| July 2008 |
 | Changes to Accounts Receivable |
| Information posted July 3, 2008: Effective August 29, 2008, TMHP will implement changes to the accounts receivable process. The TMHP accounts receivable process identifies money that a provider owes to TMHP and subtracts it from payments to the provider. Currently, TMHP processes accounts receivable separately for providers’ Texas Medicaid fee-for-service and managed care program payments. Effective August 29, 2008, TMHP will recoup money from all payments until the accounts receivable have been recovered. TMHP will recoup money from providers’ Primary Care Case Management (PCCM) case management fee payment first and then from other available fee-for-service and managed care payments. The 1099, Remittance and Status (R&S), and Electronic Remittance and Status (ER&S) reports will also change. Click on the title to view the details. |
 | Vaccine/Toxoid Reimbursement Changes |
| Information posted July 3, 2008: This is an update to a banner message that first appeared on the February 29, 2008, Remittance and Status (R&S) Report about the delayed implementation of changes to the benefit criteria of vaccines/toxoids. Effective for dates of service on or after August 1, 2008, the benefit criteria for vaccines/toxoids will change for the Texas Medicaid Program. Click on the title to view the details. |
| TMHP Scheduled System Maintenance - July 13, 2008 |
| Information posted July 9, 2008: The Texas Medicaid & Healthcare Partnership (TMHP) will perform scheduled system maintenance to the claims engine and long-term care (LTC) systems on July 13, 2008, from 6:00 p.m. until 11:59 p.m., Central Time. Some functions will be unavailable during this time period. Click on the title to view the details. |
| Update to Rate Changes following Public Hearing on June 17, 2008 |
| Information posted July 14, 2008: Texas Medicaid reimbursement rates were assigned following a public hearing on June 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.
|
| June 2008 |
| EDI Testing for MAPs |
| Information posted June 12, 2008: The state of Texas has submitted to the Centers for Medicare & Medicaid Services (CMS) a State Plan amendment pertaining to Medicare Advantage Plans (MAPs). MAPs are managed care organizations that have entered into a Medicare Risk Product Agreement with CMS. They are sometimes called Medicare Advantage Health Plans or MA Health Plans. The amendment initiates a process by which the state will pay a monthly capitated payment to MAPs. In exchange, MAPs will pay health-care service providers for the cost sharing obligations that are attributable to dual-eligible members enrolled in the MAP’s Medicare risk product. The State Agreement will be the only vehicle for recovery of the cost sharing obligations attributable to dual eligible members. The effective date is January 1, 2008. The Health and Human Services Commission (HHSC) is currently contracted with 18 MAPs. Click on the title to view the details. |
| Lack of Medicaid Identification Form (H3087) Not a Valid Reason to Deny Service |
| Information posted June 13, 2008: Providers should not deny services to Primary Care Case Management (PCCM) clients who do not present their Medicaid Identification Form (H3087 or H1027). Providers have multiple options to verify Medicaid eligibility. Eligibility can be verified through the TMHP electronic data interchange (EDI) gateway, the Automated Inquiry System (AIS) at 1-800-834-7226, and the TMHP Contact Center at 1-800-925-9126. Primary care providers can also verify eligibility using their Panel Report and “Panel Report Changes” list on the web at www.tmhp.com. For more information, call the TMHP Contact Center at 1-800-925-9126. |
| Correction to “Update to ‘New Electrodiagnostic Testing Benefits for the CSHCN Services Program’” |
| Inforamtion posted June 14, 2008: This is a correction to an article published on this website on March 24, 2008, entitled, “Update to ‘New Electrodiagnostic Testing Benefits for the CSHCN Services Program’.” The article incorrectly indicated that the total laboratory component (type of service 5) for procedure codes 51784 and 51785 will be benefits of Texas Medicaid, Also, diagnosis codes 3350, 3359, 35924, and 73605 were not included in the table of payable diagnosis codes, and diagnosis code 7605 was incorrectly added to the diagnosis table. The article also omitted some limitations for procedure codes 51784 and 51785. Click on the title to view the correct information. |
| Correction to “NPI Claims Reminder” |
| Information posted June 14, 2008: This is a correction to an article that was posted on the TMHP website at www.tmhp.com on June 6, 2008, entitled “NPI Claims Reminder”. The article incorrectly stated that providers must enter a physical address in Block 24J of the CMS-1500 claim form. Field 24J must contain only the rendering provider’s NPI. In addition, the article incorrectly indicated “32 a-b” instead of Block 33 of the CMS-1500 claim form and did not indicate when to submit a Texas Provider Identifier (TPI) on the CMS-1500 and ADA Dental Claim Form. Click on the title to view the complete, corrected article. |
| First Dental Home training |
| Information posted June 14, 2008: First Dental Home is a legislatively supported dental initiative aimed at improving the oral health of children from 6 through 35 months of age who are enrolled in Medicaid/Texas Health Steps (THSteps), the Children with Special Health Care Needs (CSHCN) Services Program, or the STAR Health foster care program. Click on the title to view the details. |
| Billing Psychological and Neuropsychological Testing |
| Information posted June 14, 2008: This is a correction to the 2008 Texas Medicaid Provider Procedures Manual, Section 38.3.1, on page 38-7, which states that providers must bill the preponderance of each quarter hour of testing for procedure codes 5-96101 or 1-96118. Click on the title to view the details. |
| Online Radiology Prior Authorization Submission |
| Information posted June 14, 2008: The Texas Medicaid & Healthcare Partnership (TMHP) has made several improvements to radiology prior authorization procedures. Providers may now request a prior authorization online for computed tomography (CT), computed tomography angiography (CTA), magnetic resonance imaging (MRI), and magnetic resonance angiography (MRA). Prior authorization for outpatient, nonemergent CT, CTA, MRI or MRA is required for Texas Medicaid fee-for-service and Primary Care Case Management (PCCM). Click on the title to view the complete, updated information. |
| Correction to 2008 Texas Medicaid Provider Procedures Manual Section 36.4.29.1 |
| Information posted June 20, 2008: This is a correction to the 2008 Texas Medicaid Provider Procedures Manual, Section 36.4.29.1, “Complete Eye Exams,” on page 36-91. The table under the heading “Valid Diagnosis Codes for Evaluation and Management Services, Consultation Codes, or Medical Eye Examinations” is missing payable diagnosis codes. Click on the title for a list of the missing diagnosis codes. |
| Updates for Bariatric Surgery Procedures Effective for Dates of Service On or After July 1, 2008 |
| Information posted June 20, 2008: This is an update to an article that was posted on this website on May 9, 2008, titled, “Update to ‘Bariatric Surgery Benefits Now Available’.” Effective for dates of service on or after July 1, 2008, additional information has been added to the benefit criteria and limitations. Reimbursement rates for bariatric surgery procedure codes will be published in a future web article. Providers will be notified in a banner message when the rates are available. Click on the title to view the complete, updated information. |
