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WARNING: THIS IS A TEXAS HEALTH AND HUMAN SERVICES INFORMATION RESOURCES SYSTEM THAT CONTAINS STATE AND/OR U.S. GOVERNMENT INFORMATION. BY USING THIS SYSTEM YOU ACKNOWLEDGE AND AGREE THAT YOU HAVE NO RIGHT OF PRIVACY IN CONNECTION WITH YOUR USE OF THE SYSTEM OR YOUR ACCESS TO THE INFORMATION CONTAINED WITHIN IT. BY ACCESSING AND USING THIS SYSTEM YOU ARE CONSENTING TO THE MONITORING OF YOUR USE OF THE SYSTEM, AND TO SECURITY ASSESSMENT AND AUDITING ACTIVITIES THAT MAY BE USED FOR LAW ENFORCEMENT OR OTHER LEGALLY PERMISSIBLE PURPOSES. ANY UNAUTHORIZED USE OR ACCESS, OR ANY UNAUTHORIZED ATTEMPTS TO USE OR ACCESS, THIS SYSTEM MAY SUBJECT YOU TO DISCIPLINARY ACTION, SANCTIONS, CIVIL PENALTIES, OR CRIMINAL PROSECUTION TO THE EXTENT PERMITTED UNDER APPLICABLE LAW.
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LICENSE FOR USE OF CURRENT PROCEDURAL TERMINOLOGY, FOURTH EDITION ("CPT® ")

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HCS and TxHmL Programs: Getting Ready for Submitting Claims to TMHP For Payment

Last updated on 8/10/2022

This article has been updated. For the updated information, click here.

Beginning August 2, 2021, Home and Community-based Services (HCS) and Texas Home Living (TxHmL) program providers and FMSAs billing on behalf of Consumer Directed Services (CDS) Employers are required to submit claims with dates of service on and after August 1, 2021, to Texas Medicaid & Healthcare Partnership (TMHP) through TexMedConnect or the Electronic Data Interchange (EDI). Claims for dates of service prior to August 1, 2021, will continue to be submitted to the Client Assignment and Registration (CARE) system. Program providers are strongly encouraged to set up all the necessary accounts at TMHP and start taking relevant training courses as soon as possible.

Next steps for HCS and TxHmL program providers, and Local Intellectual Development Disability Authorities (LIDDAs) are listed below, and detailed in the following subsections:

For both Claim Submission and Form Submission:
1. All program providers and Third party billers that will submit claims and forms to TMHP must have an active TMHP account. See the details in the section below titled “Creating a TMHP account” if an active TMHP account does not exist.
2. Note: This should be completed before signing up for claims submission using EDI, TexMedConnect, or signing up for forms submission using the Long-Term Care (LTC) Online Portal.
Claim Submission:
1. Program providers and LIDDAs can choose to submit electronic claims to TMHP by using standard EDI transactions or by using the free TMHP software application TexMedConnect. Program Providers that use a clearing house for billing or will submit claims using their own software or third-party software will need an EDI account.
2. Program providers that choose to submit electronic claims using EDI must set up an EDI account at TMHP. See section below titled “Getting Started with EDI” for instruction on how to set up an account. Once the account is set up, program providers can use any of the following options for submission of claims to TMHP:
  - A clearing house
  - Third-party vendor for billing
  - Their own claim submission software
  - Third-party claim submission software
3. Program providers that choose to submit their claims using the TMHP software application called TexMedConnect must set up an account for that system. See section below titled “Getting Started with TexMedConnect” for instructions.
HCS and TxHmL Form Submission:
1. All TxHmL/HCS program providers and LIDDAs must sign up for the TMHP LTC Online Portal, if they don’t already have an active administrator account. See the section titled “Creating a Long-Term Care Online Portal Account” below for instructions.
2. Form submission will begin on August 2, 2021.
Computer-Based Training (CBT):
1. Create a Learning Management System (LMS) Account to access Computer-based trainings (CBTs) for claim submission and form submission on TMHP systems.

Creating A TMHP Account

Program providers must have an active TMHP account to use EDI, TexMedConnect, and the LTC Online Portal. To create a TMHP account, users can get started on the Account Activation Homepage.

Refer To: Step-by-step instructions for creating a new TMHP Account, including screen shots, found in the Portal Security Training Manual, section 2.2, “Activate an Existing Provider Identifier and Create a New TMHP User Account.”

Program providers that already have an active TMHP account, but want to link their TMHP user account to their HCS or TxHmL contract numbers can do so by going to the Account Activation Homepage, and selecting the appropriate provider type. For claims submissions, users will need to click the Create Account and link to a Long-Term Care Provider box. For forms submissions, users will need to click the Create Account and link to a Nursing Facility/Waiver Program Provider box.

