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 Computer-Based Training (CBT)

TMHP offers a variety of computer-based training (CBT) modules through its Learning Management System (LMS) server. To view a CBT, you must be registered on the LMS. Registered users must log in. New users should click the Registration button in the upper left part of the LMS screen to register. To begin a CBT, click the View now button for the CBT. Users who do not have audio capability on their computer may follow the presentation through the notes tab within the CBT.

The following table shows the CBTs that are currently available on the LMS:

Title of CBT
Texas Medicaid
Crossover Claims Details

View CBT Now

Durable Medical Equipment (DME) Details

View CBT Now

Medicaid Basics Details

View CBT Now

Nursing, Therapies, and Personal Care Services Details

View CBT Now

Physician Services Details

View CBT Now

THSteps Medical and Dental Services Details

View CBT Now

Children with Special Health Care Needs (CSHCN) Services Program
CSHCN Services Program Basics Details

View CBT Now

Training Snapshot: Submitting Electronic Claims for CSHCN Services Program Clients Details View CBT Now
Department of State Health Services (DSHS) Family Planning
DSHS Family Planning and Medicaid Title XIX Details

View CBT Now

All Acute Care Programs
Ambulance Basics Details View CBT Now
Claim Appeals Details

View CBT Now

Claim Forms Details

View CBT Now

Client Eligibility Details

View CBT Now

Prior Authorization Details

View CBT Now

Provider Enrollment on the Portal Details

View CBT Now

Provider Enrollment on the Portal for Durable Medical Equipment (DME) Providers  Details

View CBT Now

Remittance and Status Reports Details

View CBT Now

TexMedConnect for Acute Care Providers Details

View CBT Now

Third Party Liability Details

View CBT Now

Training Snapshot: EOB Billed Amount Required Details View CBT Now
Training Snapshot: EOB Unable to Assign Program/Benefit Plan Details

View CBT Now

Long Term Care
Long Term Care (LTC) Community Services Waiver Programs Details

View CBT Now

Long Term Care (LTC) Nursing Facility/Hospice Programs Details

View CBT Now

Long Term Care (LTC) Online Portal Basics Details View CBT Now
TexMedConnect for Long Term Care Providers Details

View CBT Now

Medical Transportation Program (MTP)
Medical Transportation Program (MTP) Details

View CBT Now

Texas Medicaid

Crossover Claims

Topic: The Crossover Claims CBT provides an overview of the process for submitting claims and receiving reimbursement when a client has both Medicare and Medicaid.

Length: 38 minutes

Published: 07/9/2013. Updates to programs, policies, and procedures discussed in this CBT can be found on the TMHP website in the current published provider manuals, web articles, and banner messages.

At the conclusion of this CBT, you should be able to:

  • Define “crossover claim.”
  • Compare the relationship between Medicaid and Medicare.
  • Understand provider requirements for provider participation in Medicaid and Medicare.
  • Understand Medicare participation waivers and the Medicaid provider types that are not required to participate in Medicare.
  • Understand the categories of Medicare benefits.
  • Submit Medicare crossover claims.
  • Understand filing deadlines for crossover claims.
  • Submit required documentation.
  • Appeal a denied or adjusted crossover claim.

Education materials in this CBT are accurate as of publishing date 07/09/2013. Because this CBT is updated as part of an annual production schedule, for the most current information, check any attached addenda or updates associated with the CBT (attachments). Also, updates to policy and program information can be found on the TMHP website in the current TMPPM and CSHCN Services Program Provider Manual, web articles, and banner messages.

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Durable Medical Equipment (DME)

The purpose of this CBT is to give DME and pharmacy DME providers information and resources necessary to enroll in Texas Medicaid as a DME provider and provide DME and supplies to Texas Medicaid clients.

Length: 63 minutes

Publish date: 07/08/2013. Updates to programs, policies, and procedures discussed in this CBT can be found on the TMHP website in the current published provider manuals, web articles, and banner messages.