| NPI Claim Denials |
| Information posted June 20, 2008: The Texas Medicaid & Healthcare Partnership (TMHP) has seen an increase in National Provider Identifier (NPI)-related claim denials since the NPI full implementation began on May 24, 2008. The reasons for these claim denials include missing NPI information, NPI information entered in an incorrect format, and missing taxonomy codes. Click on the title to view the details. |
| Vaccine/toxoid Reimbursement Changes |
| Information posted June 20, 2008: Effective for dates of service on or after August 1, 2008, the benefit criteria for vaccine/toxoids will change for the Children with Special Health Care Needs (CSHCN) Services Program. Click on the title to view the details. |
| July/August 2008 Texas Medicaid Bulletin No. 216 |
| Information Posted June 3, 2008: The July-August 2006 Texas Medicaid Bulletin No. 216 is now available. Click the title to view the bulletin.
|
| Ambulance Services Update |
| Information posted June 6, 2008: This is a correction to an article published May 9, 2008, on this website entitled “Ambulance Services to Change.” The article incorrectly stated that emergency ambulance transport is a benefit when it is billed using emergency medical condition codes 3421, 6341, 6371, 7826, and 79791. Also, the article did not state that emergency ambulance transport is a benefit when it is billed using emergency medical condition codes 4589, 63421, 7813, and 78261. The complete, corrected article will be published in the September/October 2008 Texas Medicaid Bulletin, No. 218. For more information, call the TMHP Contact Center at 1-800-925-9126. |
| Seating Still Available for the 2008 Success With the CSHCN Services Program Workshop |
| Information posted June 24, 2008: TMHP is presenting the Success with CSHCN Services Program workshop throughout the state, and there are seats still available. This free workshop reinforces providers’ understanding of the claims filing process for the CSHCN Services Program by focusing on the problems Program providers most often encounter when filing claims. Click on the title to view the details. |
| Emergency Maintenance for Provider Enrollment on the Portal, June 5, 2008 |
| Information posted June 5, 2008: TMHP will perform emergency maintenance to the Provider Enrollment application on Thursday, June 5, 2008, from 7:00 p.m. until 10:00 p.m. During this time, users may experience intermittent connectivity for the following functionality: Provider Enrollment and Credentialing Through the TMHP Portal.
|
| NPI Claims Reminder |
| Information posted June 6, 2008: Reminder: All electronic and paper claims must contain the provider identifier(s), name, street, city, state, ZIP+4 Code, and telephone number of the billing provider in the appropriate billing provider fields. The address in this field must contain the billing provider’s address that was provided during attestation. The facility provider information fields must be completed if services were provided in a place other than the patient's home or the billing provider's facility. The facility provider information fields must contain the name, address, ZIP+4 Code, and the National Provider Identifier (NPI) of the facility where the service was provided. Click on the title to view the details. |
| Correction to “Nutritional Products, Supplies, and Equipment-Home Health Benefits to Change” |
| Information posted June 6, 2008: This is a correction to an article published on this website on March 10, 2008, entitled “Nutritional Products, Supplies, and Equipment-Home Health Benefits to Change.” The article incorrectly stated that nutritional products and supplies no longer require the use of modifiers to determine pricing. Effective for dates of service on or after June 1, 2008, nutritional products and supplies continue to require the use of modifiers to determine pricing. Future changes to modifier requirements will be communicated at a later date. Click on the title to view the complete, corrected article. |
| Rate Changes for Proton Therapy Procedure Codes |
| Information posted June 6, 2008: On May 19, 2008, reimbursement rates for proton therapy procedure codes were assigned following a public rate hearing for Texas Medicaid. Click on the title to view the details. |
| Rate Changes for Clinical Laboratory Procedure Codes |
| Information posted June 6, 2008: On May 21, 2008, the reimbursement rates for clinical laboratory procedure codes were assigned at a public rate hearing. The new rates are effective for dates of service on or after April 1, 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. |
| Revised Form for High Cost Durable Medical Equipment |
| June 6, 2008: The DME Certification and Receipt Form has been revised. An addendum page with lines for additional procedure codes and instructions for completing the form has been added. Providers must complete all fields on the form. Providers must indicate “N/A” for fields that are not applicable. Incomplete forms will be returned to the provider for correction and resubmission. Effective on or after June 27, 2008, durable medical equipment (DME) claims that meet or exceed a billed amount of $2,500 will suspend for verification of client receipt of the DME. The revised DME Certification and Receipt Form must be submitted to TMHP for these claims. The form may be submitted by fax to 512-506-6615 or submitted with the paper claim form. If a claim is submitted without the form or if receipt of the DME item(s) cannot be verified, the DME item(s) on the claim will be denied. For more information, call the TMHP Contact Center at 1-800-925-9126. Click on the title to view the details. |
| New Benefits for Bone Anchored Hearing Aid (BAHA) Devices for the CSHCN Services Program |
| Information posted June 6, 2008: Effective for dates of service on or after August 1, 2008, the bone anchored hearing aid (BAHA) device will be a benefit of the Children with Special Health Care Needs (CSHCN) Services Program for clients who are 5 years of age or older and who meet medical necessity criteria. Click on the title to view the details. |
| Correction to “Eye Surgery Reimbursement Rates” |
| Information posted June 27, 2008: This is a correction to an article that was published April 14, 2008, on the TMHP website at www.tmhp.com and in the July/August 2008 Texas Medicaid Bulletin, No. 216, entitled “Eye Surgery Reimbursement Rates.” The article incorrectly listed a rate change for procedure code 8-67820 and an incorrect reimbursement rate of $286.90 for procedure code 2-67335. Procedure code 8-67820 is not a benefit of Texas Medicaid. There was no rate change associated with this code. The correct reimbursement rate for procedure code 2-67335 is $286.98. For more information, call the TMHP Contact Center at 1-800-925-9126. |
| Rate Changes following Public Hearing on June 17, 2008. |
| Information posted June 27, 2008: Texas Medicaid reimbursement rates were assigned following a public rate hearing on June 17, 2008. Click on the title to view the details. |
| National Provider Identifier (NPI) Verification |
| Information posted June 27, 2008: Effective April 25, 2008, TMHP began verifying the National Provider Identifiers (NPIs) that were provided during attestation against the National Plan and Provider Enumeration System (NPPES) to ensure that all attested NPIs are active.
