WHP) laboratory services. Click on the title to view the details. |
| Revised Fee Schedules for Medicaid Providers and Family Planning Clinics |
| Information posted November 21, 2008: TMHP has identified an issue that affects some of the Texas Medicaid fee schedules that were posted on this website on October 3, 2008. Click on the title to view the details. |
| CSHCN Services Program Adopts New Rates for Some ENT Surgical Services |
| Information posted November 21, 2008: Effective for dates of services on or after November 20, 2008, the Children with Special Health Care Needs (CSHCN) Services Program adopted new rates for some ear, nose, and throat (ENT) surgery services procedure codes. Click on the title to view the details. |
| Portable Lifts to Be a THSteps-CCP Benefit |
| Information posted November 21, 2008: Effective for dates of service on or after December 1, 2008, hydraulic or electric portable lifts that can be folded up for transport and used outside the home setting are a benefit through the Texas Health Steps Comprehensive Care Program (THSteps-CCP) when the client must attend health related services that require an overnight stay in a non-institutional setting. Click on the title to view the details. |
| October 2008 |
| Revised Home Health Services (Title XIX) DME/Medical Supplies Order Form and Instructions |
| Information posted October 21, 2008: The Home Health Services (Title XIX) DME/Medical Supplies Physician Order Form and Instructions have been revised to make it easier for physicians to complete Section B. Click on the title for the complete article. |
 | MS-DRG 2009 Updates Effective October 1, 2008 |
| |
| Reminder for Cleft/Craniofacial Providers |
| Information posted October 3, 2008: As indicated in the 2008 CSHCN Services Program Provider Manual, providers of cleft/craniofacial (C/C) services must be enrolled by the Children with Special Health Care Needs (CSHCN) Services Program. Providers must also be part of a designated C/C team to receive reimbursement for surgical services from the CSHCN Services Program. Click on the title to view the details. |
| Providers Reminded to Keep Their NPIs Active |
| Information posted October 3, 2008: Reminder: Providers must keep their National Provider Identifiers (NPIs) active and their National Plan and Provider Enumeration System (NPPES) records updated. Click on the title for more information. |
| TexMedConnect Enhancements Coming in November |
| Information posted October 3, 2008: Beginning November 21, 2008, TexMedConnect will have new enhancements. Click on the title to view details. |
| Taxonomy Codes Expanded |
| Information posted October 3, 2008: Beginning October 1, 2008, the taxonomy codes associated with various provider types and specialties that are displayed during the National Provider Identifier (NPI) online attestation process on the TMHP website at www.tmhp.com, have been expanded. Providers are encouraged to review the taxonomy codes that are now available and, if necessary, update their attestation data. Click on the title to view the details. |
| Filing Claims for Clients with Retroactive Eligibility |
| Information posted October 3, 2008: As indicated in the 2008 Texas Medicaid Provider Procedures Manual, Section 5.1.4 “Claims Filing Deadlines,” TMHP must receive claims within a specified time frame. Claim filing deadlines apply to claims submitted on behalf of an individual who has applied for Medicaid coverage but has not been assigned a Medicaid number on the date of service. Click on the title to view the details. |
| November/December 2008 Texas Medicaid Bulletin No. 219 |
| Information Posted October 3, 2008: The November-December 2008 Texas Medicaid Bulletin No. 219 is now available. Click the title to view the bulletin
|
| Texas Medicaid Fee Schedule Enhancements to Start October 7 |
| Information posted October 3, 2008: Beginning October 7, 2008, TMHP will increase the number of Medicaid fee schedules, which will be published quarterly on the TMHP website at www.tmhp.com. TMHP will also add functionality to help providers locate the correct fee schedule for their provider type and provider specialty. Click on the title to view the details. |
| Emergency System Maintenance Scheduled for TMHP EDI System on October 26, 2008 |
