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| New Banner Messages Are Available
Information posted November 20, 2009: Banner messages containing important informational updates regarding the Medicaid, Managed Care, Family Planning, and CSHCN Services Programs appear on the providers' Remittance and Status (R&S) reports each week. Click on the title to view this week's banner messages. | | TMHP Closed November 26-27, 2009 and December 24-25, 2009; Claims Filing Deadline Extended
Information posted November 20, 2009: TMHP will be closed November 26, 2009, and November 27, 2009, for the Thanksgiving holiday and December 24, 2009, and December 25, 2009, for the Christmas holiday. Because of these closures, claims filing deadlines will be extended until the next business days--Monday, November 30, 2009, and December 28, 2009--as outlined in the 2009 Texas Medicaid Provider Procedures Manual, page 5-8, and the 2009 CSHCN Services Program Provider Manual, page 5-4.
During the holidays, providers can access the Automated Inquiry System (AIS) or use this website to obtain eligibility or claim status information.
For more information, call the TMHP Contact Center at 1-800-925-9126 or the CSHCN Services Program Contact Center at 1-800-568-2413.
| | Screening, Brief Intervention, and Referral to Treatment Benefit for Texas Medicaid
Information posted November 20, 2009: Effective November 25, 2009, for dates of service on or after October 1, 2009, screening, brief intervention, and referral to treatment (SBIRT) will be a benefit of Texas Medicaid. Click on the title to view the details.
| | Update to Closure of Wounds Services
Information posted November 20, 2009: Effective November 25, 2009, for dates of service on or after October 1, 2009, benefit criteria for closure of wounds will change for Texas Medicaid. Click on the title to view the details.
| | Update to Home Health Skilled Nursing (SN) Services Benefits
Information posted November 20, 2009: This is an update to the 2009 Texas Medicaid Provider Procedures Manual section 24.4.1, “Home Health Skilled Nursing (SN) Services.” Effective November 25, 2009, for dates of service on or after October 1, 2009, skilled nursing visits will not be approved for the sole purpose of instructing the client on the use of the subcutaneous injection port device. Any necessary instruction for the use of the device must be performed as part of the office visit with the prescribing physician.
| | Subcutaneous Injection Port Device to Be a Benefit
Information posted November 20, 2009: Effective November 25, 2009, for dates of service on or after October 1, 2009, the subcutaneous injection port device will be a benefit of Texas Medicaid. Click on the title to view the details.
| | Cardiac Rehabilitation Services to Be a Benefit
Information posted November 20, 2009: Effective November 25, 2009, for dates of service on or after October 1, 2009, cardiac rehabilitation services will be a benefit of Texas Medicaid. Click on the title to view the details.
| | Online Fee Lookup and Static Fee Schedule Note Codes Correction
Information posted November 20, 2009: TMHP has identified an issue with note codes 15 and 16 that appear in the Online Fee Lookup (OFL) and static fee schedules on this website. Note codes 15 and 16 displayed incorrect note messages.
The following are the correct note messages: Note code 15: “Displayed fee reflects reimbursement for the service rendered in a non-facility location.” Note code 16: “Displayed fee reflects reimbursement for the service rendered in a facility location.”
The note messages have been corrected in both the OFL and the static fee schedules.
For more information, call the TMHP Contact Center at 1-800-925-9126 or the TMHP-CSHCN Services Program Contact Center at 1-800-568-2413.
| | Revised Provider Enrollment Applications to Be Available January 1, 2010
Information posted November 13, 2009: Beginning January 1, 2010, revised enrollment applications for each of the state health-care programs will be available for providers on this website. The revisions to the applications reflect enhancements that are being made to Provider Enrollment on the Portal (PEP). Click on the title to view the details. | | Correction to Reimbursement Rate Changes for Ambulance Services
Information posted November 12, 2009: This is a correction to an article that was published in the November/December 2009 Texas Medicaid Bulletin, No 226 titled “Reimbursement Rate Changes for Ambulance Services.” The article listed some incorrect procedure code reimbursement rates. Click on the title to view the correct rates.