Providers may have received letters from Centers for Medicare & Medicaid Services (CMS) NPI Enumerator regarding issues that need to be corrected. Providers must correct all of the NPI issues that were identified by the CMS NPI Enumerator. Providers must contact the CMS NPI Enumerator at the phone number listed on the letter to discuss the issues that were identified. Click on the title to view the details. |
| Second Quarter 2008 Healthcare Common Procedure Coding System (HCPCS) Updates |
| Information posted June 27, 2008: The second quarter 2008 Healthcare Common Procedure Coding System (HCPCS) additions, changes, and deletions that are effective for dates of service on or after July 1, 2008, are now available. Deleted procedure codes are no longer benefits of Texas Medicaid or the Children with Special Health Care Needs (CSHCN) Services Program. Click on the title to view the details. |
| Grace Period for CSHCN Services Program Prior Authorization Request for Palivizumab (Synagis) |
| Information posted June 27, 2008: This is an update to a banner message that was published in the April 11, 2008, Remittance and Status (R&S) report about the revised CSHCN Services Program Prior Authorization Request for Palivizumab (Synagis). TMHP is allowing a 90-day grace period during which the previous form is accepted for processing by TMHP. Effective September 1, 2008, prior authorization requests submitted on the old form will be returned to the provider with instructions to submit the request on the revised form. For more information, call the TMHP-CSHCN Services Program Contact Center at 1-800-568-2413. |
| Correction to EMG and NCS Article |
| Information posted June 27, 2008: This is a correction to an article published on this website on March 24, 2008, entitled, “Update to ‘Benefit Changes for Electromyography (EMG) and Nerve Conduction Studies (NCS)’.” The article incorrectly indicated that the total laboratory component (type of service 5) for procedure codes 51784 and 51785 will be a benefit of Texas Medicaid. Additionally, diagnosis codes 9540, 9541, 9548, and 9549 were not included in the table of payable diagnosis codes. The article also did not include some limitations for procedure codes 51784 and 51785, and indicated an incorrect limitation for procedure code 5/I/T-95864. Click on the title to view the correct information. |
| Client Other Insurance Verification Through TMHP Vendor AIM Healthcare Services Inc. |
| Information posted June 27, 2008: Effective September 27, 2008, TMHP will forward electronic hospital institutional claims for clients suspected of having other insurance to TMHP vendor AIM Healthcare Services Inc. Click on the title to view the details. |
| Provider Check Amounts Available Online |
| Information posted June 27, 2008: Beginning June 27, 2008, acute care providers can search, view, and print on this website all payment amounts issued during the previous year. Click on the title to view the details. |
| May 2008 |
| Revised Policy Information for Augmentative Communication Devices (ACDs) |
| Information posted May 16, 2008: This is an update to an article posted on the TMHP website on February 8, 2008, entitled “Current Policy Information for ACDs.” HHSC has completed its review of the current policy for ACDs. Click on the title to view the details. |
| Primary Birth Control Method Code at the End of the Visit |
| Information posted May 16, 2008: Effective June 30, 2008, providers must indicate the appropriate primary birth control method code at the end of the visit in order to bill certain procedures when using the Family Planning 2017 claim form. Click on the title to view the details. |
| CSHCN Services Program Reimbursement Rates Assigned for Some 2008 HCPCS Procedure Codes |
| Information posted May 16, 2008: The Children with Special Health Care Needs (CSHCN) Services Program has adopted the Texas Medicaid reimbursement rates for some 2008 annual Healthcare Common Procedure Coding System (HCPCS) procedure codes. The Texas Medicaid rates were adopted after a rate hearing held on March 18, 2008, and are effective June 1, 2008, for the CSHCN Services Program for dates of service on or after January 1, 2008. Claims submitted with any of the affected procedure codes 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. |
| Future reprocessing of claims submitted for clients in an IMD |
| Information posted May 16, 2008: TMHP has identified an issue affecting professional claims for services rendered in the inpatient setting to clients who are 21 years of age and younger or who are 65 years of age and older and were in an institute for mental disorders (IMD) for dates of service on or after January 1, 2007. These claims may have denied in error, and will be reprocessed in the near future. TMHP will notify providers of the exact claims reprocessing dates in a future notification.