This CBT introduces you to the basics of enrolling as a Medicaid DME provider, state health-care programs that provide DME benefits, types of DME services and supplies, and the steps for providing DME.

Topics covered in this CBT include:

  • Advantages of Becoming a DME Provider.
  • DME Process and Guidelines.
  • DME Services, Supplies, and Enrollment.
  • Providing DME: Client Eligibility, Prior Authorization Forms, Delivery DME Claims. (Updated 5/1/14)
  • Identifying Waste, Abuse, and Fraud.
  • Additional Resources

This CBT takes approximately 1 hour to complete.

Education materials in this CBT are accurate as of publishing date 06/27/2013. Because this CBT is updated as part of an annual production schedule, for the most current information, check any attached addenda or updates associated with the CBT (attachments). Also, updates to policy and program information can be found on the TMHP website in the current TMPPM and CSHCN Services Program Provider Manual, web articles, and banner messages.

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Medicaid Basics

Topic: Introduction to the programs and services offered by Texas Medicaid and resources available through TMHP.

Modules in this CBT range in length from 2 minutes to 20 minutes.

Published: 8/1/2013. Updates to programs, policies, and procedures discussed in this CBT can be found on the TMHP website in the current published provider manuals, web articles, and banner messages.

This Medicaid Basics CBT is designed to provide a basic introduction to the programs and services offered by Texas Medicaid and the resources available to you through Texas Medicaid & Healthcare Partnership. The administrative processes and procedures pertain to Fee-for-service and services that are carved out of Managed Care.

Providers contracted with Managed Care Organizations or dental plans should refer to their provider manuals for administrative processes and procedures.

Topics covered in the Medicaid Basics CBT include:

  • State Health-Care Programs. (Updated 8/22/2014)
  • Medicare Basics.
  • Enrollment Basics.
  • Provider Responsibilities.
  • Verifying Client Eligibility.
  • Third Party Liability Basics.
  • Prior Authorization Basics.
  • Claim Basics.
  • R&S Report Basics.
  • Appeal Basics.
  • TMHP Resources. (Updated 5/1/2014)

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Nursing, Therapies, and Personal Care Services

Topic: Rules and regulations of nursing services, Therapy services, and personal care services and provider responsibilities for providers in a Texas Medicaid home health services and Comprehensive Care Program (CCP) environment.

Length: 45 minutes

Published: 12/19/2012. Updates to programs, policies, and procedures discussed in this CBT can be found on the TMHP website in the current published provider manuals, web articles, and banner messages.

At the conclusion of this CBT, you should be able to:

  • Identify the different types of
    • Nursing services that are benefits of Texas Medicaid home health and Comprehensive Care Program (CCP).
    • Therapy services that are benefits of Texas Medicaid home health and CCP.
    • Personal care services (PCS) that are benefits of CCP.
  • Submit timely, accurate, and complete prior authorization initial request, revisions, or certifications for nursing, therapy, and personal care services.
  • Properly complete and retain a plan of care (POC) consistent with TMHP and other provider requirements for home health agencies.
  • Access, research, and effectively use the TMHP website, TMPPM, banner messages, and web articles.

The four sections in this CBT are:

  • Nursing Services.
  • Therapy Services.
  • Personal Care Services.
  • Resources and Closing.

Education materials in this CBT are accurate as of publishing date 12/19/2012. Because this CBT is updated as part of an annual production schedule, for the most current information, check any attached addenda or updates associated with the CBT (attachments). Also, updates to policy and program information can be found on the TMHP website in the TMPPM, CSHCN Services Program Provider Manual, web articles, and banner messages.

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Physician Services

Topic: Modules include ACA; managed care plans; the 72-Hour Emergency Policy; telemedicine and telehealth; NP, CNS, CNM, and PA services; claim denials & common EOB codes; Medicaid Benefit Implementation; and Resources.

Modules: 2 to 12 minutes.

Published: 4/17/2013. Updates to programs, policies, and procedures discussed in this CBT can be found on the TMHP website in the current published provider manuals, web articles, and banner messages.