| | CSHCN Services Program Benefits to Change for Outpatient Behavioral Health Services
Information posted November 10, 2009: Effective for dates of service on or after January 1, 2010, benefit criteria for outpatient behavioral health services will change for the Children with Special Health Care Needs (CSHCN) Services Program. Click on the title to view the details.
| | Peramivir EAU authorized by FDA October 23, 2009
Information posted November 10, 2009: On October 23, 2009, the U.S. Food and Drug Administration (FDA) announced that it has issued an emergency use authorization (EUA) for the investigational antiviral drug Peramivir intravenous (IV) in certain adult and pediatric patients who are admitted to a hospital with confirmed or suspected 2009 H1N1 influenza infection. This is in response to a request from the U.S. Centers for Disease Control and Prevention (CDC). Click on the title to view the details. | | EFT Payments Delayed Due to Bank Holiday
Information posted November 9, 2009: Wednesday, November 11, 2009, is Veterans Day, which is a bank holiday. As a result, electronic funds transfer (EFT) payments will be delayed by one business day. Providers receiving EFT payments can expect funds by Friday, November 13, 2009. For more information, call the TMHP Contact Center at 1-800-925-9126 or the TMHP-CSHCN Contact Center at 1-800-568-2413.
| | Update to “Physical, Occupational, and Speech Therapy Benefits to Change for CCP”
Information posted November 6, 2009: This is an update to an article that was posted on this website on July 10, 2009, titled “Physical, Occupational, and Speech Therapy Benefits to Change for CCP.” The article did not include procedure code 97535 as payable for speech therapy. Click on the title to view the details. | | Revised Documentation Criteria for Home Health Glucose Testing Equipment and Supplies
Information posted November 6, 2009: Effective for dates of service on or after November 1, 2009, the documentation requirements for obtaining glucose testing equipment and supplies for home health services have changed for Texas Medicaid. Click on the title to view the details. | | Osteopathic Manipulative Treatment (OMT) Benefits to Change
Information posted November 6, 2009: Effective for dates of service on or after January 1, 2010, benefit criteria for osteopathic manipulative treatment (OMT) will change for Texas Medicaid. Click on the title to view the details.
| | Behavioral Health Form Changes
Information posted November 6, 2009: Effective for dates of service on or after January 1, 2010, the Extended Outpatient Psychotherapy/Counseling Request Form will be revised. In addition, a new Psychological/Neuropsychological Testing Request Form will be created, and providers will be required to use this form to request prior authorization for psychological and neuropsychological testing. Click on the title to view the details. | | Texas Medicaid and CSHCN Services Program Hearing Services Quick Reference Guides
The Texas Medicaid and CSHCN Services Program Hearing Services Quick Reference Guides, which summarize hearing services benefits, are resources for Texas Medicaid and CSHCN Services Program providers of hearing services. Click on the title to view the quick reference guides.
| | WHP Certification Form Deadline Extension
Information posted November 6, 2009: This is an update to an article that was published on the TMHP website at www.tmhp.com on June 29, 2009 and in the September/October 2009 Texas Medicaid Bulletin, No. 225 titled “Women’s Health Program (WHP) Providers and Performance of Elective Abortion.”
On June 22, 2009, a WHP Certification Form was mailed to billing providers who delivered family planning services to WHP clients in 2008 and 2009. Providers were given until September 18, 2009 to respond. The Texas Health and Human Services Commission (HHSC) has extended the deadline for submission of the certification form until November 30, 2009. TMHP may place a payment hold on all Medicaid fee-for-service claims filed by, or on behalf of, any billing provider who fails to respond by this date.
For more information, call the TMHP Contact Center at 1-800-925-9126.
| | Reprocessing Claims with WHP Procedure Codes
Information posted November 6, 2009: TMHP has identified an issue that impacts claims submitted by Women’s Health Program (WHP) providers or family planning providers for dates of service on or after April 1, 2009 and the following procedure codes: 00851, 58340, 58611, 58615, 58670, 74000, 74010, 81005, 87252, 99001, 99243, E1399, or Q0111. These claims might have been processed incorrectly.
