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HCS and TxHmL Programs: Act Now to Prepare for Claims and Forms Submission to TMHP

Last updated on 7/28/2021

Despite the postponement of the Home and Community-based Services (HCS) and Texas Home Living (TxHmL) release on August 2, 2021, providers are required to create accounts at Texas Medicaid & Healthcare Partnership (TMHP) for forms and claims submissions. HCS and TxHmL program providers and financial management services agencies (FMSAs) billing on behalf of Consumer Directed Services (CDS) that have not created their TMHP accounts by the new release date may experience delays in submitting forms or claims.

HCS and TxHmL providers that have not created their TMHP accounts should use the information in this article to begin the account creation process.

Submit Claims

HCS and TxHmL program providers, and FMSAs billing on behalf of CDS will submit claims to TMHP using one of the following claims submission tools:

  • TexMedConnect, which is used by providers to submit claims directly. Providers using TexMedConnect can register their account by doing the following:
    1. Follow the steps outlined in section 2.2 Activate an Existing Provider Identifier and Create a New TMHP User Account in the Portal Security Training Manual.
      1. HCS and TxHmL program providers will select Create Account and Link to A Long Term Care Provider.
    2. Request a Personal Identification Number (PIN) Steps for requesting a PIN can be found in section 2.4 How to Request a Personal Identification Number (PIN) in the Portal Security Training Manual. It can take up to 10 days to receive a PIN.
  • Electronic Data Interchange (EDI), which is used by providers that use a trading partner, such as a billing organization or a third-party billing software to submit claims. Account registration for EDI can take up to 30 days. Providers that will use EDI should complete the following steps and begin trading partner testing as soon as possible.
  1. Complete and submit the EDI Agreement.
  2. Complete trading partner testing.

After the agreement has been accepted and trading partner testing is completed, users will receive a unique, nine-digit submitter ID that they will use to submit claims. 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. When the EDI account creation process is complete, providers using EDI can submit practice claims using their submitter ID.

Providers can refer to the 837P Long-Term Care Health Care Claim Companion Guide for more information about trading partner testing and submitting claims using EDI.

Managing Forms

Providers will use the Long-Term Care (LTC) Online Portal for submitting and managing forms. See the Managing Your Long-Term Care Online Portal Account: A Step-by-Step Guide for more information, including instructions for creating an LTC Online Portal account.

Additional Resources

Providers that have questions about the different claims submission tools, trading partner testing, or other questions related to this transition can refer to the LTC HCS/TxHmL FAQs document on the TMHP Learning Management System (LMS), and the LTC HCS/TxHmL FAQs document on the TMHP website.

Note: To access materials on the LMS, users must have an account. They can register for an account on the New User Registration webpage. Providers are strongly encouraged to register for an LMS account, which may be used to administer future relevant trainings and to access different learning materials. New TMHP LMS users can access the Learning Management System (LMS) Registration and Navigation Job Aid for Providers located on the LMS homepage or can email TMHP Training Support for support on creating an LMS account or navigating the LMS.

An implementation date for the transition from CARE to TMHP will be announced in future articles on the TMHP website. To stay up to date with news about the HCS and TxHmL programs transition to TMHP and general LTC news and information, providers should regularly check the Recent News section of the TMHP LTC webpage. Providers can have Medicaid and LTC news delivered to their inbox with a free subscription to the HHSC mailer GovDelivery.

For additional support or questions that aren’t covered in the above resources, providers can contact the TMHP EDI Help Desk 888-863-3638.