The Physician Services CBT is intended for physicians, their staff, and those responsible for providing physician services and submitting Medicaid claims. The information in this CBT is useful for individual or group practices.

After viewing the modules of this CBT, you should be able to:

  • Describe the Affordable Care Act (ACA) and know where to go to get more information.
  • Describe managed care and how it affects provider services.
  • Describe the physician’s role in the 72-Hour Emergency Prescription Drug Policy and use the Medicaid formulary resources.
  • Define “telemedicine” and “telehealth” services and be able to follow the guidelines for both.
  • Understand and describe the differences for patient and distant sites.
  • Understand the claim submission guidelines for:
    • Nurse Practitioners (NP).
    • Clinical Nurse Specialists (CNS).
    • Certified Nurse Midwives (CNM).
    • Physician Assistants (PA).
  • Identify the most common reasons that claims are denied and ways to correct the errors on those claims.
  • Explain the Medicaid Benefit Implementation Process (BIP) and submit a policy recommendation using the Interactive Medicaid Provider Voice system, commonly referred to as IMPROVE.
  • Describe the Benefit Management Workgroup (BMW) and its relationship to BIP.
  • Locate and use the resources that are available on the TMHP website.

Education materials in this CBT are accurate as of publishing date 4/17/2013. Because this CBT is updated as part of an annual production schedule, for the most current information, check any attached addenda or updates associated with the CBT (attachments). Also, updates to policy and program information can be found on the TMHP website in the current TMPPM and CSHCN Services Program Provider Manual, web articles, and banner messages.

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THSteps Medical and Dental Services

Topic: Provides an overview of Texas Health Steps (THSteps) program and specific information on medical and dental services, including the THSteps medical and dental checkups..

Length: Modules range from 4 to 20 minutes long

Published: 11/15/2013.

We recommend that you take the Medicaid Basics CBT prior to taking the THSteps Medical and Dental Services CBT.

This CBT covers the following topics:

  • THSteps Basics (Updated 8/18/2014)
  • Provider Responsibilities
  • THSteps Medical Services Enrollment
  • THSteps Medical Claims
  • THSteps Medical Checkups
  • THSteps Dental Services Enrollment
  • THSteps Dental Services Basics
  • THSteps Dental Services, Eligibility, Benefits, and Claims (Updated 5/9/2014)

Information presented in this CBT is accurate as of publishing date 11/15/2013. Because this CBT is updated as part of an annual production schedule, check any attached addenda or updates associated with the CBT (attachments). Also, updates to policy and program information can be found on the TMHP website in the TMPPM, web articles, and banner messages

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CSHCN Services Program

CSHCN Services Programs Basics

Topic: Provider responsibilities and client eligibility for the Children with Special Health Care Needs (CSHCN) Program, including benefits, authorizations, claims, and appeals.

Length: 9 Modules varying from 6 to 16 minutes

Published: 10/19/2012. Updates to programs, policies, and procedures discussed in this CBT can be found on the TMHP website in the current published provider manuals, web articles, and banner messages.

The CSHCN Services Program Basics CBT presents information that will provide new and current CSHCN Services Program providers with an overview of Provider responsibilities and client eligibility for the Children with Special Health Care Needs (CSHCN) Program, including benefits, authorizations, claims, and appeals.

This CBT is broken into 9 modules. Module topics and lengths are listed below.

  • Module 1 – Program Overview – 12 minutes
  • Module 2 – Program Clients – 6 minutes
  • Module 3 – Benefits, Limitations, and Exclusions – 15 minutes
  • Module 4 – Provider Enrollment – 10 minutes
  • Module 5 – Provider Responsibilities – 10 minutes
  • Module 6 – Authorizations and Prior Authorizations – 9 minutes
  • Module 7 – Filing Claims and Appeals – 16 minutes
  • Module 8 – Administrative Review and Fair Hearings – 8 minutes
  • Module 9 – Information and Contact Resources – 11 minutes

Education materials in this CBT are accurate as of publishing date 10/19/2012. Because this CBT is updated as part of an annual production schedule, for the most current information, check any attached addenda or updates associated with the CBT (attachments). Also, updates to policy and program information can be found on the TMHP website in the the TMPPM, CSHCN Services Program Provider Manual, web articles, and banner messages.