Affected claims will be reprocessed, and payments will be adjusted accordingly. No action on the part of the provider is necessary.
Additionally, claims with dates of service on or after January 1, 2010, and procedure code 58600 will no longer be payable to family planning providers in the office setting (place of service [POS] 1).
For more information, call the TMHP Contact Center at 1-800-925-9126.
| | Correction to THSteps PCS Reimbursement Rates Have Changed
Information posted November 6, 2009: This is a correction to an article that was published on this website on June 26, 2009, and in the November/December 2009 Texas Medicaid Bulletin, No.226, titled “THSteps PCS Reimbursement Rates Have Changed.” The article listed an incorrect reimbursement rate for procedure code T1019 with modifier U6. Effective for dates of service on or after August 1, 2009, the correct reimbursement rate for procedure code T1019 with modifier U6 is $2.92. The correction to the reimbursement rate for procedure code T1019 with modifier U6 does not apply to School Health and Related Services (SHARS) PCS.
For more information, call the TMHP Contact Center at 1-800-925-9126.
| | Reprocessing of Claims for Clients with Presumptive Eligibility
Information posted November 6, 2009: TMHP has identified an issue that impacts claims submitted for services provided to clients with presumptive eligibility (PE) and maternity diagnosis codes. Claims might have been denied in error with an explanation of benefits (EOB) message that indicated the services were not payable to clients determined to be presumptively eligible. Affected claims will be reprocessed, and payments will be adjusted accordingly. No action by the provider is necessary. Click on the title to view the affected diagnosis codes with their corresponding dates of service. | | Update to "H1N1 Administration Fee for H1N1 Vaccinations to Be Reimbursed for Texas Medicaid"
Update posted October 16, 2009: Texas Medicaid, in collaboration with the Texas Department of State Health Services (DSHS), updated the information posted October 7, 2009 regarding provider registration with DSHS to receive the vaccine and provider billing of the administration of the H1N1 vaccine to TMHP. The effective date is October 1, 2009. Providers should monitor the primary state website for information about the pandemic at www.TexasFlu.org.
Click on the title for more details.
| | PEP and OPL Enhancements
Information posted October 16, 2009: Beginning December 14, 2009, Provider Enrollment on the Portal (PEP) and Online Provider Lookup (OPL) will be enhanced to improve overall functionality. These enhancements will be accompanied by changes to the paper enrollment applications for each of the state health-care programs. Click on the title to view the details. | | Correction to “2010 ICD-9-CM Updates Now Available”
Information posted October 16, 2009: This is a correction to an article that was posted on this website on September 25, 2009, on the TMHP Code Updates – ICD-9-CM web page, titled “2010 ICD-9-CM Updates Now Available.” The article incorrectly indicated that diagnosis codes V6107, V6108, V6123, V6124, V6125, and V6142 would be valid for Texas Medicaid counseling services procedure codes 90806, 90806 with modifier U8, 90853, 90853 with modifier U8, 90847, 90847 with modifier U8, and revenue code 513. Click on the title to view the correct information.
| | Medicaid Ambulance Nonemergency Prior Authorization Request Form
Information posted November 3, 2009: TMHP has identified an issue with the “Nonemergency Ambulance Prior Authorization Request” form. The provider information section of the form is gray, and faxed authorizations are often illegible.
A revised ambulance prior authorization form has been posted on this website in the file library. Also, as an alternative to faxing the authorization form, providers may request ambulance authorizations electronically through this website.
Providers should fax only the revised ambulance prior authorization form, since faxing the authorization form that contains the gray portion will likely cause a delay in processing.
