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HCS and TxHmL Waiver Programs: Trending Issue Support, Volume 8

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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 that additional support is required. Resolutions regarding the most frequently reported issues may be found in the table below.

Topic

Resolution

Termination Forms Submitted by LIDDAs

For clients who have CDS services only, termination forms are submitted by LIDDAs. After form submission, LIDDAs need to contact HHSC Program & Eligibility Support (PES) to acknowledge and review the forms. LIDDAs can contact HHCS PES by calling 512-438-2484, faxing 512-438-4249, or emailing enrollmenttransferdischargeinfo@hhs.texas.gov.

Long-Term Care Online Portal Sessions Must Be Restarted Daily

Providers and LIDDAs need to exit and restart their Long-Term Care Online Portal session daily to avoid issues, such as Submit Form buttons disappearing. Users who use the same portal session the following day may encounter this issue. 

Using the “Resubmit to SAS” Button

If a form receives a status of “Rejected by SAS,” a response code and the following note are added to the form history: “Service Authorization System (SAS) Change Request unsuccessful.”

The response code determines whether the form is:

· Sent to HHSC-LTC staff for resolution.

· Submitted to HHSC-LTC PCS.

· Needing LIDDA or provider action.

When the form is sent to HHSC-LTC staff for resolution, the form is set to status “Pending DADS SAS Resolution.” In this status, the form can be resubmitted to SAS, and then the status changes to “Submit to SAS.”

If submitted to HHSC-LTC PCS, the form will have the status “Submitted to PCS.” In this status, the form can be resubmitted to SAS, and then the status changes to “Submit to SAS.”

When a form status is set to “Provider Action Required,” providers and LIDDAs need to take action on the form and then use the Resubmit to SAS button. This will send updated form data to SAS for validation.

Providers and LIDDAs can use the Resubmit to SAS button in the following forms:

· 8578

· 3608

· 8582

· 3615

· 3616

· IMT

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.

Access to Electronic R&S and PDF R&S Reports

Providers are encouraged to submit an Electronic Data Interchange (EDI) Agreement to access the electronic version of their Remittance & Status (ER&S) Reports.

Providers should refer to the 835 Long Term Care Companion Guide for more information about the 835 ER&S Reports. Providers can retrieve ER&S reports dating back to when their submitter number was linked to their contract number.

Providers can also access the Portable Document Format (PDF) version of the R&S Report through TexMedConnect.

Note: PDF versions of an R&S Report are only available for 90 days following the publication of the R&S Report.

Providers can refer to the Remittance and Status (R&S) Reports for LTC Providers Quick Reference Guide (QRG) for more information.

View previous postings below:

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

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