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2015 Long Term Care Nursing Facility/Hospice

1. Diagnosis Cade Descriptions Diagnosis Code Description a Hospice Information WERE esteroveer om WEM me CoO Address o mE ciy o um state o Tx 10 zipe Physician Information Physician First Name State License No e Physician Last Date of Orders m Signatures HospiceRep First Name 1s Signature on File e 1s Client Signature on File e HospiceRep Last Name Date Signed Client Date Signed e _ 68 v 2015 0703 LTC Nursing Facility Hospice User Guide Hospice Form 3074 Medicaid Medicare Physician Certification of Terminal Illness Form 3074 fulfills several purposes Form 3074 is used to capture the Medicaid Physician s certification that the individual based upon the principal hospice diagnosis has a prognosis of six months or less to live if the terminal illness runs its normal course Medicare physician certification and completion of enrollment in the Medicaid Hospice program are additional functions of Form 3074 The provider must maintain a blank Form 3074 on file for reproduction An original can be found on the DADS website www dads state tx us forms This form is also located online at www tmhp com Pages LTC ltc forms aspx or on the TMHP LTC Online Portal under the Printable Forms fcature The physician completes Form 3074 when an indi
2. 34 2015 0703 LTC Nursing Facility Hospice User Guide Error Messages Upon submission if required information is missing or information is invalid error message s will display and you will not be able to continue to the next step until resolved You may need to scroll to the top of the screen since any error message s will be displayed at the top You may click the error message hyperlink to automatically go to the field s containing the error Home Submit Form Current Activity Drafts a Cio rar MINIMUM DATA SET MDS Version 3 0 RESIDENT ASSESSMENT AND CARE SCREENING Nursing Home Comprehensive NC Item Set Current Status Awaiting LTC Medicaid Information ee sere DLN RUG Form Actions Cot Section A Section B l Section Section D Section E Section F l Section Section Section Section J Section Section L Section M Section Section Section P Section Q Section X Section 2 Entering Dates To enter dates you have the option to click on the calendar icon next to any of the date fields to activate the dynamic calendar Choose the date desired Or you may enter in the date using the mm dd yyyy format DateofBith e 202 7 swa e l lell a 2015 0703 35 LTC Nursing Facility Hospice User G
3. 2 Enter data into remaining fields that are not auto populated At this time the provider will have the option to manually enter information or click the Populate LTCMI button and modify data as necessary Note To ensure that the LTCMI can be submitted once completed first check for the Submit Form button at the bottom of the screen If the assessment is being used locked by another user the Submit Form button will not be available displayed Additionally a message will display in the upper right of the screen This form is being viewed by another user and cannot be changed 3 Click the Prine button located in the yellow Form Actions bar to print the LTCMI in progress a Printer Choose the appropriate printer name from drop down box b Print Range Click the Pages radio button c Enter the pages to print As an example pages for the LTCMI for the MDS 3 0 Comprehensive are 41 44 Pages for the LTCMI for the MDS 3 0 Quarterly are 36 39 On O mmt von O umt paoe ce Error NC d Click che button v 2015 0703 79 LTC Nursing Facility Hospice User Guide 4 From here you have two choices a Click the Submit Form button located at the bottom right of the screen if ready to submit for processing CL Submit Form J 2 or Click the Save LTCMI button located in the yellow Form Actions bar if you would like to save t
4. Informational Websites Minimum Data Set MDS Quick Reference Guide MDS Telephone Numbers MDS Informational Websites Acronyms Appendix A Medicaid Eligibility Verification Resident with Medical Eligibility Appendix B Medicaid Eligibility Verification Resident with Pending Medicaid Eligibility Appendix C PASRR Level 1 Screening PASRR Level 1 Screening Section A PASRR Level 1 Screening Section B PASRR Level 1 Screening Section C PASRR Level 1 Screening Section D PASRR Level 1 Screening Section E PASRR Level 1 Screening Section F v 2015 0703 v LTC Nursing Facility Hospice User Guide Learning Objectives After reading this Long Term Care LTC Nursing Facility Hospice User Guide you will be able to Understand the Medicaid team roles Identify National Provider Identifier NPI requirements Obtain an LTC Online Portal administrator account Understand basic LTC Online Portal features Understand Medical Necessity MN and the MN Determination Process including the fair hearing process Identify the forms and screenings to be submitted and their sequencing including when and how to submit them Use Form Status Inquiry FSI to determine the number of residents in a facility with Mental Illness MI Intel lectual Disability ID or Developmental Disability DD Understand the Long Term Care Medicaid Information LTCMI section submission proces