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Training Snapshot: Submitting Electronic Claims for CSHCN Services Program Clients

Topic: Submitting claims through TexMedConnect and third-party software for services rendered to a client of the CSHCN Services Program.

Length: Approximately 5 minutes

Published: 09/27/2013. Updates to procedures discussed in this snapshot can be found on the TMHP website in the current published provider manuals, web articles, and banner messages.

Refer to the TexMedConnect for Acute Care Providers CBT for more information regarding electronic claim submission.

Education and materials in this CBT are accurate as of 09/27/2013. It is your responsibility to regularly review the current TMPPM and CSHCN Services Program Provider Manual and all updated information as it is published on the TMHP website in web articles and banner messages.

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DSHS Family Planning

DSHS Family Planning and Medicaid Title XIX

Topic: An overview of the rules, regulations, and funding sources for the DSHS Family Planning Program and Medicaid Title XIX.

Length: 62 minutes

Published: 11/19/2013. Updates to programs, policies, and procedures discussed in this CBT can be found on the TMHP website in the current published provider manuals, web articles, and banner messages and on the Department of State Health Services Family Planning Program website in the Family Planning Policy and Procedures Manual.

The purpose of the DSHS Family Planning Program and Medicaid Title XIX CBT is to provide an overview of the rules, regulations, and funding sources for both programs. It also discusses providers’ roles and responsibilities in the programs. This CBT is intended for all Medicaid and DSHS family planning providers.

At the conclusion of this CBT, you should be able to:

  • Understand the general guidelines for family planning providers.
  • Give an overview of the DSHS Family Planning Program and Texas Medicaid Title XIX.
  • Verify a client’s eligibility for the DSHS Family Planning Program.
  • Verify a client’s eligibility Texas Medicaid Title XIX services.
  • Determine the benefits and limitations of each program.
  • Understand and fulfill the provider responsibilities of the DSHS Family Planning Program and Texas Medicaid Title XIX.
  • Understand and follow the procedures for obtaining consent for sterilization.
  • Understand and follow the procedures for providing services to minors.
  • Understand the requirements, procedures, and deadlines for submitting claims.
  • Use the resources available on the TMHP website.

This CBT takes approximately 62 minutes to complete.

Education materials in this CBT are accurate as of the publish date 11/19/2013. Because this CBT is updated as part of an annual production schedule, for the most current information, check any attached addenda or updates associated with the CBT (attachments). Also, updates to policy and program information can be found on the TMHP website in the current TMPPM and CSHCN Services Program Provider Manual, web articles, and banner messages. The DSHS Family Planning website also has a Family Planning Policy and Procedure manual for more policy and procedure updates.

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All Acute Care Programs

Ambulance Basics

Ambulance Basics CBT contains information for regarding policies and procedures for providing ambulance transports for Medicaid and CSHCN Services Program clients.

Published: 10/22/2013. Updates to programs, policies, and procedures discussed in this CBT can be found on the TMHP website in the current published provider manuals, web articles, and banner messages.

Modules include:

  • Ambulance basics.
  • Provider responsibilities.
  • Verifying client eligibility and health plan Information.
  • Third party liability.
  • Emergency transports.
  • Prior authorization.
  • Additional supplies and services.
  • Types of transports.
  • Codes and claims. (Updated 5/1/2014)
  • Additional information.
  • Top reasons for claim and prior authorization denials.

Education materials in this CBT are accurate as of publishing date 10/22/2013. Because this CBT is updated as part of an annual production schedule, for the most current information, check any attached addenda or updates associated with the CBT (attachments).  Also, updates to policy and program information can be found on the TMHP website in the current TMPPM and CSHCN Services Program Provider manual, web articles, and banner messages.