| Information posted October 24, 2008: On Sunday, October 26, 2008, the Texas Medicaid & Healthcare Partnership (TMHP) will perform emergency maintenance to install a Microsoft critical vulnerability patch to the electronic data interchange (EDI) system. Some functions will be unavailable during this time period. Click on the title to view the details. |
| Clinician-Directed Care Coordination Services Changes for THSteps-CCP |
| Information posted October 24, 2008: Effective for dates of service on or after January 1, 2009, benefits for clinician-directed care coordination services for the Texas Health Steps-Comprehensive Care Program (THSteps-CCP) will change for Texas Medicaid. Click on the title to view the details. |
| Online Provider Enrollment |
| Information posted October 24, 2008: Reminder: Potential and current Texas Medicaid, Children with Special Health Care Needs (CSHCN) Services Program, and Primary Care Case Management (PCCM) providers can complete the initial enrollment and reenrollment applications online at the Access Provider Enrollment page on this website. Click on the title to view the details. |
| Benefit Information for Clients with Cleft Palates |
| Information posted October 24, 2008: Reminder: Texas Health Steps (THSteps) clients with cleft palates are eligible for THSteps dental and orthodontic benefits. Click on the title to view the benefit information. |
| Correction to “CHIP Perinatal Labor-and-Delivery-Related Professional Services Claims Processing” |
| Information posted October 24, 2008: The website article published on September 26, 2008, titled “CHIP Perinatal Labor-and-Delivery-Related Professional Services Claims Processing,“ has been corrected. Click on the title to view details. |
| Online Provider Lookup |
| Information posted October 24, 2008: Reminder: Online provider lookup is available on the public access portion of this website. Provider information is available for viewing by providers, clients, or anyone who accesses the TMHP website. Providers can change their demographic information through the online update function, so that users of the online provider lookup tool can see the most current information about the provider. Click on the title to view a detailed description of the online provider lookup tool. |
| Clinician-Directed Care Coordination Services to Change for the CSHCN Services Program |
| Information posted October 24, 2008: Effective for dates of service on or after January 1, 2009, benefits for clinician-directed care coordination services will change for the Children with Special Health Care Needs (CSHCN) Services Program. Click on the title to view the details. |
| Reminder to Include NDC Number on Palivizumab (Synagis) Claim Forms |
| Information posted October 24, 2008: The respiratory syncytial virus (RSV) season is quickly approaching, and providers are reminded that they must include the complete 11-digit National Drug Code (NDC) number when submitting claims for the administration of the palivizumab (Synagis) vaccine using procedure code 90378. If the NDC information is missing, claims submitted with procedure code 90378 will be denied even when they have been prior authorized. Click on the title to view details. |
| Scheduled System Maintenance for October 12, 2008 |
| Information posted October 6, 2008: TMHP will perform scheduled system maintenance to the claims engine and long term care (LTC) systems on October 12, 2008, from 6:00 p.m. until 11:59 p.m. Some functions will be unavailable during this time period. This is a reminder that the previous extended Columbus Day maintenance window will be rescheduled for a later date and will not apply to the scheduled system maintenance for October 12, 2008. Click on the title to view the details.
|
| 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. |
| Correction to Medicare Advantage Plan Contact List |
| Information posted October 17, 2008: This is an update to an article that was published on this website on August 29, 2008, titled “Correction to EDI Testing for MAPs Article.” The contact information for Texas Health Springs, one of the Medicare Advantage Plans (MAPs) contracted with the Health and Human Services Commission, has changed. The telephone number to contact Texas Health Springs is 1-800-280-8888. For more information, call the TMHP Contact Center at 1-800-925-9126. Click on the title for the complete, corrected list of MAPs. |
| November Long Term Care Bulletin No. 36 |
| Information posted October 27, 2008: The November 2008 Long Term Care Bulletin No. 36 is now available. Click the title to view the bulletin.