5. Alternate Placement Process Resident Review Process How to Perform a PASRR Level 1 Screening How to Submit a PASRR Level 1 Screening Form Using FSI to Identify Residents with Specific PASRR Condition Interdisciplinary Team IDT Meeting IDT Tab on the PLI Medical Necessity and the MN Determination Process Definition of Medical Necessity General Qualifications for Medical Necessity Determinations Manual Medical Necessity Determination Process on MDS Manual Medical Necessity Determination on PASRR Evaluation Request for Fair Hearing MDS set to status PE MN Denied Forms to be Submitted Form 3618 Resident Transaction Notice Purpose of Form 3618 Repercussions of Submitting Form 3618 Late How to Submit Form 3618 Form 3619 Medicare Skilled Nursing Facility Patient Transaction Notice Purpose of Form 3619 Repercussions of Submitting Form 3619 Late How to Submit Form 3619 Hospice Form 3071 Election Cancellation Discharge Notice How to Submit Form 3071 ii v 2015 0703 LTC Nursing Facility Hospice User Guide Hospice Form 3074 Medicaid Medicare Physician Certification of Terminal Illness How to Submit Form 3074 MDS Assessments Validating the Appropriateness of an Admission Assessment MDS Dually Coded Assessments Long Term Care Medicaid Information LTCMI Submis
6. Individual Name 0200 social Security and Medicare Numbers Medicaid No BO400 Birth Date BOSDD Age at Time of Screening E 0000 Gender B0650 Individual is deceased ar has been F laischarged ased Discharged Date m B0700 Previous Residence 9 A Previous Residence Type Other Residence C Street Address D city 1 E State F ZIP Code 18 County of Residence B0800 of Kin Relationship to individual Other Relationship to individual a C First Name E Lost Name 1 Lt Phone Number Ec Street Address 2 State K ZIP code B0655 Des 184 42015 0703 19 Facility Hospice User Guide PASRR Level 1 Screening Section C eme A STATE MEDICAID CONTRACTOR Intellectual Disability 0300 Developmental Disability 15 there evidence or an indicator this is an individual that has a Mental Illness evidence or an indicator this is an individual that has an Intellectual Disability 1s there evidence or indicators that this is an individual that has a Developmental sebiity Related Condition other than an Intellectual Disability e g Autism Cerebral alsy Spina Bifida E See DADS related condition list Click Here Loc
7. A0310A has a response of 01 02 03 04 05 or 06 A0310A does not contain a 99 v 2015 0703 77 LTC Nursing Facility Hospice User Guide Name on the MDS is exactly the same as the individual s Medicaid ID card NPI entered in field AO100A matches the Vendor Contract information on the MESAV for that individual Using FSI to Identify Residents with Specific PASRR Conditions Nursing Facilities can use FSI to identify residents with specific PASRR conditions This can assist NFs in identifying the number of residents in the facility with Mental Illness MI and or Intellectual and Developmenral Disability IDD When selecting MDS 3 0 Minimum Data Set Comprehensive or MDSQTR 3 0 Minimum Data Set Quarterly assessment from the FSI Type of Form drop down box enter the appropriate value in the drop down box titled PASRR Eligibility Type 1 Click the Form Status Inquiry link in the blue navigational bar 2 Type of Form Choose one of the following options from the drop down box MDS 3 0 Minimum Data Set Comprehensive MDSQTR 3 0 Minimum Data Set Quarterly 3 Vendor Number Choose the submitter Vendor Number Contract Number from the drop down box 4 From the PASRR Eligibility Type drop down box choose one of the following 1 IDD Only 2 MI Only 3 IDD and MI 4 Negative E pem TMHP _A STATE MEDIK us Parte CONTRACTOR Form Status Inquiry Form Select Type of Form
