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HCS and TxHmL Waiver Programs: Trending Issue Support, Volume 9

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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 needed. Resolutions regarding the most frequently reported issues may be found in the tables below.

Topic

Resolution

Preventing claim denials for invalid date spans

Claims billed with date spans may deny with one of the following explanations of benefits (EOBs):

F0126: Claim line items cannot span current fiscal years.

The new state fiscal year (SFY) runs from September 1, 2022, through August 31, 2023. Claims will be denied with EOB F0126 if they are submitted with line item dates of service (DOS) spanning the previous SFY ending August 31, 2022, and the current SFY. Providers and LIDDAs submitting claims with DOS spanning the previous and current SFYs should submit separate claims for each SFY.

F0326: Incorrect number of days billed for this service.

Services that only allow billing for individual DOS may be denied with EOB F0326 if they are billed with date spans. These services should be billed as separate line items for each service date.

Claims adjustments reminder

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.

Providers can also adjust a previously adjusted claim in TexMedConnect. For instructions, refer to HCS and TxHmL Waiver Programs: How to Adjust a Previously Adjusted Claim.

View previous postings below:

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

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

HCS and TxHmL Providers Must Use Bill Codes Listed in the HCS and TxHmL Bill Code Crosswalk for Claims Submission

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, then Option 7.