|
| Correction to “Medicaid Rate Implements Following a Public Rate Hearing on August 18, 2008” Article |
| Information posted October 10, 2008: This is a correction to an article published on this website on August 22, 2008, titled “Medicaid Rate Implements Following a Public Rate Hearing on August 18, 2008." Click on the title to view the details. |
| Implementation of New Medicaid Reimbursement Rates for Nutritional Products |
| Information posted October 31, 2008: Effective for dates of service on or after June 1, 2008, Texas Medicaid has implemented new reimbursement rates for nutritional products. Click on the title to view the details. |
| TMHP Scheduled System Maintenance |
| Information posted October 31, 2008: TMHP will perform scheduled system maintenance to the claims engine and long term care (LTC) systems on November 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. |
| Additional Diagnoses Codes Now Accepted for EMG and NCS Claims |
| Information posted October 31, 2008: Effective for dates of service on or after November 1, 2008, additional diagnosis codes are accepted on electromyography (EMG) and nerve conduction studies (NCS) procedure codes claims. Click on the title to view the details. |
| TMHP Closed November 27-28, 2008; Claims Filing Deadline Extended |
| Information posted October 31, 2008: As outlined in the 2008 Texas Medicaid Provider Procedures Manual, page 5-7, and the 2008 CSHCN Services Program Provider Manual, page 5-6, claims filing deadlines will be extended for the Thanksgiving Day holiday. In addition to Thanksgiving Day, TMHP will be closed the day after Thanksgiving, November 28, 2008. Because of these closures, claims filing deadlines are extended until the next business day, Monday, December 1, 2008. The TMHP Contact Center will close at 5:00 p.m., Central Time on Wednesday, November 26, 2008. Providers may access the automated inquiry system (AIS) or use this website to obtain eligibility or claim status information after hours or during the holidays. For more information, call the TMHP Contact Center at 1 800 925 9126 or the CSHCN Services Program Contact Center at 1 800 568 2413. |
| Medicaid Fees Change for Optometrist Office Visits |
| Information posted October 31, 2008: New reimbursement rates were adopted after a rate hearing on July 29, 2008, for office visit procedure codes that are submitted by optometrists. Click on the title to view the details. |
| ER&S Report to Show Outlier Payment Information for Inpatient Hospital Claims |
| Information posted October 31, 2008: Beginning December 19, 2008, providers will be able to view their day and cost outlier payment information for inpatient hospital claims on the Electronic Remittance and Status (ER&S) Report. Click on title to view details. |
| Locations Change for THSteps Medical and Dental Workshops in Amarillo and Harlingen |
| Information posted October 31, 2008: The locations have changed for December Texas Health Steps (THSteps) medical and THSteps dental workshops in Amarillo and Harlingen. Click on the title to view the details. |
| Clarification to Medicare/Medicaid Waste, Abuse and Fraud Policy |
| Information posted October 17, 2008: This is a clarification to information that was published in the 2008 Texas Medicaid Provider Procedures Manual, Section 1.3, “Medicare/Medicaid Waste, Abuse and Fraud Policy” and in the 2008 CSHCN Services Program Provider Manual, Section 3.2.6, “Suspected Cases of Provider Fraud and Abuse.” Texas Medicaid and Children with Special Health Care Needs (CSHCN) Services Program providers must follow the coding and billing requirements in the Texas Medicaid Provider Procedures Manual and the CSHCN Services Program Provider Manual. However, if coding and billing requirements for a particular service are not addressed in the provider manuals, bulletins, or banner messages, then providers must follow the most current coding guidelines. Click on the title to view the current coding guidelines. |
| Reimbursement Rates to Change for Physician-Administered Drugs and Biologicals for the CSHCN Service |
| Information posted October 17, 2008: Effective for dates of service on or after November 1, 2008, reimbursement rates for procedure codes for physician-administered drugs and biologicals will change for the Children with Special Health Care Needs (CSHCN) Services Program. Click on the title to view the new reimbursement rates. |
| NDC-to-HCPCS Crosswalk Now Published by Noridian Administrative Services LLC |
| Information posted October 16, 2008: Effective August 18, 2008, the National Drug Code (NDC) to Healthcare Common Procedure Coding System (HCPCS) crosswalk is now published by Noridian Administrative Services LLC. Previously, the NDC-to-HCPCS crosswalk was published by Palmetto Government Benefits Administrator (GBA). Click on title to view the details.