8. bormerasum TMHP _ A STATE MEDICAID CONTRACTOR Form Status Inquiry Current Activity Alerts amine oco fandust pasan Evaluation C Lorem mo Gonduct Evaluation p Conduct evaluation Frstienfessan E wawa ow n p aana wo The Alerts screen displays A list of incoming and outgoing alerts are displayed The alert list only contains alerts for your Vendor Contract numbers Alerts are shown for the last 30 days from the current date Alerts older than 30 days from the current date are not available Alerts can be sorted by clicking the column header of the Alerts list Alerts can be deleted Once deleted they can not be retrieved 136 v 2015 0703 LTC Nursing Facility Hospice User Guide The Alert Subject column provides a brief description of the alert Click the Alert Subject link to see the alert detail Li pem TMHP STATE MEDICAID CONTRACTOR Form Status Inquiry Current Activity wt and 00 B E sumus wand ioe E sun 1p E azana 100 pH The alert detail describes exactly what needs to be done It also provides information about the individual and a link to the current PLI Screening Form or PE Click the Return to Alerts Page butt
9. 6 clicking the Update IDT button NFs will have the ability to update a successfully submitted IDT until it is confirmed by the LA LMHA PASRR LEVEL 1 SCREENING Current status tndlvidual placed in NF PE Confirmed Names wm DLN Username PEDEN Form Actions Na EDS essei v 2015 0703 49 LTC Nursing Facility Hospice User Guide Medical Necessity and the MN Determination Process For the PASRR Preadmission type TMHP is responsible for reviewing submitted PASRR Evaluations to determine MN for PASRR Positive individuals The initial MDS assessment will inherit the MN determination from the PE if the MDS assessment effective date is within 30 days plus or minus of the date of assessment of the For other MDS submissions including all other admission types and for PASRR Negative individuals TMHP is responsible for reviewing submitted MDS assessments to determine MN Definition of Medical Necessity 40 TAC 19 101 75 states Medical Necessity is the determination that a recipient requires the services of licensed nurses in an institutional setting to carry out the physician s planned regimen for total recipients need for custodial care in a 24 hour institutional setting does not constitute a medical need A group of health care professionals employed or contracted by the Medicaid claims administrator contracted with HHSC makes indivi
10. Pull a MESAV and review the Service Authorizations for this recipient Compare those dates to the dates that the recipient was in your facility Ifthe discharge of the pair was submitted as a Death in error inactivate the form then resubmit it as a Discharge If the form was correctly used to report the recipient s death validate the transaction date and correct the form as needed Ifthe transaction type Death and transaction date are correct identify the admission form that was submitted with an effective date after the death and correct the transaction date on that admission It may be necessary to contact DADS Provider Claims Services at 512 438 2200 Option 1 for assistance NF 0052 This admission modifica tion cannot be processed because the new admission date would create an overlap with an existing Service Authorization Verify the Service Authorizations already established and submit any ad ditional modifications 3618 3619 Admit Mod The earlier admission date on this correction will create an overlap with an existing Service Authorization if this correction is processed Review the facility s records to determine the recipient s admission and discharge dates and identify the Spell of Illness Pull a MESAV and compare the Service Authorizations to the earlier admission date that would be created by the rejected admission Consider the Qualifying Stays reported on any processed 3619s T
11. Section n Section c Section v Section E Section F Section Section Section t Section 1 Section x Section L Section M Section Section 0 Section P Section Q Section v Section X Section 2 Section 1 If che MN determination on the PE has not been overturned the NF will see the following error message Necessity MN on PE has not been overturned to approved MINIMUM DATA SET MDS Version 3 0 RESIDENT ASSESSMENT AND CARE SCREENING Nursing Home Comprehensive NC Item Set sa Marsa RR gt pel RUMINUS PREND Sect Section c section p Section 1 Section J Section K Section L Section M Section n Section Section P EET TES Note When MN on PE has not been overturned the NF may be able to find more information by viewing the History trail of the PE or by contacting the LA LMHA v 2015 0703 57 LTC Nursing Facility Hospice User Guide Forms to be Submitted Form 3618 Resident Transaction Notice Purpose of Form 3618 Form 3618 is used when the individual is in a Full Medicaid or Medicaid pending status refer to low chart in the Sequencing of Documents section of this User Guide A 3618 submission informs Medicaid Eligibility workers about transactions and status changes and provides DADS with information to initiate or close service authoriza tions or adjus
