Texas Home Living (TxHmL), Home and Community-based Services (HCS) providers, and Local Intellectual and Development Disability Authorities (LIDDAs) can begin trading partner testing and practicing claims submissions to Texas Medicaid & Healthcare Partnership (TMHP).
Note: The ability to submit practice claims will be limited to EDI submitters only. The practice of claim submission in TexMedConnect is not available.
Providers and LIDDAs that do not have an active TMHP account, and an active electronic data interchange (EDI) account need to do the following before they can begin trading partner testing or practicing claims submissions:
- Activate a TMHP account.
- Complete and submit the EDI Agreement for each provider number (also known as contract number).
Details about activating the appropriate accounts can be found in the article, “HCS and TxHmL Program: Getting Ready for Submitting Claims to TMHP for Payment,” on the TMHP Long-Term Care (LTC) and EDI webpages.
Providers that have submitted their EDI Agreement, and are using a proprietary software or a vendor that is on the Approved Vendor list, can begin testing by following these steps:
- Begin by going to the TMHP EDI Testing website.
- Select the Register for a TMHP Community Account link, which will open an email to request an account. Accounts are created within 24 hours of the request being submitted.
- Begin trading partner testing using the TMHP EDI Testing website. The testing site will automatically track testing results, report capabilities, and resolve errors.
- After testing is complete, providers using a proprietary software need to complete and submit the following:
- TMHP EDI Gateway Trading Partner Enrollment Form (TPEF)
- Trading Partner Agreement (TPA).
Following the submissions of the TPEF and TPA, the EDI account will be activated, and providers can begin submitting practice claims using their submitter ID. Providers should refer to the draft of the HCS TxHmL Bill Code Crosswalk when submitting practice claims.
Providers can find more information about EDI, and types of claims submitted using EDI in the TMHP EDI Connectivity Guide. Providers can find more information about claims submissions and TMHP claims submission software in the LTC HCS/TxHmL FAQs document on the TMHP Learning Management System (LMS).
Note: To access material on the LMS, users will need an LMS account. Detailed instructions for creating an account can be found in the “Creating an LMS Account” section of the article “HCS and TxHmL Programs: Getting Ready for Submitting Claims to TMHP for Payment.”
Providers can learn more about TMHP claims by watching this brief video, TMHP Claims Video, and reviewing the Remittance and Status (R&S) Report for LTC Providers quick reference guide on the TMHP LMS.
For EDI-related questions, call the TMHP EDI Help Desk at 888-863-3638.