|
| Revised Synagis Prior Authorization Forms |
| Information posted October 15, 2008: This is a correction to the Texas Medicaid Palivizumab (Synagis) Prior Authorization Request Form and the CSHCN Services Program Prior Authorization Request for Palivizumab (Synagis) located on this website. Click on the title to view the details. |
| Review of Psychotropic Medications for Foster Care Children Enrolled in STAR Health |
| Information posted October 17, 2008: The Superior Health Plan Network, in conjunction with Integrated Mental Health Services (IMHS), is reviewing state pharmacy data and conducting case reviews for clients birth through 22 years of age enrolled in the State of Texas Access Reform (STAR) Health program. Providers may receive a telephone call or other inquiry about psychotropic medications that may have been prescribed for a foster care child. Click on the title to view the details. |
| Update to “Revised THSteps Mandatory Prior Authorization Request Form” Article |
| Information posted October 17, 2008: This is an update to an article that was published in the July/August 2008 Texas Medicaid Bulletin, No. 216 titled “Revised THSteps Mandatory Prior Authorization Request Form.” TMHP is allowing a grace period during which the previous THSteps Dental Mandatory Prior Authorization Form is accepted for processing by TMHP. Effective November 1, 2008, prior authorization requests submitted on the previous THSteps Dental Mandatory Prior Authorization Form will be returned to the provider with instructions to submit the revised form. For more information, call the TMHP Contact Center at 1-800-925-9126. |
| September 2008 |
| Physical, Occupational, and Speech Therapy Benefit Changes Postponed for Texas Medicaid |
| Posted September 24, 2008: This is an update to a banner message that first appeared on the September 26, 2008, Remittance and Status (R&S) Report. The article stated that benefit criteria for the following services will be changing for Texas Medicaid: physical, occupational, and speech therapy for the Comprehensive Care Program (CCP); physical and occupational therapy for Home Health; and physical, occupational, and speech therapy for acute services. Benefit criteria will not be changing at this time for these services. The benefit changes will be effective at a later date. Providers should monitor future banner messages and bulletins for additional information about upcoming benefit changes for these services. |
| CSHCN Services Program Claim Filing Deadline Waived for Services to Ike Evacuees |
| Information posted September 24, 2008: In response to Hurricane Ike, the Department of State Health Services (DSHS) has directed the Texas Medicaid & Healthcare Partnership (TMHP) to waive the filing deadline for services rendered to Children with Special Health Care Needs (CSHCN) Services Program clients who are Hurricane Ike evacuees. The waiver applies to claims received with dates of service on or after September 9, 2008, and until further notice. Claims submitted after the filing deadline will initially be denied but will then be reprocessed by TMHP with no further action required by the provider. The filing deadline will be waived only for providers whose ZIP codes have been identified as an evacuation area. For more information, call the TMHP Contact Center at 1-800-568-2413. Click on the title to view the list of ZIP codes in the evacuation area. |
| CHIP Perinatal Labor and Delivery-Related Professional Services Claims Processing |
| Information posted September 26, 2008: Effective November 1, 2008, the TMHP claims system will no longer process claims for Children’s Health Insurance Program (CHIP) Perinatal labor with delivery-related professional services. This change only applies to professional claims. Claims for delivery-related professional services are processed and paid by CHIP Perinatal health plans. The TMHP claims system will continue to process labor and delivery facility claims for CHIP Perinatal clients at or below the 185 percent of the Federal Poverty Level (FPL). If a provider receives a denial notice from TMHP for a delivery-related professional service claim, the claim should be resubmitted to the CHIP Perinatal health plan. Click on title to view the details. |
| Healthcare Services for Uninsured Ike Evacuees |
| Information posted September 26, 2008: The Texas Health and Human Services Commission (HHSC) anticipates that federal legislation will be filed to provide relief for uninsured Hurricane Ike evacuees who seek medical care. While HHSC awaits Congressional action, providers should be aware of information that may be necessary to process claims for services provided to uninsured evacuees. Click on the title to view the details. |
| Update to Telephone Appeals Provider Identifier Requirements |
| Information posted September 26, 2008: This is an update to a banner message that first appeared on the June 2, 2008, Remittance and Status (R&S) Report and a website article posted on this website on May 30, 2008, titled, “NPI Required for Telephone Appeals.” The article did not indicate that a Texas Provider Identifier (TPI) may still be required in addition to the National Provider Identifier (NPI) for certain appeals requests. Click on the title for the complete, revised article. |