12. 5124 City Conditional This field is required if field 511a 1 Yes Enter the city of the Legally Authorized Representative 512e State Conditional This field is required if field 511a 1 Yes Enter the state of the Legally Authorized Representative 5121 ZIP Code Conditional This field is required if field 511a 1 Yes Enter the ZIP code of the Legally Authorized Representative 5129 Phone Optional This field is optional if field 511a 1 Yes Enter the contact telephone number for the Legally Authorized Representative if known 92 v 2015 0703 LTC Nursing Facility Hospice User Guide Sequencing of Documents The PLI Screening Form must always be submitted prior to admission regardless of payor source Refer to the Overview of PASRR Processes section of this User Guide for details Admission as a Full Medicaid Recipient Submit Admission P Full ATE d Comprehensive Submit ical em MDS per the oe CMS Guidelines This flow chart displays the process of an individual who is admitted as a Full Medicaid recipient Nursing facilities are required to initiate the HHSC Medicaid Eligibility application process to ensure valida tions occur with the Medicaid ID Medicaid Eligibility and the Applied Income A facility must submit a Form 3618 for an individual who has full Medicaid or is ap
13. LA LMHA collaborates with NF to secure Is individual a current LA LMHA is notified that individual requests LA LMHA performs Section E on the PL1 Alternate Placement NF resident Alternate Placement NS LA LMHA completes and A dates Section E on the PLI RE faxes PL1 to LA LMHA submits w gt Piton the Portai gt the Portal after submission by clicking on the Enter Disposition button 1 The LA LMHA is notified that the individual requests Alternate Placement The notification could come from DADS DSHS the or the individual LAR If the individual is NOT a current resident the LA LMHA is notificd by the RE by filling out Section E on the PLI 2 Ifthe individual is a current resident of an NF a The LA LMHA works in collaboration with the NF and Diversion Coordinator to coordinate Alternate Placement b The LA LMHA performs Section E on the PLI Screening Form by clicking on the Enter Disposition button c The NF will also indicate discharge of the individual on the PLI Screening Form if the PE has not been completed and the PL1 is not older than 90 days 3 Ifthe individual is NOT a current resident of an NF a RE faxes the Screening Form to the LA LMHA with Section E on the completed b The LA LMHA submits the PL1 Screening Form on the Portal c TheLA or LMHA completes the PE d The LA LMHA compl
14. Start date cannot be prior to September 1 2008 The following errors must be fixed before the form will submit v 2015 0703 103 LTC Nursing Facility Hospice User Guide Validations Requiring Provider Monitoring Documents process through several validations before reaching status SAS Request Pending The following will outline the various statuses which require close monitoring by the provider to ensure timely processing 1 Awaiting PE results in an alert being sent by the LTC Online Portal to the LA LMHA notifying the LA LMHA to complete the PE Until the LA LMHA submits the PE an NF cannot certify Able to Serve Individual or Unable to Serve Individual If the PE is successfully submitted it continues to the next validation Pending Placement in NF PE Confirmed An NF must view the PLI Screening Form and PE and certify Able to Serve Individual or Unable to Serve The admitting NF must also enter the Admitted To date on the PLI Screening Form 2 Medicaid ID Pending validation results in either ID Confirmed If confirmed it continues to next validation Medicaid ID Pending In this status validation attempts will occur nightly until eligibility is found the request is canceled or until six months has expired whichever comes first ID Invalid If the form or assessment is in this status the provider must verify Medicaid number SSN Medicare number and the first four letters of the last name