Note: Users will need a National Provider Identifier (NPI)/Atypical Provider Identifier (API) to link to an existing TMHP account.

Refer To: Step-by-step instructions for linking an existing TMHP account to HCS or TxHmL contract numbers, including screen shots, found in the Portal Security Training Manual, section 2.3, “Activate an Existing Provider Identifier with an Existing TMHP User Account.”

Getting Started With EDI

Program providers that use a clearing house for billing or will submit claims using their own software or third-party software, will need an EDI account. To set up an EDI account, program providers will need to fill out the EDI Agreement and complete software testing. After the agreement has been accepted and software testing completed, users will receive a unique nine-digit submitter ID that they will use to submit claims. It can take up to 30 days to process the request for a submitter ID. Program providers are encouraged to begin the process for registering their EDI account as soon as possible to avoid delays.

Note: Program providers that use a third-party claims submitter will need to contact their third-party claim submitter to determine if a separate submitter ID is necessary.

To get started using EDI, begin by filling out the EDI Agreement for each provider number (also known as contract number). After the EDI Agreement is complete, program providers can submit it by following the instructions outlined in the article, “New Electronic EDI Agreement Submission Method.”

All program providers, trading partners, or software vendors need to complete software testing on the TMHP EDI Testing Site. Users will need to click the Register for a TMHP Community Account link, which will open an email to request an account. After submitting the request, an account will be created within 24 hours. After users have successfully registered an account, they can begin testing. TMHP will activate EDI accounts after software testing is complete.

Refer To: Instructions for completing testing in the “Get Started” section of the EDI homepage.

For EDI-related questions, call the TMHP EDI Help Desk at 888-863-3638.

Getting Started with TexMedConnect

Before activating a TexMedConnect account, program providers will need to request a Personal Identification Number (PIN).

Refer To: Step-by-step instructions for getting a PIN, including screen shots, found in the Portal Security Training Manual, section 2.4, “How to Request a Personal Identification Number (PIN).”

After getting a PIN, program providers can access TexMedConnect by clicking the TexMedConnect button on the left side of the TMHP homepage. Program providers can submit claims once they have activated their TexMedConnect account.

Training: Program providers are strongly encouraged to learn more about creating and utilizing a TexMedConnect account by taking the TexMedConnect for Long-Term Care (LTC) Providers Computer-Based Training (CBT) on the TMHP LMS. Information about the LMS can be found in the “Creating an LMS Account” section below.

Creating a Long-Term Care Online Portal Account

Beginning August 2, 2021, HCS and TxHmL program providers and LIDDAs will submit forms to TMHP using the TMHP LTC Online Portal. This account is where program providers will have access to all their forms, letters, and reports. To prepare for this change, all HCS and TxHmL program providers and LIDDAs that don’t have an active LTC Online Portal user account must set up an account.

Note: To create an LTC Online Portal user account, users will need the following:

Provider number (also known as contract number)
Vendor number (also known as component code)
Vendor password

After clicking the LTC Online Portal button from the TMHP homepage, a Form Status Inquiry (FSI) page will be displayed.

Refer To: Step-by-step instructions for creating a new LTC Online Portal Administrator Account, including screen shots, found in the “How to Create a LTC Online Portal Administrator Account” section, on page 6, of the Long-Term Care (LTC) User Guide for General Information, Online Portal Basics, and Program Resources.

Training: Program providers are strongly encouraged to learn more about creating and utilizing a TMHP LTC Online Portal account by taking the Long-Term Care (LTC) Online Portal Basics Computer-Based Training (CBT) on the TMHP LMS. Information about the LMS can be found in the “Creating an LMS Account” section below.

Creating an LMS Account

Program providers should fill out the form on the TMHP Learning Management System (LMS) new user registration webpage to access the training and guides referenced in this article. Additional training opportunities and user guides will be available on the TMHP LMS.

Refer To: The Learning Management System (LMS) Registration and Navigation Job Aid for Providers for step-by-step instructions, including screen shots, for creating an LMS Account and using the LMS.

Program providers are strongly encouraged to use the following learning materials to help them register for, navigate, and use all necessary accounts:

For additional help setting up an LMS account, or help with training, program providers should contact TMHP Training Support.

Program providers are encouraged to sign up for GovDelivery electronic notifications for Texas Health and Human Services Commission (HHSC) news and alerts. Additional articles and announcements for LTC program providers can be found under the “Recent News” section of the LTC homepage. For questions related to the HCS & TxHmL Forms and Claims Migration Project, email HCS_TxHmL_Form_Migration@hhs.texas.gov.