| 2009 ICD-9-CM Updates Now Available |
| Information posted September 26, 2008: On October 1, 2008, Texas Medicaid & Healthcare Partnership (TMHP) will apply the 2009 additions, deletions, and changes to the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) effective for dates of service on or after October 1, 2008. Click on the title to view the details. |
| Physical, Occupational, and Speech Therapy Benefits Changes Postponed for the CSHCN Services Program |
| Posted September 25, 2008: This is an update to banner message that first appeared on the September 26, 2008, Remittance and Status (R&S) Report. The article stated that benefit criteria for the following services will be changing for the Children with Special Health Care Needs (CSHCN) Services Program: outpatient speech-language pathology; and physical medicine and rehabilitation. Benefit criteria will not be changing at this time for these services. The benefit changes will be effective at a later date. Providers should monitor future banner messages and bulletins for additional information about upcoming benefit changes for these services. |
| Revised DME Certification and Receipt Form |
| Information posted September 26, 2008: Providers billing durable medical equipment (DME) with a billed amount of $2,500 or more may now use the information sheet attached to the DME Certification and Receipt Form. The information sheet is a resource that notifies clients about the option to call the TMHP Community Health Services Client hotline at 1 888 276 0702 to verify receipt of their equipment. Click on the title to view the details. |
| Children with Special Health Care Needs (CSHCN) Services Program Waiting List Information |
| Information posted September 4, 2008: The Children with Special Health Care Needs (CSHCN) Services Program has removed 120 clients from the program's waiting list. The effective date of this removal is September 1, 2008. These new clients received a gray CSHCN Eligibility Form that indicates the dates they are eligible to receive CSHCN Services Program health care benefits. When scheduling a client for an appointment, ask the client to bring the form to the appointment so that a copy can be made for your records. For more information, call the TMHP-CSHCN Services Program Contact Center at 1-800-568-2413.
|
| Benefit Criteria for Radiology Magnetic Resonance Imaging (MRI) to Change for the CSHCN Services Pro |
| Information posted September 8, 2008: Effective for dates of service on or after November 1, 2008, benefit criteria for radiology magnetic resonance imaging (MRI) will change for the Children with Special Health Care Needs (CSHCN) Services Program. Click on the title to view the details. |
| Revised CSHCN Services Program DME Prior Authorization Request Form |
| Information posted September 8, 2008: The Children with Special Health Care Needs (CSHCN) Services Program Prior Authorization and Authorization Request for Durable Medical Equipment (DME) form has been revised. The physician signature is required only on page 1 of the section titled “Statement of Medical Necessity”. Providers must submit page 1 of the form to TMHP, pages 2 through 5 are required only for certain DME requests. Providers can refer to the text under the form title to determine which additional pages must be submitted.
Click on the title for more details and to access the revised form. |
| Gustav Information for Medicaid Providers |
| Information posted September 2, 2008: The federal Centers for Medicare & Medicaid Services (CMS) has declared that Hurricane Gustav represents a public health emergency in Texas, Louisiana, Mississippi, and Alabama. Medicaid providers in Texas can enroll as Louisiana Medicaid providers. Click on the title to view the Texas Health and Human Services Commission (HHSC) homepage, which has additional information. |
| Obstetric Services Benefits to Change |
| Information posted September 8, 2008: Effective for dates of service on or after November 1, 2008, benefits for obstetric services will change for Texas Medicaid. Click on the title to view the details. |
| Benefit Criteria for Bone Growth Stimulators to Change for the CSHCN Services Program |
| Information posted September 8, 2008: Effective for dates of service on or after November 1, 2008, benefit criteria for bone growth stimulators will change for the Children with Special Health Care Needs (CSHCN) Services Program. Click on the title to view the details. |
| Correction to “Rate Changes Following Public Hearing on June 17, 2008” |
| Information posted September 8, 2008: This is a correction to a bulletin article that appeared in the 2008 September/October Texas Medicaid Bulletin, No. 218, titled “Rate Changes Following Public Hearing on June 17, 2008.” Procedure codes 2-43887, 8-43887, and 2-43888 were printed with incorrect rates. Click on title to view the completed corrected article. |
|