15. Facility should submit a 3618 Admission indicating admission from private pay Once the 3618 has been submitted any MDS assessment will be loaded onto the LTC Online Portal within 24 to 48 hours Please remember that the MDS LTCMI must be completed and submitted before TMHP can process the assessment IFTMHP is unable to retrieve the assessment from CMS because the individual s Medicaid number or SSN is dif ferent on the assessment from the current Form 3618 Admission the provider will have to submit an MDS modi fication to allow the LTC Online Portal to retrieve the assessment Modifications should be submitted to CMS in accordance with the RAJ Users Manual Note If the last name on the assessment does not exactly match the Medicaid Identification card there will be a conflict Correct the assessment to match the Medicaid Identification card if the card is correct If the name on the Medicaid Identification card is incorrect contact the appropriate Medicaid Eligibility worker to make name corrections so that there is an exact match Full Medicare Transitioning to Medicaid Full Form 3619 Medicare Admission Form 3619 Discharge Form 3618 Days 21 100 Admission This flow chart displays the process of an individual that is Full Medicare and transitioning to Full Medicaid Medicare reimburses for the first 20 days The facility must submit a 3619 Admission on da
16. Type of Form in the drop down box could result in status Provider Action Required Therefore cach of these Type of Form options must be reviewed individually This example will continue with choosing Form 3618 Providers will need to review all the other applicable Type of Forms as well Lk pem TMIP MEDICAID CONTRACTOR Mome form status Current Acivity Drafts Vendors Letters PrmtableForms Alens Help Form Status Inquiry Form Select Type of Form reve Transaction Notice 3535 Medioare SAP pacer Transaction Notice chent 2eseseni Reven anci Evaluation CARE 3 Enter the From Date and To Date range in the fields allocated 4 Form Status Choose Provider Action Required from the drop down box X EE lome sabm fom Gareat city Drafts Vendor Bele Form Status Inquiry Form Select Type of Form 3c kesden Sraniasion Weter s Vendor Number S fer Corie Kinder SES Form Status Inquiry DLN Medicaid Number Last Name First Name ES EH Form Status F From Date S Teese 5 Click the Search button found on the bottom right of the screen to submit the Inquiry 108 v 2015 0703 LTC Nursing Facility Hospice User Guide 6 Those 3618 forms with status Provider Action Required will display Note For confidenti
17. 138 v 2015 0703 LTC Nursing Facility Hospice User Guide 4 Choose the Alert Subject from the drop down box Each alert includes a standard message to the recipient Nursing Facility users can create the following alerts Conduct PLI Screening Conduct PE First Notification Conduct PE Second Notification Complete IDD Section on the PE Complete MI Section on the PE 5 Enterthe PLI Screening Form DLN or PE DLN if applicable 6 Enterthe Vendor No and Contract No for the LA LMHA to whom the alert will be sent 7 Enter individual identifying information 8 Click the Send Alert button The Create Alert window will close and you will be returned to the Alerts page Deleting Alerts Alerts can be deleted by a user When you have completed the action requested on an alert you may want to delete the alert Once an alert is deleted it cannot be retrieved 1 Select the alert you wish to delete by clicking the box in the Select column next to the alert You can select multiple alerts Menea x Hrarmicixs barras TMHP _A STATE MEDICAID CONTRACTOR mus 3 2 2036 s p 4735 2034 WLand 100 Outgoing Alerts por E etn sphow E Suma E snos E same DD B ansam B Aon 100 2 Click the Delete Alert button above the alert list A confirmation message is displayed Click the OK button to delete the alert clic
18. 3 0 Minimum Daia Set Comprehensive si Vendor Number Tor Contract Number MEH Form Status Inquiry Medicaid Number Last Name Fist Name Form Status SSN 4o From Date e Cw To Dato wi Purpose Code Reason for Assessment PASRR Eligibility Type 5 Click the Search button The search will return all current residents who meet the search criteria Current residents are determined by 78 v 2015 0703 LTC Nursing Facility Hospice User Guide 3618 3619 forms and or PASRR Level 1 PL1 Screening Form fields B0650 and B0655 NOTE The PASRR Eligibility Type field will display on the FSI page to Local Authorities and Local Mental Health Authorities LAJLMHAs who have authority to select an MDS 3 0 or MDSQTR 3 0 assessment however LAs LMHAs will not be able to obtain FSI search results using the PASRR Eligibility Type field How to Submit Long Term Care Medicaid Information LTCMI Once you have found and opened the assessment set to status Awaiting LTC Medicaid Information using FSI or Current Activity l Click the Section LTCMI tab eee a MINIMUM DATA SET MDS Version 3 0 Nursing Home Comprehensive ltem Set statusa wating LTC Medicaid Infomation Name DIN Form Actions Sia Verder ste 10 number Contract ravider Number sie Service Group S14 Hospice Contract Humber 1