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Claim Appeals

Topic: How and when to appeal a claim, and when to escalate an appeal.

Length: 31 minutes

Published: 10/26/2012. Updates to programs, policies, and procedures discussed in this CBT can be found on the TMHP website in the current published provider manuals, web articles, and banner messages.

At the conclusion of this CBT, you should be able to:

  • Identify a claims appeal.
  • Know why to appeal a claim.
  • Identify when to appeal a claim.
  • Understand the difference between first and second level appeals.
  • Submit appeals through TexMedConnect, the Automated Inquiry System (AIS), or on paper.
  • Escalate complaints and second level appeals to HHSC for managed care and fee-for-service.
  • Escalate complaints and administrative review requests to DSHS for Family Planning and the Children with Special Health Care Needs (CSHCN) Services Program.

Education materials in this CBT are accurate as of publishing date 10/26/2012.  Because this CBT is updated as part of an annual production schedule, for the most current information, check any attached addenda or updates associated with the CBT (attachments).  Also, updates to policy and program information can be found on the TMHP website in the current TMPPM and CSHCN Services Program Provider manual, web articles, and banner messages.

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Claim Forms

Topic: Procedures and forms for submitting paper claims. This CBT does not discuss electronic claim submission.

Length: Modules vary from 8 to 14 minutes

Published: 6/3/2014. Updates to programs, policies, and procedures discussed in this CBT can be found on the TMHP website in the current published provider manuals, web articles, and banner messages.

At the conclusion of this CBT, you should be able to:

  • Identify which claim form to use to bill for professional, facility, dental, or family planning services.
  • Discuss the claim form submission guidelines.
  • Identify the most common reasons that claims are returned to providers.
  • Identify which blocks are required on the CMS-1500, UB-04 CMS-1450, ADA Dental, and the 2017 Family Planning claim.

This CBT primarily deals with the submission of paper claims. Refer to the TexMedConnect for Acute Care Providers CBT for information regarding electronic claim submission.

Education materials in this CBT are accurate as of publishing date 06/03/2014. It is your responsibility to regularly review the current TMPPM and CSHCN Services Program Provider Manual and all updated information as it is published on the TMHP website in web articles and banner messages.

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Client Eligibility

Topic: How to verify a client’s eligibility and benefits available in Medicaid and the Children with Special Health Care Needs (CSHCN) Services Program.

Length: 50 minutes

Published: Published: 01/17/2013. Updates to programs, policies, and procedures discussed in this CBT can be found on the TMHP website in the current published provider manuals, web articles, and banner messages

The Client Eligibility CBT will help providers to:

  • Identify client eligibility and benefits related to various programs.
  • Determine what methods are used to verify client eligibility.
  • Identify when a client has retroactive eligibility.
  • Describe the differences between Medicaid and the CSHCN Services Program.
  • Determine the services a client is eligible to receive based on their eligibility and where to find this information.

Education materials in this CBT are accurate as of publishing date 1/17/2013. Because this CBT is updated as part of an annual production schedule, for the most current information, check any attached addenda or updates associated with the CBT (attachments). Also, updates to policy and program information can be found on the TMHP website in the current TMPPM and CSHCN Services Program Provider Manual, web articles, and banner messages.

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Prior Authorization

Topic: Prior authorization information for providers who provide services to State Health-care Program clients, that may require prior authorization

Length: 17 minutes

Published: 3/1/2012. Updates to programs, policies, and procedures discussed in this CBT can be found on the TMHP website in the current published provider manuals, web articles, and banner messages.

This CBT is designed to provide a basic introduction to the Prior Authorization policies and procedures.

The programs discussed in the Prior Authorization CBT include:

  • Home Health (HH).
  • Comprehensive Care Program (CCP).
  • Comprehensive Care Inpatient Psychiatric (CCIP).
  • Family Planning (FP).
  • Nonemergency Ambulance Services.
  • THSteps Dental.
  • Vendor Drug Program (VDP).
  • Special Medical.

