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HCS and TxHmL Waiver Programs: Trending Issue Support, Volume 7

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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 and information regarding the most frequently reported issues may be found in the tables below.

Topic

Resolution

 

Update: Compatible Internet Browser for the Long-Term Care (LTC) Online Portal

 

TMHP recommends that providers and LIDDAs only use Microsoft Edge when submitting forms using the LTC Online Portal. Providers and LIDDAs who use any other internet browsers may experience issues.

Providers and LIDDAs who continue to have issues submitting forms using Microsoft Edge can find instructions for clearing their browser cache here.

Note: This link will take you away from the TMHP website.

Dental Code 5A to Use Contract Rate

 

Effective June 24, 2022, dental code 5A will be paid using a contract rate of $1 instead of the procedure rate of $87.50. Providers need to bill by entering the dollar amount as the unit amount.

Example: If the billed amount is $100, enter “100” as the number of units.

If previous claims were paid incorrectly due to the dollar amounts not being billed as units, providers can rebill correctly by performing adjustments on the paid claims.

Selecting an Individual Movement (IMT) Purpose and Individual Plan of Care (IPC) Type

Providers are advised to utilize Appendix A in the LTC HCS and TxHmL Waiver Programs – Provider User Guide for assistance selecting an IMT Purpose and IPC Type. Appendix A lists the different scenarios for selecting an IMT Purpose and IPC Type and includes the scenario descriptions and the sequence of required forms. Scenarios include:

· County Change

· Contract Change

· Location Code Change

· Residential Type Change

· LIDDA Change

Top Claims Rejections and Steps to Avoid Claim Rejections

HCS and TxHmL providers and LIDDAs might see one of the following explanations of benefits (EOBs) when a claim is rejected:

Explanation of Benefits

Description

F0138

A valid service authorization for this client for this service on these dates is not available.

F0268

A valid service authorization for this client for these service dates is not available or claim dates cannot overlap more than one service authorization.

F0077

Billing Code was not submitted or cannot be determined.

F0277

National Code is missing, invalid, or not billable with Procedure Code Qual.

F0325

Line item control number - required HHMM (military format)

To avoid having claims rejected, HCS and TxHmL providers should do the following before submitting claims to TMHP:

  1. Check the TexMedConnect Medicaid Eligibility Service Authorization Verification (MESAV) to get client Service Auth/Level/Client Hold/Eligibility information. The following client information should be verified:
    • Services authorized for the client.
    • Service dates authorized for the client.
    • The levels authorized for the client.
  2. Use the HCS and TxHmL Bill Codes Crosswalk to check for important claims information, such as the Line Item Control Number (LICN).

View previous postings below:

HCS and TxHmL Waiver Programs: Trending Issue Support, Volume 6

HCS and TxHmL Waiver Programs: Trending Issue Support, Volume 5

HCS and TxHmL Waiver Programs: Trending Issue Support, Volume 4

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 any additional questions, contact the TMHP LTC Help Desk at 800-626-4117 (select option 1, then option 7).