| Community Services Waiver Providers – Corrections to the MN and LOC
Information posted November 18, 2009: Community Services Waiver Providers are reminded that there is a 14-day time limit to submit corrections to a Medical Necessity and Level of Care (MN and LOC) assessment. Click on the title to view the details. |
| Nursing Facility/Hospice Providers - Update to Form Status Inquiry on PASARR Screenings
Effective November 20, 2009, TMHP has added an additional filter option to the Form Status Inquiry for Pre-admission Screening and Resident Review (PASARR) Screenings. When performing a Form Status Inquiry on PASARR Screenings, providers will have the option to search for screenings that are in a status of “Form Complete”. PASARR Screenings are set to “Form Complete” status when a system check has determined that there is a previous, valid PASARR on file.
For questions, please contact TMHP at 1-800-626-4117, Option 1. |
| Long Term Care Information Letter 09-167
Information posted November 18, 2009: DADS has issued DADS Information Letter No. 09-159: No Automatic Increase for Cost of Living Adjustments (COLA) for Medicaid Consumers with Supplemental Security Income (SSI) for 2010. Click on the title to link to the information letter. |
| 2009 DADS Holiday Claims Processing Schedules
Information posted November 10, 2009: Click on the title of this message to view planned changes in DADS claims processing schedules for the upcoming Thanksgiving, Christmas, and New Year’s holidays. Schedules are provided for the following provider claim types: NF/Community Care; ICF/MR Service Group 5 (community/state); ICF/MR Service Group 6 (non-state); and HCS/TxHmL (Home and Community-based Services / Texas Home Living Waivers).
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| Form 3619 - Medicare Dates of Qualifying Stay
Information posted November 9, 2009: The Nursing Facility must document the 20 days of Full Medicare Coverage in the Qualifying Stay date fields on the Form 3619 admission. Medicare Co-Insurance (Code 3) cannot be authorized until DADS processing has validated 20 days of Full Medicare Coverage. Click on the title for more information.
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| Long Term Care Information Letter 09-159
Information posted November 4, 2009: DADS has revised DADS Information Letter No. 09-159: Texas Medicaid Case Mix Index Update, addressed to Nursing Facility Providers. Click on the title to link to the revised information letter. |
| 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. |
| 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. |
| Nursing Facilities-Inappropriate Ventilator Service Authorizations
Information posted October 27, 2009: The DADS Service Authorization System is creating Nursing Facility ventilator service authorizations (service code 4) independently of whether the resident qualifies for the service or not. When accessing a Medicaid Eligibility and SAVERR Authorization Verification (MESAV), providers may see a service code 4 ventilator services authorization. Providers should ignore these service authorizations unless the resident’s MDS meets the requirements for the ventilator. DADS will make a correction to stop generating these erroneous ventilator service authorizations in the near future. Incorrect ventilator service authorizations will be removed once a correction has been deployed.
Please contact the Provider Claims Services Help Desk at 512/438-2200, Option 1, with questions about this notice.
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| Community Services Waiver Providers Update to Incorrect RUG Issue
Information posted October 23, 2009: Beginning October 22, 2009 Texas Medicaid & Healthcare Partnership (TMHP) has started the process to correct the Resource Utilization Group (RUG) value on Medical Necessity and Level of Care (MN and LOC) assessments that received an incorrect RUG value (see postings on October 16, 2009 and October 22, 2009). Click the title of this article for more information.
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| Nursing Facilities – PC E and PC M Assessments for a One-Day Gap
Information posted October 22, 2009: TMHP has identified an issue with submitting Purpose Code E (PC E) and Purpose Code M (PC M) assessments. Since October 2, 2009, providers have not been able to submit a PC E or PC M for a one day gap. When attempting to submit a PC E or PC M where the Missed Assessment Start Date and the Missed Assessment End Date are the same date, providers will receive an error message and will not be able to submit the assessment. This issue should be corrected effective October 30, 2009, and providers will again be able to submit PC E and PC M assessments for a one-day gap at that time. Until the correction is made, the Purpose Code can be submitted for two days, and the system will adjust to one day. For questions, please contact TMHP at 1-800-626-4117, Option 1. |
| Explanation of Benefits (EOB) F0117
Information posted October 22, 2009: A number of Long Term Care (LTC) providers are receiving EOB F0117 (Unit rate must be greater than zero), when attempting to submit claims. This EOB may be received when submitting new day claims or adjustments, when using a template, a draft or a saved batch. Please click on the title of this article for detailed information on how to resolve this error. |
| Important Information for Community Services Waiver Providers
Information posted October 21, 2009: Effective October 22, 2009 Texas Medicaid & Healthcare Partnership (TMHP) will implement a correction to the issue with the Resource Utilization Group (RUG) value on some Medical Necessity and Level of Care (MN and LOC) assessments (see posting on October 16, 2009). Click the title for more information.
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