|
| Correction to Paper Claims Instructions Bulletin Article |
| Information posted May 16, 2008: This is a correction to a bulletin article that was published in the May/June 2008 Texas Medicaid Bulletin No. 215 entitled “National Provider Identifier Implemented May 23, 2008”. Under the “Paper Claims” subheading, the instructions for fields 76, 78 and 79 of the UB-04 CMS-1450 Claim Form contained incorrect information. Paper claims require a Texas Provider Identifier (TPI) in addition to the National Provider Identifier (NPI) only for the billing and performing providers. All other provider fields on the claim forms (referring, facility, admitting, other A or B, and operating) require only the NPI. Click on the title for the complete article. |
| Benefits Changes for Anesthesia Services for Texas Medicaid and the CSHCN Services Program |
| Information posted May 23, 2008: Effective for dates of service on or after September 1, 2008, the benefit criteria for anesthesia will change for Texas Medicaid and the Children with Special Health Care Needs (CSHCN) Services Program. Please disregard the previously published banner message and web article information for the new benefit changes. The new benefit changes for these services will be published in a future provider notification. For more information, call the TMHP Contact Center at 1-800-925-9126 or the TMHP-CSHCN Contact Center at 1-800-568-2413. |
| Allergen Immunotherapy Benefit Changes for Texas Medicaid |
| Information posted May 23, 2008: Effective for dates of service on or after July 1, 2008, allergen immunotherapy benefit criteria will change for Texas Medicaid. Click on the title to view the details. |
| NPI Data Submission Errors Cause Higher-Than-Usual Rejection Rate |
| Information posted May 27, 2008: Some providers are experiencing a higher-than-usual rejection rate because of National Provider Identifier (NPI) data submission errors. Many of these errors are because clearinghouses and third-party software programs are submitting incorrect claims information. Click on the title to view the details. |
| Change to Application Process for CHIP Perinatal Clients at or below 185% Federal Poverty Level |
| Information posted May 30, 2008: Effective August 1, 2008, the Health and Human Services Commission (HHSC) will change the process many expectant mothers use to obtain perinatal services provided through the Children’s Health Insurance Program (CHIP). The change involves the form that must be filled out to ensure the hospital is paid facility fees for labor and delivery for women with CHIP perinatal coverage whose income is at or below 185 percent of the federal poverty level. Click on the title to view details. |
| NPI Required for Telephone Appeals |
| Information posted May 30, 2008: The Texas Medicaid & Healthcare Partnership (TMHP) cannot process telephone appeals without a National Provider Identifier (NPI). Telephone appeals require an NPI for all provider identifier fields (i.e., billing, performing, referring, facility, admitting, other A or B, and operating). Telephone appeals follow the same process as electronic appeals. The NPI requirement includes claims previously processed using a TPI.
For more information, call the TMHP Contact Center at 1-800-925-9126.
|
| TMHP Scheduled System Maintenance |
| Information posted May 30, 2008: TMHP will perform scheduled system maintenance to the claims engine and long term care (LTC) systems on June 8, 2008, from 6:00 p.m. until 11:59 p.m. Some functions will be unavailable during this time period. Click on the title to view the details. |
| Computed Tomography and Magnetic Resonance Imaging Benefit Changes for Texas Medicaid |
| Information posted May 30, 2008: Effective for dates of service on or after July 1, 2008, the benefit criteria for computed tomography (CT) and magnetic resonance imaging (MRI) services will change for Texas Medicaid. Click on the title to view the details. |
| Eligibility for Women's Health Program (WHP) clients for January 2008 |
| Information posted May 2, 2008: This is an update to a website article entitled, “Eligibility for Women's Health Program (WHP) clients for January 2008” and a banner message that were published on February 15, 2008, about claims for Women's Health Program (WHP) clients whose year-long certification period expired on December 31, 2007. These clients received new identification cards in error, showing eligibility for January 2008. Click on the title to view the details. |
| Helicobacter Pylori (H. Pylori) 2008 TMPPM Correction |
| Information posted May 2, 2008: This is a correction to the 2008 Texas Medicaid Provider Procedures Manual, Section 26.4.6, “Helicobacter Pylori (H.Pylori),” on page 26-6. Click on the title to view the details. |
| Enhanced Services Through the PCCM+PLUS Program |
| Information posted May 2, 2008: Effective May 1, 2008, the Health and Human Services Commission (HHSC) and the Texas Medicaid & Healthcare Partnership (TMHP) launched Primary Care Case Management (PCCM)+PLUS. PCCM+PLUS provides enhanced services including additional care coordination services for clients who are elderly, blind, or disabled; reside in one of the 202 PCCM counties; and need additional support and care management to improve health outcomes. Clients eligible for PCCM+PLUS services are mostly adults, although children with disabilities and those who qualify for Supplemental Security Income (SSI) are also included. Click on the title to view the details. |
| Myocardial Perfusion Imaging Correction |
| Information posted May 2, 2008: This is a correction to an article posted on this website on March 10, 2008, entitled “Benefit Changes for Myocardial Perfusion Imaging.” Click on the title to view the details. |
| Revised THSteps Dental Mandatory Prior Authorization Request Form |
| Information posted May 2, 2008: This is an update to a banner message that first appeared on the March 7, 2008, Remittance and Status (R&S) report about the revised THSteps Dental Mandatory Prior Authorization Request Form. The banner message stated that the revised form would be required effective May 1, 2008. That date has changed; TMHP will accept only the revised form effective September 1, 2008. On or before August 31, 2008, either form may be used. The banner message also stated the form would be published in May/June 2008 Texas Medicaid Bulletin, No. 215. The form was not published in this bulletin but will be published in the July/August 2008 Texas Medicaid Bulletin, No. 216. Click on the title to view the complete, revised banner message. |
| Osteogenic Stimulation Benefits to Change |
| Information posted May 9, 2008: Effective for dates of service on or after July 1, 2008, benefit criteria for osteogenic stimulation will change for Texas Medicaid. Click on the title to view the details. |