For more information, call the TMHP Contact Center at 1-800-925-9126. Click on the title to view the form.
| | Correction to the January 2009 Inpatient and Outpatient Behavioral Health Services Special Bulletin
Information posted November 1, 2009: This is a correction to the January 2009 Inpatient and Outpatient Behavioral Health Services Special Bulletin, No. 1. The diagnosis code tables on pages 26 through 30 in the bulletin have been revised to include all of the appropriate codes. In addition, the procedure code table on page 30 of the bulletin has been revised to include all of the appropriate codes. Click on the title to view the details.
| | Revised PCCM Inpatient/Outpatient Authorization Form
Information posted October 30, 2009: A revised Primary Care Case Management (PCCM) Inpatient/Outpatient Authorization Form is now available. Click on the title to view the details
| | Prior Authorization Criteria for Manual Wheelchairs to Change
Information posted October 30, 2009: Effective for dates of service on or after November 1, 2009, prior authorization criteria for manual wheelchairs will change for Texas Medicaid. Click on the title to view the details. | | CSHCN Services Program Reimbursement Rate to Change for Cochlear Implants
Information posted October 30, 2009: Effective for dates of service on or after November 1, 2009, the Children with Special Health Care Needs (CSHCN) Services Program reimbursement rate for cochlear implants will change. The reimbursement rate for procedure code L8614 will change from $15,522.20 to $23,380.00 for purchased durable medical equipment. For more information, call the TMHP-CSHCN Services Program Contact Center at 1-800-568-2413.
| | 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. | | Reimbursement Rates for Blood Product Procedure Codes to Change for the CSHCN Services Program
Information posted October 23, 2009: Effective for dates of services on or after November 1, 2009, reimbursement rates for blood product procedure codes will change for the Children with Special Health Care Needs (CSHCN) Services Program. Click on the title to view the details. | | Providers and Excluded Entities
Information psoted October 23, 2009: The Health and Human Services Office of Inspector General (HHS-OIG) restricts individuals and entities with exclusions on file from participation in all federal health-care programs. These restrictions include receiving reimbursement for items or services furnished, ordered, or prescribed. Click on the title to view the details. | | Prior Authorization of Palivizumab (Synagis) Through the TMHP Website to Cease
Information posted October 23, 2009: Effective October 30, 2009, prior authorization requests for palivizumab (Synagis) will no longer be completed through the TMHP website at www.tmhp.com. Providers may fax prior authorization requests for palivizumab to the TMHP-CCP Prior Authorization Department at 1-512-514-4212 using the revised Texas Medicaid Palivizumab (Synagis) Prior Authorization Request Form, which is available in the Providers Forms section of this website and on page 57 of the November/December 2009 Texas Medicaid Bulletin, No. 226. For more information, call the TMHP Contact Center at 1-800-925-9126. Click on the title to view the form.
| | Diabetic Equipment and Supplies Home Health Updated Article
Information posted October 30. 2009: This is an update to an article published on this website on October 23, 2009, titled “Texas Medicaid Diabetic Equipment and Supplies Home Health Benefits to Change.”
The article was removed from this website, because changes to the diabetic equipment and supplies Home Health benefit have not been finalized. Providers should disregard the previously published article and monitor future provider notifications for updates.
For more information, call the TMHP Contact Center at 1-800-925-9126.
| | Tamiflu and Relenza Are Benefits of Texas Medicaid and the CSHCN Services Program
Information posted October 27, 2009: Effective for dates of service on or after October 1, 2009, antiviral medications zanamivir inhalation powder (Relenza) and oseltamivir phosphate (Tamiflu) are benefits of Texas Medicaid and the Children with Special Health Care Needs (CSHCN) Services Program for clients of all ages when provided by a physician, advance practice nurse, or physician assistant in the office setting. Click on the title to view the details. | | Recoupment of IMD Claims
Information posted October 21, 2009: Reminder: Institute for Mental Disease (IMD) services and any associated professional services are not a benefit of Texas Medicaid if they are provided to clients who are from 21 through 64 years of age and residents of an IMD facility.
Beginning October 26, 2009, TMHP will begin to recoup claims that were paid to providers in error for services provided to Medicaid clients who were from 21 through 64 years of age and residents of an IMD facility.
