Nursing Facility/Hospice Providers
The following enhancements to the Long Term Care (LTC) Online Portal are effective July 31, 2009. For questions regarding any of these portal enhancements please contact the Texas Medicaid & Healthcare Partnership (TMHP) at 1-800-727-5436, Option 1.
- Validation will be done to ensure that the effective date of the assessment, rather than the TMHP received date, is within the dates the contract is in effect. Form effective dates are based on the type of assessment being submitted. Minimum Data Set (MDS) Admission Assessment effective dates are based on the AB1 date. Quarterly and Comprehensive/Annual MDS assessment form effective dates are based on the R2b date. For any assessment containing a Purpose Code = ‘E’ or ‘M,’ the effective date will be based on the S1f Missed Assessment Start Date. All current form timeliness rules still apply.
- The Long Term Care Medicaid Information (LTCMI) has been changed to allow providers to submit an LTCMI for a single day on a missed assessment. Previously, the portal would not allow the Missed Assessment Start Date and the Missed Assessment End Date fields to be the same date. This prevented providers from submitting a missed assessment to cover only one day. These fields will now allow the same date to be entered in both fields, thus allowing providers to seek reimbursement for a single missed day.
- 3618 Admission/Discharge Resident Transaction Notice and 3619 Discharge Medicare/Skilled Nursing Facility Patient Transaction Notice will no longer allow a correction to Field 10 Transaction if the parent form or any predecessor form has been successfully processed at the Department of Aging and Disability Services (DADS). A successfully processed form will be indicated by a status of Processed/Complete or PCS Processed/Complete. If a modification to the Transaction field needs to be made, the form will need to be inactivated and a new form submitted.
- 3619 Admission Medicare/Skilled Nursing Facility Patient Transaction Notice forms will no longer allow a correction to Field 10 Transaction if the parent form or any predecessor form has been submitted to the DADS Service Authorization System (SAS). If a modification to the Transaction field needs to be made, the form will need to be inactivated and a new form submitted.
- The text in the Medical Necessity Letters that are generated via the LTC Online Portal has been updated by DADS to provide more clarity and better understanding of the intent of letters sent to providers, doctors, and clients. There is no impact to receivers of these letters.
Community Waiver Providers
The following enhancements to the Long Term Care (LTC) Online Portal are effective July 31, 2009. For questions regarding any of these portal enhancements please contact the Texas Medicaid & Healthcare Partnership (TMHP) at 1-800-727-5436, Option 1.
- Validation will be done to ensure that the effective date of the assessment, rather than the TMHP received date, is within the dates the contract is in effect. For the Medical Necessity and Level of Care (MN and LOC) form, the effective date is based on the TMHP Received As Complete Date. If Purpose Code = ‘1’ for Utilization Review (UR), the effective date will be based on the S5g DADS UR RN Signature Date.
- The text in the Medical Necessity Letters that are generated via the LTC Online Portal has been updated by DADS to provide more clarity and better understanding of the intent of letters sent to providers, doctors, and clients. There is no impact to receivers of these letters.