| Electrodiagnostic Testing, EMG and NCS Benefit Changes Effective July 1, 2008 |
| Information posted May 9, 2008: This is an update to articles posted on this website about new electrodiagnostic (EDX) testing benefits (including electromyography [EMG] and nerve conduction studies [NCS]) for Texas Medicaid and for the Children with Special Health Care Needs (CSHCN) Services Program. Click on the title to view the details. |
| Neurostimulator Benefits Are Changing |
| Information posted May 9, 2008: Effective for dates of service on or after June 1, 2008, the benefit criteria for neurostimulators will change for the Children with Special Health Care Needs (CSHCN) Services Program. Click on the title to view the details. |
| Benefits for Anesthesia Services for the CSHCN Services Program to Change |
| Information posted May 9, 2008: Effective for dates of service on or after July 1, 2008, benefit criteria for anesthesia will change for the Children with Special Health Care Needs (CSHCN) Services Program. Click on the title to view the details. |
| Providers Must Also Attest for the CSHCN Services Program |
| Information posted May 9, 2008: Effective May 23, 2008, National Provider Identifier (NPI) full compliance will be implemented. Claims submitted without an NPI will not be processed and will be denied. Providers that have completed the NPI attestation for Texas Medicaid must also complete the NPI attestation for the Children with Special Health Care Needs (CSHCN) Services Program. Providers that have not completed their NPI attestation will experience claim denials and rejections. Provider attestation can be completed on this website under the “I would like to” section on the right-hand side. For more information, call the TMHP-CSHCN Services Program Contact Center at 1-800-568-2413. |
| New Benefit Code Helps Mental Retardation Providers with NPI Crosswalk |
| Information posted May 9, 2008: Benefit code MH2 has been created to assist with the National Provider Identifier (NPI) crosswalk solution. The new benefit code must be used by case management mental retardation (MR) providers that submit NPI-only claims to Texas Medicaid. A benefit code is an additional data element that the Texas Medicaid & Healthcare Partnership (TMHP) uses to identify state programs.
For more information, call the TMHP Contact Center at 1-800-925-9126.
|
| Update to “Bariatric Surgery Benefits Now Available” |
| Information posted May 9, 2008: This is an update to an article that was posted on this website on January 9, 2008, titled, “Bariatric Surgery Benefits Now Available.” Effective for dates of service on or after July 1, 2008, bariatric surgery services will be benefits of Texas Medicaid (for clients 21 years of age and older) and the Texas Health Steps-Comprehensive Care Program (THSteps-CCP) (for clients birth through 20 years of age). Also, the previous article incorrectly stated that procedure code 2/8/F-43845 will be a benefit. Procedure code 2/8/F-43845 is not a benefit of Medicare and will not be a benefit of Texas Medicaid. Click on the title to view the details. |
| Correction to the Paper Appeals Requirements that are Effective May 23, 2008 |
| Information posted May 9, 2008: This is a correction to an article published in the May 2008 National Provider Identifier (NPI) Special Bulletin, No. 217, entitled “Claims Submission Reminders.” Under the “Appeals” subheading, the article incorrectly indicated that providers have the option to submit appeal requests on paper for Texas Provider Identifier (TPI)-only claims that were submitted before the end of the contingency period. Click on the title to view the details. |
| PCCM Precertification Will Not Be Required for Some Procedure Codes |
| Information posted May 9, 2008: Effective July 1, 2008, some procedure codes will no longer require precertification for Primary Care Case Management (PCCM) providers. Click on the title to view the details. |
| Ambulance Services to Change |
| Information posted May 9, 2008: Effective for dates of service on or after July 1, 2008, benefit criteria for ambulance services will change for Texas Medicaid. Click on the title to view the details. |
| Correction to the New Benefits for Wearable Cardiac Defibrillators Article |
| Information posted May 9, 2008: This is a correction to a website article that was posted on the this website on February 11, 2008, entitled “New Benefits for Wearable Cardiac Defibrillators (WCD)” and an article that was published in the May/June 2008 Texas Medicaid Bulletin, No. 215. The articles did not include information about modifier RR when billing for a WCD lease, and incorrectly listed prior authorization requirements for the WCD. Click on the title to view the details. |
| Second Quarter 2008 HCPCS Updates Available July 1, 2008 |
| Information posted May 9, 2008: On July 1, 2008, the Texas Medicaid & Healthcare Partnership (TMHP) will implement second quarter 2008 Healthcare Common Procedure Coding System (HCPCS) additions, changes, and deletions that are effective for dates of service on or after July 1, 2008. Click on the title to view the details. |
| Correction to the New Benefits for Continuous Glucose Monitoring Article |
| Information posted May 9. 2008: This is a correction to an article that was posted on this website on March 10, 2008, entitled “New Benefits for Continuous Glucose Monitoring Systems.” The article stated that effective May 1, 2008, benefit changes for the continuous glucose monitoring system would be implemented for Texas Medicaid. The benefit changes for continuous glucose monitoring will be implemented on June 1, 2008. Click on the title to view the complete, corrected article. |
| April 2008 |
| Reimbursement Rates for Brachytherapy Procedure Codes |
| Information posted April 7, 2008: Reimbursement rates for brachytherapy procedures were adopted after a rate hearing, held on March 18, 2008, and are effective for dates of service on or after April 1, 2008. Click on the title to view the details. |
| System Downtime Schedule for May 24, 2008 |
| Information posted April 25, 2008: Due to the completion of the National Provider Identifier (NPI) implementation on May 23, 2008, system maintenance for the Texas Medicaid & Healthcare Partnership (TMHP) claims processing system is scheduled for Saturday, May 24, 2008, 12 a.m. to 8 p.m. During system maintenance some applications related to the claims engine will be unavailable. Click on the title to view the details. |
| May 2008 Long Term Bulletin No. 34 |
| Information posted April 25, 2008: The May 2008 Long Term Bulletin No. 34 is now available. Click the title to view the bulletin.