This CBT was published on 3/1/2011. Because this CBT is updated as part of an annual production schedule, for the most current information, check any attached addenda or updates associated with the CBT (attachments). Also, updates to policy and program information can be found on the TMHP website in the TMPPM, CSHCN Services Program Provider Manual, web articles, and banner messages.

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Provider Enrollment on the Portal

Topic: How to use Provider Enrollment on the Portal (PEP) to quickly and easily enroll in Medicaid programs.

Length: 32 minutes

Published: 12/17/2012. Updates to the programs, policies, and procedures covered in this CBT can be found on the TMHP website in current provider manuals, web articles, and banner messages.

Provider Enrollment on the Portal Computer-Based Training This course is designed to provide a basic introduction to Provider Enrollment on the Portal (PEP).

Topics covered in the PEP CBT include:

  • Identify reasons to enroll using PEP.
  • Understand the steps in the enrollment process.. (updated 5/9/2014)
  • Understand the user expectations during the PEP process. (updated 6/26/2014)
  • Use the “hover-over” feature to get Field descriptions.
  • Identify error-messages.
  • List Affordable Care Act (ACA) requirements.
  • Perform the steps to enroll using PEP.
  • Find additional resources on the TMHP website.

Education materials in this CBT are accurate as of publishing date 12/17/2012. Because this CBT is updated as part of an annual production schedule, for the most current information, check any attached addenda or updates associated with the CBT (attachments). Also, updates to policy and program information can be found on the TMHP website in the TMPPM, CSHCN Services Program Provider Manual, web articles, and banner messages.

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Provider Enrollment on the Portal for Durable Medical Equipment Providers

Topic: How to get started with PEP for DME providers.

Length: 2 minutes

Published: 06/11/2014. Updates to procedures discussed in this snapshot can be found on the TMHP website in the current published provider manuals, web articles, and banner messages.

Refer to the Provider Enrollment on the Portal CBT for more information regarding PEP enrollment.

Education and materials in this CBT are accurate as of 06/11/2014. It is your responsibility to regularly review the current TMPPM and all updated information as it is published on the TMHP website in web articles and banner messages.

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Remittance and Status Reports

Topic: How to access R&S Reports, including a description of the different sections of the R&S Report.

Length: Approximately 38 minutes

Published: 2/4/2014. Updates to programs, policies, and procedures discussed in this CBT can be found on the TMHP website in the current published provider manuals, web articles, and banner messages.

At the conclusion of the Remittance and Status (R&S) CBT, you should be able to:

  • Understand your R&S Report and the Information it contains.
  • Get copies of R&S Reports.
  • Locate an R&S Report on the TMHP website.
  • Understand each section that makes up the R&S Report.
  • Balance your R&S Reports after recoupments are applied.
  • Understand how the EHR Incentive Program relates to the R&S Report.

Education materials in this CBT are accurate as of publishing date 11/14/2012. Because this CBT is updated as part of an annual production schedule, for the most current information, check any attached addenda or updates associated with the CBT (attachments). Also, updates to policy and program information can be found on the TMHP website in the TMPPM, CSHCN Services Program Provider Manual, web articles, and banner messages.

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TexMedConnect for Acute Care Providers

Topic: Using TexMedConnect to verify client eligibility, enter and submit claims and appeals, and find claim status.

Length: 38 minutes

Published: 10/1/2013. Updates to programs, policies, and procedures discussed in this CBT can be found on the TMHP website in the current published provider manuals, web articles, and banner messages.

At the conclusion of the TexMedConnect for Acute Care Providers CBT, you should be able to:

  • Create an account.
  • Log in to TexMedConnect.
  • Verify client eligibility.
  • Perform a claims entry.
  • Save a claim as a draft.
  • Save a claim as a template.
  • Save to a batch.
  • Identify a Claims Status Inquiry (CSI).
  • Process appeals.
  • Interpret batch history.

