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Effective May 15, 2021, Referring Provider Information Fields Will be Added to the LTC Claims

Last updated on 5/14/2021

Effective May 15, 2021, the following changes will be made to the TexMedConnect (TMC) user interface (UI) for the Long-Term Care (LTC) Institutional (837I), Professional (837P), and Dental (837D) Claims:

  • A new Referring Provider section will be added to the provider tab of the LTC claims (below the existing Rendering Provider section on Institutional claims and the Performing Provider section on Professional and Dental claims), with the following fields:
    • National Provider Identifier (NPI)/Atypical Provider Identifier (API)
    • First Name
    • Last Name
    • Middle Initial
    • Suffix
    • These new Referring Provider fields will initially be enabled, blank, and optional. However, the NPI/API, First Name, and Last Name fields will all become required once the user has entered data into any one of them.
  • In addition, the following new validations will be put into place:
    • The system will validate that the Referring Provider NPI is not the same as the Billing Provider NPI.
    • The Place of Service (POS) submitted on the LTC claim will be checked to ensure that it is appropriate for the service(s) billed on the claim.

The above changes will be applied to all LTC 837I, 837P, and 837D claims, including those received from third-party/EDI submitters. 

 

Referring providers are required to be enrolled in Texas Medicaid. Additional information regarding these changes will be announced in future news articles on the TMHP LTC web page.

For more information, call the Long Term Care Help Desk at 1-800-626-4117, Option 1.