Since May 2, 2022, Home and Community-based Services (HCS) and Texas Home Living (TxHmL) program providers, local intellectual and developmental disability authorities (LIDDAs), and financial management services agencies (FMSAs) billing on behalf of consumer-directed services (CDS) have been submitting claims and forms to the Texas Medicaid & Healthcare Partnership (TMHP). TMHP has received feedback from providers indicating additional support is required. Resolutions regarding the most frequently reported issues may be found in the table below.
Topic |
Resolution |
Finding Client and Form Status |
Providers and LIDDAs can use the “Individual Search” function in the Long-Term Care (LTC) Online Portal (LTCOP) to view a client’s status. The “Form Status Inquiry” function can be used to view current form statuses for any client who currently receives services from the provider. For additional information, including directions on how to perform status searches, and explanations of the status messages, refer to the LTC HCS and TxHmL Waiver Programs Provider User Guide. |
Topic |
Resolution |
Dental Claim Billing |
Providers encountering issues submitting dental claims should review the following information to ensure the claims are being submitted correctly: · When billing dental claims, providers need to select the “Dental” claim type. · D0120 is the billable code for dental services and D9220 is the billable code for general anesthesia. These services do not require a procedure code qualifier. Note: LTC does not advise providers regarding what to select for the oral cavity code. · When billing for Dental Requisition fees, providers need to select the “Professional” claim type. Note: Providers must submit the code that matches the amount of the fees listed in the description on the bill code crosswalk. The procedure code qualifier is required for dental requisition fees. For additional information, refer to the “Filing A Claim” section of the LTC User Guide for TexMedConnect or watch the HCS and TxHmL Claims Submission webinar recording on the TMHP Learning Management System (LMS). |
Topic |
Resolution |
Client on Hold Removal |
The following list describes types of holds and how to remove them: · Intellectual Disability Related Condition (IDRC) Timeliness Penalty (TP1) Hold: The IDRC was initiated by a late submission. The provider needs to submit a Purpose Code E (PCE) to release the hold. If it is for CDS services, the LIDDA needs to submit the PCE. · Individual Plan of Care (IPC) Timeliness Penalty (TP2) Hold: The IPC was initiated by a late submission. To remove the hold, contact the HCS/TxHmL Utilization Review (UR) Message Line at 512-438-5055. · Suspension Reason (or Review) Hold: There is an Individual Movement (IMT) Suspension in place. To release the hold, return the individual to service. · ID CARE (IDC) Hold: There is no suspension on the LTC Online Portal so the provider cannot return the individual to service. Contact the HCS/TxHmL Utilization Review (UR) Message Line at 512-438-5055. |
Topic |
Resolution |
Updating Addresses for Individuals |
To update an individual’s address, contact the Legally Authorized Representative (LAR) or call 211. Additionally, addresses can be updated via the Individual Movement (IMT) Individual Update form. |
Topic |
Resolution |
Adjusting Submitted Claims |
Claims that have processed successfully can be adjusted. For instructions on how to adjust claims, refer to the “Adjustment” section of the LTC User Guide for TexMedConnect. |
Topic |
Resolution |
Individual Plan of Care (IPC) Revision Button Missing |
Providers have reported that the IPC Form Revise IPC button is sometimes missing. This is not an error. The IPC cannot be revised by providers or LIDDAs if it has been more than 30 calendar days from the IPC end date. For more information, contact the HCS/TxHmL UR Message Line at 512-438-5055. |
Topic |
Resolution |
Line Item Control Number (LICN) “Rollup” and “Sequence Number” |
Providers using TexMedConnect have expressed needing clarification regarding the meanings of “Rollup” and “Sequence Number”. · “Rollup” refers to accumulated services billed according to the submitter's schedule, as opposed to services billed daily. · The “Sequence Number” must be unique when there are multiple claim details for the same date of service for an individual. For directions on how to create a Sequence Number, refer to the LTC User Guide for TexMedConnect, Appendix: Using the LICN Field for HCS and TxHmL Waiver Programs. |
Topic |
Resolution |
Local Case Number Error Message |
Providers have reported receiving an error message when entering the Local Case Number on the following forms: · ID/RC Assessment 8578 · IPC forms 3608 and 8582 The error message states “Individual’s identifying information is not valid. Please review individual’s identifying information and resubmit.” This issue has been resolved. Providers who received the error message can resubmit their rejected forms. For more information, contact the LTC Help Desk at 800-626-4117. |
Topic |
Resolution |
Using the LICN Field |
Providers submitting claims for HCS and TxHmL services using the TMHP claims submission tool, TexMedConnect, will need to use the LICN field to identify the individual who provided the HCS and TxHmL service. Proper use of the LICN field will prevent claim mismatches, denials, or rejections. Important: Each claim detail must have a unique, user-generated sequence number and must follow military-time format. To locate the appropriate service for the LICN, providers should reference the HCS and Texas Home Living TxHmL Bill Code Crosswalk on the LTC Bill Code Crosswalks web page. Providers can find step-by-step instructions on filling out the LICN field in the LTC User Guide for TexMedConnect, Appendix: Using the LICN Field for HCS and TxHmL Waiver Programs. Frequently asked questions about the LICN can be found in the HCS and TxHmL Waiver Programs Frequently Asked Questions document. Providers can find additional detailed information about submitting claims to TMHP in the HCS and TxHmL TexMedConnect Claims Submission Webinar recording. |
View previous postings below:
HCS and TxHmL Waiver Programs: Trending Issue Support, Volume 3
HCS and TxHmL Waiver Programs: Trending Issue Support, Volume 2
HCS and TxHmL Waiver Programs: Trending Issue Support
Important Claims Submission Information for HCS and TxHmL Programs
LTC Online Portal Dashboard Accessibility Issue Resolved
IPC Forms 3608 and 8582 Issue Resolved
HCS and TxHmL FAQ Updates Available May 9, 2022, and May 23, 2022
Individual Plan of Care (IPC) Training Materials for HCS and TxHmL Waiver Programs
Now Available: HCS and TxHmL Programs Forms and Claims Submissions to TMHP
EVV Updates for the HCS and TxHmL Transition to TMHP for Claims Submission
For additional questions, contact the TMHP LTC Help Desk at 800-626-4117.