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HCS and TxHmL Waiver Programs: Trending Issue Support, Volume 13

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

Topic

Resolution

Individual Plan of Care (IPC) Form Revisions

To revise an IPC form (e.g., to increase/decrease services or to add/change requisition fees), the form must currently be in one of the following statuses:

· Processed/complete

· Dads SAS resolution complete

· PCS processed/complete

· Denial of services sustained

· Modification of services sustained

· Denial of transfer services sustained

· Modification of transfer services sustained

Providers may then click the Revise IPC button in the IPC form that needs revisions.

Step-by-step instructions for completing IPC Forms and revisions can be found in the following training materials in the Long-Term Care (LTC) Online Portal User Guides for Home and Community-based Services (HCS) and Texas Home Living (TxHmL) Waiver Programs learning path:

· LTC HCS and TxHmL Waiver Programs User Guide

· 3608 HCS Individual Plan of Care Item-by-Item Guide

· 8582 TxHmL Individual Plan of Care Item-by-Item Guide

Note: To access the TMHP Learning Management System (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 for support on creating an LMS account or navigating the LMS.

CDS Claims Billing

Data entered into the IPC for the IPC year must be verified before billing for CDS services. Submitters should enter the dollar amount in the following IPCs and their fields for CDS services:

For IPC 3608, the fields are:

· 31a, Consumer Directed Services Agency Authorized Units

· 87b, Authorized Units

For IPC 8582, the fields are:

· 31, Consumer Directed Services Agency Authorized Units

· 87b, Authorized Units

If a CDS service is billed using units instead of dollars, providers are at risk of not getting the correct dollar amount for their claim.

Note: CDS and Community First Choice (CFC) financial management services (service codes 63V and 63CFV) are not billed by dollar amounts; they are billed by units.

Retain TMHP Ticket Numbers

Providers who contact the TMHP LTC Helpdesk should keep a record of the ticket number provided. In the event of a disconnect, or if further assistance is needed, the ticket number is beneficial for tracking and resolving issues.

Billing for Day Habilitation

The correct Healthcare Common Procedure Coding System (HCPCS) codes and modifier combinations must be used when submitting Electronic Visit Verification (EVV) claims for in-home day habilitation.

EVV claims that do not match an accepted EVV visit transaction for HCS and TxHmL services will be denied.

Refer to the HHSC notice “HCS and TxHmL Providers Must Use Bill Codes Listed in the HCS and TxHmL Bill Code Crosswalk for Claims Submission” for more information on billing requirements, such as which day habilitation billing codes to use.

Rejection Code F0110

Providers can avoid receiving claims rejection code F0110 (“Matching history detail not found or not in adjustable status”) by making sure that the claim they are adjusting is the most recent claim and it is in paid status.

Individual Movement (IMT) IPC Improvement

Effective October 24, 2022, Health and Human Services (HHS) implemented processing improvements in the Service Authorization System (SAS) to minimize errors in the Service Coordinator validation. Changes to the processing of the IMT form and IPC forms (3608 HCS and 8582 TxHmL) will result in fewer forms moving to status Provider Action Required because of SAS error “GN-0034: Service Coordinator ID not valid or inactive for this Contract No.”

No action is required by the provider or LIDDA submitter. HHS has reprocessed active forms with this error.

If newly submitted forms appear in Provider Action Required with this response in the form history, please contact Provider Claims Services at 512-438-2200 (select option 5).

LTC Online Portal Dashboard Access Instructions

To access the LTC Online Portal dashboard, the administrator of the facility must ensure that a user account is created under the nursing facility (NF)/waiver programs (select "NF/Waiver Programs" from the drop-down box) and provide only the HSC/TxHmL permissions (listed below). There should be no Local Authority (LA) evaluator permission given. The administrator must also ensure that they do not have the same username account registered for TexMedConnect. Additionally, the TexMedConnect user account should not have hospice permissions.

The following permissions are applicable to users if their organization is currently contracted to provide HCS/TxHmL program services:

· Individual Movement Submitter

· Individual Movement Miscellaneous permission

· Provider Location Update Submitter

· Provider Location Update Miscellaneous permission

· IPC 3608 Submitter

· IPC 3608 Miscellaneous permission

· RCSS3615 Miscellaneous permission

· RTS3616 Submitter

· RTS3616 Submitter Miscellaneous permission

· IDRC 8578 Submitter

· IDRC 8578 Miscellaneous permission

· Dashboard Viewer

View previous postings below:

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

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

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