Affected claims will be reprocessed, and payments will be adjusted accordingly. Adjustments will be reflected on providers’ Remittance and Status (R&S) Reports. No action on the part of providers is required.
For more information, call the TMHP Contact Center at 1-800-925-9126.
| | Benefit Update for THSteps Preventive Dental Services
Information posted October 29, 2009: Effective for dates of services on or after November 1, 2009, benefit criteria for Texas Health Steps (THSteps) preventive dental services will change for Texas Medicaid. Click on the title to view the details. | | Update to “CSHCN Reimbursement for H1N1 Vaccination Administration”
Information posted October 16, 2009: This is an update to an article published on this website on October 9, 2009, titled “CSHCN Reimbursement for H1N1 Vaccination Administration”. The Children with Special Health Care Needs (CSHCN) Services Program is reimbursing the administration fee for the pandemic H1N1 flu vaccine when it is administered to CSHCN Services Program clients of all ages in the office setting. In order to be reimbursed for the administration of the H1N1 flu vaccine, providers have a choice of procedure codes to submit for the administration of the vaccine. Click on the title to view the details. | | Online Fee Lookup and Static Fee Schedules Updated to Include Missing Cardiac-Related Procedure
Information posted October 16, 2009: TMHP has identified an issue with the online fee lookup and static fee schedules on this website. Procedure codes 93541, 93542, 93543, 93544, and 93545, which were missing from the online fee lookup and the static fee schedules for physicians or ambulatory surgical centers from July 1, 2009, through October 5, 2009, have been added as of October 6, 2009.
For more information, call the TMHP Contact Center at 1-800-925-9126.
| | Claims Reprocessing of Procedure Code 57295
Information posted October 16, 2009: TMHP has identified an issue with claims that were submitted by physicians, ambulatory surgical centers, and hospitals with dates of service from January 1, 2006, through October 6, 2009, and procedure code 57295. Claims that were submitted with procedure code 57295 and diagnosis codes other than 25520, 25541, or 25542 may have been denied in error. Effective for dates of service on or after January 1, 2006, procedure code 57295 is no longer diagnosis-restricted.
Affected claims will be reprocessed, and payments will be adjusted accordingly. No action on the part of the provider is necessary.
| | Administration Fee for H1N1 Vaccinations to Be Reimbursed for Texas Medicaid
Information posted October 7, 2009: Texas Medicaid, in collaboration with the Texas Department of State Health Services (DSHS), is reimbursing the administration fee for the pandemic H1N1 flu vaccine when it is administered to Texas Medicaid clients of all ages in the office setting. The effective date is October 1, 2009. Providers should monitor the primary state website for information about the pandemic at www.TexasFlu.org. Click on the title to view the details. | | Update to “Pharmacists and Pharmacies May Enroll in Texas Medicaid to Administer Immunizations”
Information posted October 8, 2009: This is an update to an article published on this website on September 25, 2009, titled “Pharmacists and Pharmacies May Enroll in Texas Medicaid to Administer Immunizations.” Pharmacists who participate in Medicaid must adhere to all state and federal regulations, including the Texas Occupations Code, Section 554.052, “Immunization and Vaccinations; Physician Supervision.” In addition, pharmacists and pharmacies that are enrolled in Medicaid for the administration of vaccines must adhere to all State Board of Pharmacy licensing, certification, and scope-of-practice requirements Click on the title to view the complete, updated article.
| | 2009-2010 Seasonal Influenza Vaccination Information
Information posted October 2, 2009: Seasonal flu vaccine is available for all Texas Medicaid clients. Click on the title to view the details.
| | EFT Payments Delayed Due to Bank Holiday
Information posted November 20, 2009: Thursday, November 26, 2009 is Thanksgiving Day, which is a bank holiday. As a result, electronic funds transfer (EFT) payments will be delayed by one business day. Providers receiving EFT payments can expect funds by Friday, November 27, 2009. For more information, call the TMHP Contact Center at 1-800-925-9126 or the TMHP-CSHCN Contact Center at 1-800-568-2413.
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