|
| Scheduled System Maintenance |
| Information posted April 25, 2008: System maintenance for the Texas Medicaid & Healthcare Partnership (TMHP) claims processing system is scheduled for Sunday, May 11, 2008, 6:00 p.m. to 11:59 p.m. During system maintenance some applications related to the claims engine will be unavailable. This downtime is a replacement to the Extended Yearly Memorial Day system maintenance window previously scheduled for May 25, 2008, through May 26, 2008, (3 p.m. on Sunday to 6 p.m. on Monday), which will be canceled. Click on the title to view the details. |
| Nonemergency Ambulance Transport Prior Authorization Available 24 Hours a day |
| Information posted April 25, 2008: Effective June 29, 2008, the Texas Medicaid & Healthcare Partnership (TMHP) will begin receiving and processing certain telephone prior authorization requests for nonemergency ambulance transports 24 hours a day, including weekends and holidays. Click on the title to view the details. |
| Reconstructive Finger Surgery |
| Information posted April 25, 2008: Effective for dates of service on or after May 1, 2008, procedure code F-26587 is a benefit when performed at ambulatory surgical centers (ASC) and hospital ambulatory surgical centers (HASC). Procedure code F-26587 is reimbursed under ASC Group 5.
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.
|
| Online Provider Enrollment Systems Maintenance Scheduled For April 24, 2008 |
| Information posted April 23, 2008: TMHP will perform maintenance to the online provider enrollment system on April 24, 2008, from 7:00 p.m. until 8:00 p.m. Central Time. Online provider enrollment will not be available during this time period. |
| Refunds to TMHP Reminder |
| Information posted April 25, 2008: Reminder: As indicated in the 2008 Texas Medicaid Provider Procedure Manual, Section 6.2, “Refunds,” on page 6-4 and Section 4.10.6, “Refunds to TMHP Resulting from Other Insurance Payments and Conditions Surrounding Provider Billing of Third Party Insurers,” on page 4-15, providers are prohibited from receiving payment from Medicaid, billing a third-party resource (TPR), and then refunding the lesser of the two payments to Medicaid. The Texas Medicaid & Healthcare Partnership (TMHP) Cash Reimbursement Unit is responsible for processing financial adjustments when any of the following occur: overpayment, duplicate payment, payment to incorrect providers, and overlapping payments by Medicaid and a TPR. Click on the title to view the details. |
| Provider Enrollment Online for Primary Care Case Management (PCCM) Providers |
| Information posted April 25, 2008: Beginning April 29, 2008, PCCM providers and potential PCCM providers can enroll on this website. Click on the title to view the details. |
| Family Planning Benefits and Reimbursement Updates for Titles V, X, and XX |
| Information posted April 25, 2008: Effective for dates of service on or after May 1, 2008, the following benefit changes have been implemented for the Titles V, X, and XX family planning program. Click on the title to view details. |
| Health Insurance Premium Payment (HIPP) Program |
| Information posted April 25, 2008: The Health Insurance Premium Payment (HIPP) Program reimburses for the cost of medical insurance premiums. An individual is eligible for the HIPP Program when Medicaid finds it more cost effective to reimburse for an individual’s private health insurance premiums than to reimburse his or her medical bills directly through Medicaid. Click on the title to view the details. |
| Discontinued Procedure Codes |
| Information posted April 25, 2008: The Texas Medicaid & Healthcare Partnership (TMHP) has identified an issue regarding procedure codes that remained payable in the claims system after the procedure code had been discontinued. These codes were also published in the fee schedules on this website. Click on the title to view the details. |
| Children with Special Health Care Needs (CSHCN) Services Program Waiting List Information |
| Information posted April 11, 2008: The Children with Special Health Care Needs (CSHCN) Services Program has removed 226 clients from the program's waiting list. The effective date of this removal is April 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. The program will waive prior authorization requirements for program-covered services provided to these clients between April 1, 2008, and April 18, 2008. Note that this waiver only applies to the 226 clients who are included in this release.
For more information, call the TMHP-CSHCN Services Program Contact Center at 1-800-568-2413.
|
| Extended Claims Engine and Long Term Care Systems Maintenance Scheduled For May 25 - 26 2008 |
| Information posted April 11, 2008: TMHP will perform a full backup of Claims Engine and Long Term Care systems on Sunday, May 25, 2008, 3:00 p.m. to Monday, May 26, 2008, 6:00 p.m. Some functions will be unavailable during this time period. Click on the title to view the details.
|
| Restriction Changes for 2008 HCPCS Procedure Codes |
| Information posted April 14, 2008: Effective for dates of service on or after June 1, 2008, the restrictions for procedure codes 1-90765, 1-90766, 1-90767, 1-90768, 1-90772, 1-90773, 1-90774, 1-90775, 1 J2790, and 1-J2792 have changed for Texas Medicaid. Click on the title to view the details. |
| Nutritional Products Valine or Isoleucine |
| Information posted April 14, 2008: Effective for dates of service on or after May 1, 2008, the medical nutritional products valine (any strength) and isoleucine (any strength) will be benefits of the Children with Special Health Care Needs (CSHCN) Services Program and will be added to the CSHCN Services Program Medical Nutritional Products Formulary. Providers must use procedure code 1-A9150 to submit claims for valine or isoleucine and must enter the product name valine or isoleucine in the Remarks area of the claim. For more information, call the TMHP-CSHCN Contact Center at 1-800-568-2413.