19. 4 If the steps above do not resolve the error message continue on to the Specific Instructions section for the specific Provider Message displayed in the History trail of the form or assessment and its Suggested Action to correct the message v 2015 0703 113 LTC Nursing Facility Hospice User Guide Specific Instructions Provider Message Form Displayed in History Assessment Suggested Action GN 9101 GN 9105 This form 3618 3619 The recipient s applied income is not available to DADS cannot be processed because the MDS Pull a MESAV for the recipient covering the date requested on the client s Applied Income is not avail form or assessment able to DADS Contact the HHSC Note f the recipient does not already have Service Authorizations for Eligibility Worker to update the your contract this information will not be available on the MESAV client s Applied Income Once the If the MESAV does not show an Applied Income for the dates of Applied Income has been updated the form or assessment contact the HHSC Eligibility Worker to this form can be resubmitted update the Applied Income records Once the Applied Income has been updated resubmit the rejected form or assessment If the recipient is already estab lished in your facility you may monitor the MESAV for updated Applied Income If the MESAV does show an Applied Income for the dates of the form or assessment resubmit the rejecte
20. Appii Income 9 50 26 am Applied Income requested Applied 6 2 2015 9 56 00 AM Confirmed 72 2015 9 58 38 TMHP Applied Income confirmed SAS Request 6 2 2015 9 58 39 Pending 6 2 2015 9 58 39 aM The request being processed by DADS Please alow 2 4 business days for the next status change Procossed Comy 6 2 2015 10 00 02 AM 72 2015 10 00 02 AM SAS Change Request successful The example below shows status ZD Invalid indicating that the assessment failed Medicaid ID validation 10 invalid 5 1 2010 12 35 02 p 6 1 2010 12 55 02 Pm TMHP Medicaid ID is not vald 106 v 2015 0703 LTC Nursing Facility Hospice User Guide Provider Workflow Process Provider workflow allows providers to independently manage their documents when errors in the system s processing occur The system sends the form and assessment information to DADS and updates the MESAV The functionality of provider workflow allows providers to directly manage their rejections which occurred during the nightly process ing The benefit to this process is shorter time in resolution In summary documents are sent to the provider workflow if they are set to status Provider Action Required Documents reach this status if The form or assessment has not been successfully processed Ancrror occurred during the nightly batch processing Note Rejection error messages can be found within the form and assessment
21. Cerebrovascular Accident CVA Stroke Syncope Fainting ete Seja Foor Balance Weakness S amp js Confusion Disoriantaion Ssje gt Assault by Resident or staff Resident s Current Address 82 v 2015 0703 LTC Nursing Facility Hospice User Guide 58 Residents Current Address Sea Resk ress Sic ET Ste Pre 9 Medications all medications that ther ed medications that are used regularly but ess than weakly Medication Certification 1 certify 9 510 comments S11 Advance Care Planning Sia DADS Vendor Site ID Number Auto populated This field is auto populated based on the NPI number in field A0100A This field is not correctable If A0100A National Provider Identifier NPI is not correct on the MDS then the NPI must be fixed at the federal CMS level Sib Contract Provider Number Auto populated This field is auto populated based on the NPI number in field A0100A This field is not correctable selected from the drop down box If an NPI has more than 1 contract provider number associated with it be sure the correct contract provider number is Sic Service Group Auto populated This field is auto populated based on the user s log in credentials This field is not correctable on the TMHP LTC Online portal Sid Hospice Contract Number Conditional This field