Education materials in this CBT are accurate as of publishing date 10/1/2013. Because this CBT is updated as part of an annual production schedule, for the most current information, check any attached addenda or updates associated with the CBT (attachments). Also, updates to policy and program information can be found on the TMHP website in the current TMPPM and CSHCN Services Program Provider Manual, web articles, and banner messages.

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Third Party Liability

Topic: This CBT is intended for Medicaid and CSHCN Services Program providers who submit claims for clients who may have other insurance or third parties that are responsible for the reimbursement for services.

Length: 30 minutes

Published: 11/01/2013. Updates to programs, policies, and procedures discussed in this CBT can be found on the TMHP website in the current published provider manuals, web articles, and banner messages.

At the conclusion of this CBT, you should be able to:

  • Define Third Party Liability and its components.
  • Find links for and list key points from each component of federal and state requirements.
  • Identify if a client has other insurance.
  • Recognize the differences relating to the CSHCN Services Program.
  • Define the components of cost avoidance, cost recovery, and Tort.
  • Describe Health Insurance Premium Payment (HIPP) and Insurance Premium Payment Assistance (IPPA), their benefits, eligibility, and where to get more information.
  • Determine claim submission deadlines.
  • Notify TMHP of Third Party Resources (TPR).
  • Find TPL contact information.

Education materials in this CBT are accurate as of publishing date 11/01/2013. Because this CBT is updated as part of an annual production schedule, for the most current information, check any attached addenda or updates associated with the CBT (attachments). Also, updates to policy and program information can be found on the TMHP website in the current TMPPM and CSHCN Services Program Provider Manual, web articles, and banner messages.

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Training Snapshot: EOB Billed Amount Required

Topic: Information on Explanation of Benefits “Billed Amount Required” and how to troubleshoot this common claim denial.

Length: Approximately 7 minutes

Published: 08/27/2014. Updates to procedures discussed in this snapshot can be found on the TMHP website in the current published provider manuals, web articles, and banner messages.

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Training Snapshot: EOB Unable to Assign Program/Benefit Plan

Topic: Information on Explanation of Benefits “Unable to Assign Program/Benefit Plan” and how to troubleshoot this common claim denial.

Length: Approximately 7 minutes

Published: 08/27/2014. Updates to procedures discussed in this snapshot can be found on the TMHP website in the current published provider manuals, web articles, and banner messages. Refer to the TexMedConnect for Acute Care Providers CBT for more information regarding electronic claim submission. Education and materials in this CBT are accurate as of 08/27/2014. It is your responsibility to regularly review the current TMPPM and CSHCN Services Program Provider Manual and all updated information as it is published on the TMHP website in web articles and banner messages.

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Long Term Care

Long Term Care (LTC) Community Services Waiver Programs

This CBT is designed to assist LTC Community Services Waiver providers in submitting assessments accurately and efficiently in the LTC Online Portal.

Length: Modules vary from 6 to 15 minutes.

Published: 11/22/13. This CBT is divided into five modules.  Module topics and lengths are listed below.

  • Module 1 – LTC General Medicaid Information – 7 minutes
  • Module 2 – Medical Necessity and Level of Care (MN/LOC) Assessment – 15 minutes
  • Module 3 – Medical Necessity, Fair Hearings, and Resource Utilization Group (RUG) – 13 minutes
  • Module 4 – Provider Workflow and Provider Action Messages – 6 minutes
  • Module 5 – Resources and Additional information – 6 minutes

Changes to programs, policies, and procedures covered in this CBT can be found on the TMHP website in LTC news articles, provider bulletins, and DADS Information Letters.

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Long Term Care (LTC) Nursing Facility/Hospice

This CBT is designed to assist LTC Nursing Facility and Hospice providers in submitting documents accurately and efficiently in the LTC Online Portal. This CBT is divided into 13 modules. Module topics and lengths are listed below.

