Beginning August 2, 2021, Home and Community-based Services (HCS) and Texas Home Living (TxHmL) providers will be required to submit their claims and forms to Texas Medicaid & Healthcare Partnership (TMHP). HCS and TxHmL providers that do not have an account with TMHP will need to prepare for this transition.
TexMedConnect and Electronic Data Interchange (EDI)
Home and Community-based Services (HCS) and Texas Home Living (TxHmL) providers must submit claims to TMHP for dates of service on or after August 1, 2021.
Providers who want to submit claims directly will use TMHP’s TexMedConnect, a free billing software. To get started using TexMedConnect, review the Long-Term Care (LTC) User Guide for TexMedConnect, and set up a TMHP secure portal account by following the steps in the Basic Tasks for Managing an Account on the TMHP Secure Portal manual and the TMHP Portal Security Training Manual.
Providers that use a trading partner, such as a billing organization, or third-party billing software, will submit claims through EDI. To become an EDI submitter, visit the TMHP EDI web page for more information.
Note: Submission of the EDI Agreement will be required if using a third-party submitter. Providers can find the EDI Agreement on the EDI Forms webpage.
Long-Term Care Online Portal
Starting August 2, 2021 HCS and TxHmL providers and Local Intellectual or Development Disability Authorities (LIDDAs) must submit forms online through the TMHP LTC Online Portal. To prepare for this transition to the TMHP LTC Online Portal, HCS and TxHmL providers will need to create an administrator account, and a Nursing Facility (NF)/Waiver Account.
Providers can find directions for creating an LTC Online Portal account in the Long-Term Care (LTC) Online Portal Basics computer-based training (CBT) in the TMHP Learning Management System (LMS), and the Long-Term Care (LTC) User Guide for General Information, Online Portal Basics, and Program Resources on the TMHP website and in the TMHP LMS.
HCS and TxHmL Providers can find information for setting up an NF/Waiver account in the Long-Term Care (LTC) User Guide for Intermediate Care Facilities for Individuals with an Intellectual Disability or Related Conditions (ICF/IID) Program Providers.
Note: To access the LMS, users will need to register for the LMS by clicking the Don’t Have an Account? Sign Up Here button beneath the login field. Completion of the LTC User Guide for General Information, Online Portal Basics, and Program Resources, and the TexMedConnect Claims Entry System is highly recommended.
Additionally, providers are encouraged to visit the TMHP Long-Term Care web page. In the left-hand menu of the LTC web page, providers can find Medicaid and LTC training materials and navigational videos. In the Recent News section, providers can find published bulletins containing news and information about this change, training opportunities, and other LTC news.
More information about this change will be available in future articles on this website and in upcoming Long-Term Care Provider Bulletins. Providers can sign up to receive Gov Delivery, an electronic mailer from HHSC that includes current news and topics of interest for LTC providers.
In the time leading up to this transition, providers can prepare by:
- Keeping claims submissions current in Intellectual Disability Client Assignment and Registration (ID-CARE).
- Submitting Intellectual Disability/Related Condition (ID/RC) and Individual Plan of Care (IPC) renewals in a timely manner.
- Completing Client Assignment and Registration (CARE) Data entry for services delivered before August 1, 2021.
- Reconciling any errors relating to location exceptions.
For any questions related to the HCS & TxHmL Forms and Claims Migration Project, email HCS_TxHmL_Form_Migration@hhs.texas.gov.
For EDI-related questions, call the TMHP EDI Help Desk at 888-863-3638.