22. Long Term Care Nursing Facility Hospice LTC Nursing Facility Hospice User Guide Contents Learning Objectives Medicaid Team National Provider Identifier NPI Atypical Provider Identifier API Requirements The LTC Online Portal Benefits of Using the LTC Online Portal LTC Online Portal Security How to Create an LTC Online Portal Administrator Account My Account Log In to the LTC Online Portal LTC Online Portal Basics Blue Navigational Bar Links Hom Submit Form Form Status Inquiry FSI Current Activity Draft Printable Forms Alerts Help Yellow Form Actions Bar Print Use as template Correct this form Update Form Add Inactivate Form Check MN Form Actions Available When Assessment is Set to Status Awaiting LTC Medicaid Information Save LTCMI Populate LTCMI v 2015 0703 i LTC Nursing Facility Hospice User Guide Required Certification of Able or Unable to Serve the Individual Other Basic Information Required Fields History UnLock Form Error Messages Entering Dates Timeout RUG Value Preadmission Screening and Resident Review PASRR Overview of PASRR Processes Admission Process Exempted Hospital Discharge Expedited Admission Process Preadmission Process
23. S6f Special Ports Central Lines PICC Optional Choose from the drop down box 0 N none present 1 Y 1 or more implantable access system or CVC 2 U unknown Use this field to indicate if the resident has any type of implantable access system or central venous catheter CVC This includes epidural intrathecal or venous access or Peripherally Inserted Central Catheter PICC devices This does NOT include hemodialysis or peritoneal dialysis access devices 88 v 2015 0703 LTC Nursing Facility Hospice User Guide LTCMI Fields S6g At what developmental level Conditional Choose from the drop down box Unknown or unable to assess 1 1 Infant 2 1 2Toddler 3 3 5 Pre School 4 6 10 School age 5 11 15 Young Adolescence 6 16 20 Older Adolescence This is a required field for all assessments on residents who are 20 years of age or younger based on birth date minus date of submission TMHP Received date This field is not available for data entry if the resident is 21 years of age older S6h Enter the number of times this resident has fallen in the last 90 days Required Record the number of times the resident has fallen in the last 90 days Enter 0 zero if no falls Each fall should be counted separately If the resident has fallen multiple times in one day count each fall individually Valid range includes 0 zero 999 Leading zeroes may be included or
24. Transaction that is equal to or more than five years old the form will not be accepted onto the LTC Online Portal Additionally forms with a future date in the Date of Above Transaction field will not be accepted onto the LTC Online Portal Please provide a reason in the comments field why the Dates of Qualifying Stay for this client do not equal 20 The Dates of Qualifying Stay must add up to exactly 20 non duplicative days If the Dates of Qualifying Stay do not equal 20 a comment is required in the Comments field Correct the Dates of Quali equal 20 ing Stay to If the dates do not equal 20 days because additional space is needed add a comment to the form indicating that additional forms are being submitted to capture the full 20 days If the client has a Medicare replacement policy indicate the following information in the comments Medicare replacement Name of the insurance carrier Number of co pay days allowed Daily co pay amount v 2015 0703 157 LTC Nursing Facility Hospice User Guide Document Statuses Providers can retrieve the status of their documents by using FSI or Current Activity on the LTC Online Portal The following are statuses that a provider may see and their definition AI Check Inactive Applied Income validation attempted nightly for up to six months and failed or the request was canceled The provider may restart the assessment once the rea
25. amp Recipient s LastName S Address Address 2 Social Security No Name Recipient s First Name Cty 3 Medicare or RR Retirement Reciplent s Middle Claim No Initial ze T Reciplent Name Suffx Service Group ___ Transaction stion Date of Physical Admis ter i Date of Above Transaction F IF Newly Admitted FronDischarged To Hospital cert that to the best of my knowledge the date in 11 Date of Above Transaction i for services provided and the date is not included In the 100 Medicare Part A reimbursement time frame Administrator State Board License No Administrator Last Name 1 Administrator First Name Is Administrator Signature Form Ci e Date Sioned S 7 From here you have two choices Click the Save as Draft button in the yellow Form Actions bar to save the form or screening until you are ready to submit The form or screening does not have to be complete to save the draft or b Click the Submit Form button located at the bottom of the screen to submit the form or screening v 2015 0703 15 LTC Nursing Facility Hospice User Guide Form Status Inquiry FSI The FSI feature provides a query tool for monitoring the status of documents that have been successfully submitted ESI allows providers to retrieve submissions in order to Access
