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HCS and TxHmL Waiver Programs: Trending Issue Support, Volume 12

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Since May 2, 2022, Home and Community-based Services (HCS) and Texas Home Living (TxHmL) waiver 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 and LIDDAs indicating that additional support is required. Resolutions regarding the most frequently reported issues may be found in the tables below.

Topic

Resolution

Claims payment processing

TMHP typically pays claims within 5–7 business days of billing. Providers and LIDDAs experiencing delays for any claim payments, including American Rescue Plan Act (ARPA) claims, should contact the TMHP Long-Term Care (LTC) Help Desk at 800-626-4117 (select option 1 and then option 7).

Common Claims Rejections and Steps to Avoid Rejections

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

Explanation of Benefits

Description

F0077

Billing Code was not submitted or cannot be determined

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 authorization, level, client hold, and/or eligibility information. The following client information should be verified:
  • Services authorized for the client
  • Service dates authorized for the client
  • Levels authorized for the client
  1. Use the HCS and TxHmL Bill Code Crosswalks 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 11

HCS and TxHmL Waiver Programs: Trending Issue Support, Volume 10

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

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 (select option 1 and then option 7).