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 requested assistance resolving status and moving forms through the workflow in the Texas Medicaid & Healthcare Partnership (TMHP) Long-Term Care (LTC) Online Portal.
To find a form that has a status message, providers and LIDDAs can use the search link in the blue navigational bar on the LTC Online Portal and select Form Status Inquiry (FSI) from the drop-down menu. Performing a search by Form Type will display all forms of the selected type. The search can be narrowed by Form Status. Additionally, FSI can be performed for an individual by entering the Medicaid number, Social Security number (SSN), or Client Assignment and Registration (CARE) ID. This notification discusses the most common statuses that providers and LIDDAs are seeing.
Note: To ensure that enrollment forms are included in the FSI results, perform the search using the client’s CARE ID.
Pending DADS Review
The following forms can have a status of Pending DADS Review, and submitters (providers or LIDDAs) may need to submit a review packet to the Texas Health and Human Services Commission (HHSC) Utilization Review department:
Note: All enrollments and transfers will be in Pending DADS Review status while the enrollment or transfer is being processed. Check Form History to determine whether the Individual Plan of Care (IPC) also needs utilization review.
The following additional forms can have a status of Pending DADS Review, and LIDDAs need to submit a review packet. HHSC reviewers will review these forms in sequence:
Note: For level of care (LOC) and initial level of need (LON) purpose code (PC) 2, if documentation is needed to review the LOC, the instructions for submission will be added to the Form History.
If seeking an LON (PC3 and PC4) increase, submit a review packet to HHSC Utilization Review.
- Provider Location Update (PLU)
Pending Coach Review
The following forms can have a status of Pending Coach Review, and providers or LIDDAs must submit a review packet to HHSC Utilization Review:
Submitting Review Packets
Review packets can be submitted via the IDD Operations Portal or faxed to 512-438-4249. For questions regarding the information that is required in the review packet, providers and LIDDAs can contact the HCS/TxHmL Utilization Review (UR) message line at 512-438-5055 or the Program Eligibility and Support (PES) message line at 512-438-5055. Responsibility for form and packet submissions has not changed.
Location Code Already Exists and Location Address Already Exists
The PLU form can have a status of Location Code Already Exists or Location Address Already Exists. The provider must correct the issue by making sure that the location code and the address of the location are both unique. The provider must then submit a new PLU form with the corrected data.
Provider Action Required
To learn more about the Provider Action Required (PAR) status for a specific form, providers and LIDDAs can click the View Detail link in the FSI results. In the PAR status, providers and LIDDAs will see an error message.
Providers and LIDDAs will need to perform one or more of the following actions to move a form out of the form workflow and review the form history to determine what corrections are needed:
- Correct this form
- Resubmit to SAS
Providers and LIDDAs can find detailed information about form status and workflow actions in the Long-Term Care (LTC) Home and Community-based Services (HCS) and Texas Home Living (TxHmL) Waiver Programs Provider User Guide.
Note: For additional information on form status content, access the Learning Management System (LMS). To access the LMS, users must have an account. Users can register for an account here. New TMHP LMS users can access the Learning Management System (LMS) Registration and Navigation Job Aid for Providers located on the LMS homepage or send an email to TMHP Training Support to receive help with creating an LMS account or navigating the LMS.
For additional questions regarding form submission, providers and LIDDAs can refer to HCS and TxHmL Waiver Programs Frequently Asked Questions or call the TMHP helpdesk at 800-626-4117 (select option 1, then option 7).