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Clarification: Home and Community-based Services and Texas Home Living Programs Can Submit 837P Professional and 837D Dental Claims Using Electronic Data Interchange or TexMedConnect

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Beginning March 1, 2022, 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 will submit claims and forms to Texas Medicaid & Healthcare Partnership (TMHP). Providers, LIDDAs, and FMSAs billing on behalf of CDS employers that will submit claims can submit 837P (Professional) and 837D (Dental) claims using TexMedConnect or 837P and 837D claims using Electronic Data Interchange (EDI).

Note: Claim date of service from March 1, 2022 and forward should be submitted in the TMHP system.

Providers, LIDDAs, and FMSAs that will submit claims using TexMedConnect will select Dental as the claim type for dental procedures and Professional as the claim type for all other services. Providers can refer to the Filing A Claim section of the Long-Term Care (LTC) User Guide for TexMedConnect. Providers that still need to set up a TexMedConnect account can refer to the TMHP Account Setup for HCS and TxHmL Waiver Programs Quick Reference Guide for information about setting up a TexMedConnect account.

Claims submitted using EDI for dental procedures must be submitted with 837D dental claims. All other claims will need to be submitted with 837P professional claims. Providers can refer to the Long-Term Care (LTC) 837 Companion Guides under the Companion Guides header of the TMHP EDI web page for more information about 837P and 837D claims.

Providers, LIDDAs, and FMSAs that will use EDI to submit claims, and still need to set up an EDI account, must begin by completing and submitting the EDI Agreement for each provider number (or contract number.)

Note: It can take up to 30 days to complete the EDI account setup process. Providers that will be submitting HCS and TxHmL claims using EDI should begin setting up their EDI accounts as soon as possible.

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 HCS and TxHmL Waiver Programs Frequently Asked Questions (FAQ) or contact the TMHP EDI Help Desk at 888-863-3638.