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Updated 837P LTC Companion Guide Now Available for HCS and TxHmL Program Claims Submission Practice

Last updated on 10/18/2021

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

The 837P Long-Term Care (LTC) Companion Guide has been updated and is available on the TMHP Electronic Data Interchange (EDI) webpage. Texas Home Living (TxHmL), Home and Community-based Services (HCS) providers, Local Intellectual and Development Disability Authorities (LIDDAs), and financial management services agencies (FMSAs) billing on behalf of Consumer Directed Services (CDS) employers that will submit claims using EDI can use the updated guide to complete trading partner testing (if necessary) and practice submitting EDI claims to Texas Medicaid & Healthcare Partnership (TMHP).

Note: The ability to submit practice claims will be limited to EDI submitters only. TexMedConnect users will not be able to submit practice claims prior to the March 1, 2022 deployment.

Providers and LIDDAs that do not have an active TMHP account, or an active EDI account, need to do the following before they can begin trading partner testing or practicing claims submissions:

Submitting Practice Claims

Providers using a third-party claims vendor that is on the Approved Vendor List do not need to complete testing and can have their claims vendor begin submitting practice claims. Instructions for submitting EDI claims can be found in the TMHP EDI Connectivity Guide.

Providers and claims vendors should refer to the draft version of the HCS TxHmL Bill Code Crosswalk when submitting practice claims.

Trading Partner Testing for New Third-Party Claims Vendors

Providers that have submitted their EDI Agreement, and are using a third-party claims vendor that is not on the Approved Vendor List, can have their claims vendor begin testing by following these steps:

  1. Go to the TMHP EDI Testing website.
  2. 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.
  3. Begin trading partner testing using the TMHP EDI Testing website. The testing site will automatically track testing results, report capabilities, and resolve errors.
  4. After testing is complete, the third-party claims vendor will need to complete and submit the following:
    • TMHP EDI Gateway Trading Partner Enrollment Form (TPEF)
    • Trading Partner Agreement (TPA).

Following the approval of the TPEF and TPA, the EDI Submitter ID will be created, and the claims vendor can begin submitting practice claims using their EDI Submitter ID.

For additional questions, providers can refer to the HCS and TxHmL Waiver Programs Frequently Asked Questions (FAQ) or contact the TMHP EDI Help Desk at 888-863-3638, Option 4.