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HCS and TxHmL Waiver Programs: Trending Issue Support, Volume 15

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

Topic

Resolution

Assistance with Rejected or Denied Claims

For assistance understanding why a claim was rejected or denied, contact the TMHP Long-Term Care (LTC) Help Desk at 800-626-4117 (select option 1 and then option 7).

In order for the Help Desk to provide assistance, the caller must have the following information:

For rejected claims:

  • Batch identification (ID) number
  • Rejection code (starting with F0)
  • Submission date
  • Date of service (DOS) billed
  • Service code billed
  • Client name, patient control number (PCN), and date of birth (DOB)

For denied claims:

  • Claim internal control number (ICN)
  • DOS billed
  • Service code billed
  • Client name, PCN, and DOB

To ensure that claims are submitted correctly, and to avoid future claim rejections, please review the LTC TexMedConnect User Guide.

Claim Rejection Code F0288

If the DOS for a submitted claim is the same day as the client hold end date, the claim will be rejected with the explanation of benefits (EOB) code F0288 (“Client cannot be paid because consumer is on client hold for the given waiver program and date(s) of service”).

To avoid this rejection, the provider or LIDDA must change the client hold “Suspension End Date” to one day prior to the claim’s DOS. This will allow the system to bill the claim for the first day that the client returns to services.

For more information on client holds, refer to TMHP’s HCS and TxHmL Waiver Programs Frequently Asked Questions.

Identifying American Rescue Plan Act (ARPA) Payments

Remittance and Status (R&S) Reports can be used to identify ARPA payments by using the rate at which the claim was paid and calculating the difference between the traditional rate and the one listed on the R&S Report.

For instructions on how to read R&S Reports, refer to parts two and three of TMHP’s R&S Report Video Series for LTC Providers and FMSAs.

ARPA Payments for March and April 2022

The TMHP LTC Help Desk does not have access to ARPA payment information prior to May 2022. Providers should contact CARE at IEE_Help@hhsc.state.tx.us to inquire about ARPA payments from March and April 2022.

View previous postings below:

HCS and TxHmL Waiver Programs: Trending Issue Support, Volume 14

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

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

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