|
| Personal Care Services (PCS) Communication Plan and Billing FAQs |
| Information posted April 14, 2008: TMHP will post the following documents for personal care services (PCS) providers under the “Alberto N. Related Information” topics on the TMHP website at www.tmhp.com: “Communication Plan for Personal Care Services (PCS) Providers to Department of State Health Services (DSHS)” and “TMHP Personal Care Services (PCS) Billing Frequently Asked Questions.” Click on the title to view the details. |
| Eye Surgery Reimbursement Rates |
| Information posted April 14, 2008: Medicaid rates were adopted for specific eye surgery procedure codes after a rate hearing held on March 31, 2008, and are effective April 30, 2008 for dates of service on or after September 1, 2007. Click on the title to view the details. |
| The 2008 Clinical Decision Support Tool for Advanced Imaging Guide Available Now |
| Information posted April 14, 2008: The 2008 Clinical Decision Support Tool for Advanced Imaging guides can now be accessed from the Provider Manuals and Guides section of the homepage of the TMHP website at www.tmhp.com. Click on the title to view the details. |
| Fee Schedules Updated |
| Information posted April 14, 2008: Click on the title for a list of the updated fee schedules. |
| Therapeutic Radiopharmaceuticals Benefits Update |
| Information posted April 18, 2008: This is an update to a website article posted on this website at www.tmhp.com on February 11, 2008, entitled “Therapeutic Radiopharmaceuticals To Change” and an article that was published in the May/June 2008 Texas Medicaid Bulletin, No. 215, entitled “Therapeutic Radiopharmaceuticals Have Changed.” Click on the title to view the details. |
| Update to the New Benefits for Interferon Injections Article |
| Information posted April 18, 2008: This is an update to a banner message that first appeared on the March 14, 2008, Remittance & Status (R&S) report and an article that was posted on this website on March 10, 2008, entitled “Interferon Injections Benefits to Change.” The article stated that effective May 1, 2008, benefit changes for interferon injections will be implemented for Texas Medicaid. The benefit changes for interferon injections will be implemented on June 1, 2008.The complete, updated article will be available in the July/August 2008 Texas Medicaid Bulletin, No. 216. For more information, call the TMHP Contact Center at 1-800-925-9126. |
| STAR Health Program (Foster Care) Updated Information |
| Information posted April 18, 2008: Effective April 1, 2008, Superior HealthPlan Network will manage the health care for children who are in state conservatorship and enrolled in the new Foster Care Managed Care program, STAR Health. All services provided to STAR Health clients from April 1, 2008, through June 30, 2008, will be paid by Superior HealthPlan Network regardless of whether or not the services have been authorized by TMHP. All claims with dates of service on or after April 1, 2008, must be submitted to Superior HealthPlan Network for reimbursement. Click on the title to view details. |
| THSteps Forms Correction |
| Information posted April 18, 2008: In the 2008 Texas Medicaid Provider Procedures Manual (TMPPM), TMHP has identified corrections to the THSteps Medical Checkups Periodicity Schedule for Infants, Children, and Adolescents (Birth Through 20 Years of Age), in Section 43.2.2.1 on page 43-17, and the Mental Health Interview Tool/Referral Form (Ages 10-12 Years) in Section C.16, on page C-24. Click on the title to view the details. |
| Screening and Diagnostic Studies of the Breast Benefit Update |
| Information posted April 18, 2008: This is an update to an article posted on the TMHP website on March 10, 2008, entitled “Benefit Changes for the Screening and Diagnostic Studies of the Breast.” Click on the title to view the details. |
| Update to “Nutritional Products, Supplies, and Equipment-Home Health Benefits to Change” |
| Information posted April 18, 2008: This is an update to a banner message that first appeared on the March 14, 2008, Remittance and Status (R&S) report and an article that was posted on this website on March 10, 2008, entitled, “Nutritional Products, Supplies, and Equipment-Home Health Benefits to Change.” The article stated that effective for dates of service on or after May 1, 2008, benefit criteria will change for nutritional products, supplies, and equipment for Texas Medicaid. The benefit changes will be implemented on June 1, 2008. For more information, call the TMHP Contact Center at 1-800-925-9126. |
| Texas Medicaid National Provider Identifier (NPI) Special Bulletin No. 217 |
| Information posted April 23, 2008: The May 2008 Special Bulletin No. 217 is now available. Click the title to view the bulletin.
|
| Claims Engine and Long Term Care Systems Maintenance Scheduled For April 13, 2008 |
| Information posted April 4, 2008: TMHP will perform scheduled maintenance to the claims engine and long term care (LTC) systems on April 13, 2008, from 6:00 p.m. until 11:59 p.m. Some functions will be unavailable during this time period. Click on the title to view the details. |
| May 2008 CSHCN Provider Bulletin No. 66 |
| Information posted April 4, 2008: The May 2008 CSHCN Provider Bulletin No. 66 is now available. Click the title to view the bulletin.
|
| Revised Texas Medicaid Palivizumab (Synagis) Prior Authorization Request Form |
| Information posted April 7, 2008: Effective June 1, 2008, the Texas Medicaid Palivizumab (Synagis) Prior Authorization Request Form found on page B-98 of the 2008 Texas Medicaid Provider Procedures Manual has been revised. The revised form will be available on June 1, 2008 in the provider forms section of this website and will also be published in the July/August 2008 Texas Medicaid Provider Bulletin, No. 216.
For more information, call the TMHP Contact Center at 1-800-925-9126.
|
| Benefit Criteria Changes for Docetaxel |
| Information posted April 7, 2008: Effective for dates of service on or after June 1, 2008, the benefit criteria for docetaxel will change for Texas Medicaid. Procedure code 1-J9170 and a valid and appropriate diagnosis code that describes the client’s physical condition may be used to submit claims for docetaxel. Procedure code 1-J9170 will no longer be restricted to specific diagnosis codes. Effective for dates of service on or after September 1, 2007, the reimbursement rate for procedure code 1-J9170 was increased from $294.62 to $306.13.
This information updates the 2008 Texas Medicaid Provider Procedures Manual, Section 36.4.20.15, “Docetaxel,” on page 36-59.