  • Module 1 – LTC Online Portal General Information – 6 minutes
  • Module 2 – Provider Workflow, Provider Action Messages, and Sequencing of Submissions – 20 minutes
  • Module 3 – Form 3618 Resident Transaction Notice – 13 minutes
  • Module 4 – Form 3619 The Medicare/Skilled Nursing Facility (SNF) Patient Transaction Notice – 12 minutes
  • Module 5 – Form 3071 Recipient Election/Cancellation/Discharge Notice – 13 minutes
  • Module 6 – Form 3074 Physician Certification of Terminal Illness – 12 minutes
  • Module 7 – PASRR Screening – 36 minutes
  • Module 8 – MDS Assessment – 15 minutes
  • Module 9 – LTCMI Section of an MDS Assessment – 13 minutes
  • Module 10 – Medical Necessity (MN), MN Determination, and Fair Hearing –  16 minutes
  • Module 11 – Nonemergency Ambulance – 8 minutes
  • Module 12 – Resources for Additional Information – 10 minutes
  • Module 13 – Common Topics – 21 minutes

Changes to programs, policies, and procedures covered in this CBT can be found on the TMHP website in LTC news articles, provider bulletins, and DADS Information Letters.

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Long Term Care (LTC) Online Portal Basics

Publish date: 08/23/2013. This interactive CBT provides a basic overview of the LTC Online Portal, including an overview of the features of the blue navigational bar and the yellow Form Actions bar. Demonstrations and simulations appear throughout the CBT to provide opportunities for hands-on experience.

For program-specific details of the features discussed, you will be referred to the CBT or User Guide for your LTC program.

Length: Modules vary from 2 minutes to 20 minutes.

When you have completed this CBT, you should be able to:

  • Follow the requirements for obtaining and using a National Provider Identifier (NPI) or Atypical Provider Identifier (API).
  • Log in to the LTC Online Portal.
  • Create an administrator account on the LTC Online Portal.
  • Use the features of the blue navigational bar.
  • Use the features of the yellow Form Actions bar.
  • Understand general information for the LTC Online Portal, including:
    • Required fields.
    • Unlocking forms.
    • Entering dates.
    • History trail.
    • Error messages.
    • Time-out.

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TexMedConnect for Long Term Care Providers

Topic: Using TexMedConnect to verify client eligibility, enter and submit claims and appeals, and find claim status.

Length: 75 minutes

Published: 2/22/2013. Updates to the programs, policies, and procedures covered in this CBT can be found on the TMHP website in the current published provider manuals, web articles, and banner messages.

The TexMedConnect for Long Term Care Providers CBT helps providers with:

  • Logging on to TexMedConnect.
  • Using the Medicaid eligibility and service authorization verification (MESAV) function.
  • Entering, saving, and submitting claims and adjustments.
  • Using the Claim Data Export, Claim Status Inquiry (CSI), Pending Batch, and Batch History functions.
  • Viewing Remittance and Status (R&S) Reports and Claims Identified for Potential Recoupment (CIPR) Provider Reports.

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Medical Transportation Program

Medical Transportation Program (MTP)

Topic: Basic introduction to TMHP processes for Medical Transportation Program (MTP) providers.

Length: Approximately 40 minutes

Published: 12/14/12. Addendum added: 1/31/2013. Updates to the programs, policies, and procedures covered in this CBT can be found on the TMHP website in the current published provider manuals, web articles, and banner messages.

Topics include:

  • Descriptions of provider types.
  • Provider enrollment.
  • Filing claims.
  • Finding your R&S Report.
  • Appeals.
  • Provider responsibilities.
  • Most common errors causing MTP claims to be denied.
  • Contact information.

Education materials in this CBT are accurate as of publishing date 12/14/2012, addendum added: 1/31/2013. Because this CBT is updated as part of an annual production schedule, for the most current information, check any attached addenda or updates associated with the CBT (attachments). Also, updates to policy and program information can be found on the TMHP website in the Texas Medicaid Provider Procedures Manual, web articles, and banner messages.

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