For more information, call the TMHP Contact Center at 1-800-925-9126.
|
| Reimbursement Rates Assigned for Some 2008 HCPCS Procedure Codes |
| Information posted April 7, 2008: The reimbursement rates for some 2008 annual Healthcare Common Procedure Coding System (HCPCS) procedure codes were adopted after a rate hearing held on March 18, 2008, and are effective April 1, 2008, for dates of service on or after January 1, 2008. Claims submitted with any of the affected procedure codes 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.
|
| Current Policy Information for ACDs |
| Information posted April 7, 2008: Reminder: The augmentative communication device (ACD) systems policy information is not current in the 2008 Texas Medicaid Provider Procedures Manual, section 24.5.16, "Augmentative Communication Device (ACD) System" on page 24-32. The current policy and benefit information for ACDs covered under home health services is located in the 2007 Texas Medicaid Provider Procedures Manual, section 24.5.12, “Augmentative Communication Device (ACD) System” on page 24-27. The Health and Human Services Commission (HHSC) is reviewing the current policy for ACDs. Any revisions to the ACD policy and benefit information will be published at a later date. For more information, call the TMHP Contact Center at 1-800-925-9126. |
| TMHP Third-Party Liability |
| Information posted April 7, 2008: Reminder: The Health and Human Services Commission (HHSC) and the Department of State Health Services (DSHS) contracts with the Texas Medicaid & Healthcare Partnership (TMHP) to administer third-party liability cases.
To ensure that the Texas Medicaid Program and the Children with Special Healthcare Needs (CSHCN) Services Program is the payer of last resort, TMHP performs postpayment investigations of potential casualty and liability cases. TMHP also identifies and recovers Medicaid and CSHCN Services Program expenditures in casualty cases involving Medicaid and CSHCN Services Program clients.
Click on the title for more details. |
| Revised CSHCN Services Program Prior Authorization Request for Palivizumab (Synagis) Form |
| Information posted April 7, 2008: Effective June 1, 2008, the CSHCN Services Program Prior Authorization Request for Palivizumab (Synagis) form found on page B-18 of the 2008 CSHCN Services Program Provider Manual has been revised. The revised form will be available on June 1, 2008 in the provider forms section of this website and will also be published in the August 2008 CSHCN Services Program Provider Bulletin, No. 67.
For more information, call the TMHP-CSHCN Services Program Contact Center at 1-800-568-2413.
|
| Update to 2008 Texas Medicaid Provider Procedures Manual Sections 36 and 45 |
| Information posted April 7, 2008: This is an update to the 2008 Texas Medicaid Provider Procedures Manual, Section 36.4.29.1, “Complete Eye Exams,” on page 36-91; and to Section 45.4.2, “Eye Examinations for the Purpose of Prescribing Eyewear,” on page 45-3. Click on the title to view the details. |
| New Benefit Codes |
| Information posted April 7, 2008: Effective May 23, 2008, TMHP will only accept NPI-only claims and authorizations. Two new benefit codes have been created to assist with the NPI crosswalk solution. The new benefit codes must be used by home health durable medical equipment (DME) providers that submit claims to Texas Medicaid and the Children with Special Health Care Needs (CSHCN) Services Program. A benefit code is an additional data element that TMHP uses to identify state programs. Benefit codes may be used as part of the crosswalk process. Providers must use the associated benefit code when submitting NPI-only claims and authorizations. Click on the title to view the details. |
 | May/June 2008 Texas Medicaid Bulletin No. 215 |
| Information posted April 4, 2008: The May/June 2008 Texas Medicaid Bulletin No. 215 is now available. Click the title to view the bulletin.
|
| Radiology Claims for ICM Clients |
| Information posted April 7, 2008: TMHP has identified an issue impacting radiology claims that were submitted with dates of service between February 1, 2008, and April 25, 2008, for Integrated Care Management (ICM) clients. These claims may have been denied in error. Affected claims were reprocessed on April 4, 2008. If a refund is due to providers, it will be reflected on a future Remittance and Status (R&S) report. All additional ICM claims for radiological services will be reprocessed at a later date.
For more information, call the TMHP Contact Center at 1-800-925-9126.
|
| Eyewear Claims Reprocessing for the CSHCN Services Program |
| Information posted April 7, 2008: The Texas Medicaid & Healthcare Partnership (TMHP) has identified an issue affecting claims submitted with eyewear procedure codes and modifier RP. The CSHCN Services Program allows frames to be reimbursed once per year and allows lenses to be reimbursed twice per year. Repairs or replacements of frames and lenses are allowed as needed when billed with the RP modifier. Claims submitted on or after July 6, 2007, with frames or lenses procedure codes and modifier RP may have been denied in error. 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 list of affected procedure codes. |
| Benefit Criteria Changes for Leuprolide Acetate Injections |
| Information posted April 7, 2008: Effective for dates of service on or after June 1, 2008, leuprolide acetate injection procedure codes 1-J1950, 1-J9217, 1-J9218, and 1-J9219 must be submitted with a valid and appropriate diagnosis code. These procedure codes are no longer restricted to specific diagnosis codes.
Click on the title for more details. |
| Facility Charge for Procedure Codes F-58600, F-58670, and F-58671 Under the Women’s Health Program |
| Information posted April 7, 2008: Reminder: Procedure codes F-58600, F-58615, F-58670, and F-58671, facility charges related to female sterilization, are benefits under the Women's Health Program (WHP) for freestanding ambulatory surgical centers (ASCs) and hospital-based ambulatory surgical centers (HASCs). Please refer to the 2008 Texas Medicaid Provider Procedures Manual, Section O.3, “Reimbursement,” on page O-2. |
| March 2008 |
| Changes to Heart Transplant Authorization |
| Effective for dates of service on or after May 13, 2005, age will no longer be a consideration for heart transplant authorization. |
|