26. Appendix C PASRR Level 1 Screening The PASRR Level 1 Screening is divided into six sections labeled A through E Below are images of each section 182 v2015 0703 LTC Nursing Facility Hospice User Guide PASRR Level 1 Screening Section A Current status Names rafts Vendors Letters Printable Forms Alerts PASRR LEVEL 1 SCREENING A0100 1 A0200 Address A Street Address 1 City I 1 State ense E AG300 NPI API A400 Contract No A050 Vendor o A0510 County A0700 Screener First Name Middle Initial C Last Name D Suffix A0800 Position Title of Entity A1000 Current Location A1100 Date of Last Physical Examination A TypeofEntity 8 Other Type ul Entity HL 1 Physician First D Physician Middle Initial 34 a E Physician Last Name Physician suffix A Nome 1 Street Address c city State a E A1200 Signature certify that to the best of my knowledge this information is true and accurate A Certification of Signature B Signature Date Submit rom 2015 0703 183 LTC Nursing Facility Hospice User Guide PASRR Level 1 Screening Section B PASRR LEVEL 1 SCREENING
27. Confir mation will be made that the Spell of Illness does not exceed 80 days n to be processed v 2015 0703 LTC Nursing Facility Hospice User Guide Provider Message processed because it would cancel the client s Enrollment with a dif ferent provider Verify the effective date and correct it as needed If the date is correct contact Provider Claims Services for assistance Form Assessment 3618 Admit Suggested Action is 3618 admission would cancel the previous provider s Service Authorization rather than auto discharge the reci nt from the previous provider Review the facility s records to determine the recipient s admission and discharge dates If the 3618 admission s transaction date is correct contact the prior facility and request that they review their admissions and discharges If the prior facility agrees to make adjustments allow processing time and resubmit your rejected admission NF 0081 This admission cannot be processed because the client is already admitted into your facility as of the submitted admission date Verify current Service Authoriza tions on file and submit the needed 3618 3619 discharge prior to the submitted admission date to allow this 3619 admission to process 3619 Admit The recipient has an ongoing Service Authorization for your facility processed 3618 or 3619 admission Review the facility s records to determine
28. If the individual s medical condition is not appropriate for transport by ambulance nonemergency ambulance services are not a benefit Prior authorization is a condition for reimbursement but is not a guarantee of payment The individual and provider must meet all of the Medicaid requirements such as individual eligibility and claim filing deadlines Medicaid providers who participate in one of the Medicaid Managed Care Organization MCO plans must follow the MCOs prior authorization requirements The TMHP Ambulance Unit reviews the prior authorization request to determine whether the individual s medical condition is appropriate for transport by ambulance Incomplete information may cause the request to be sus pended for additional medical information or be denied The following information assists TMHP in determining the appropriateness of the transport An explanation of the individual s physical condition that establishes the medical necessity for transport The explanation must clearly state the individual s conditions requiring transport by ambulance The explanation must clearly state the individual s condition requiring transport by ambulance The necessary equipment treatment or personnel used during the transport origination and destination points of the individual s transport Prior authorization is required when an extra attendant is needed for any nonemergency transport When an indi vidual condition chang
29. LA Local Authority Legally Authorized Representative Late Assessment An assessment received on day 123 is considered late The previous RUG for that individual has expired as of day 123 LMHA Local Mental Health Authority v 2015 0703 175 LTC Nursing Facility Hospice User Guide LIC Long Term Care LTCME Long Term Care Medicaid Information The LTCMI is the replacement for the federal MDS Section S and contains items for Medicaid state payment Once your MDS assessments have been transmitted to CMS will retrieve all assessments that meet the retrieval criteria and assign DLN The assessment will be set to Awaiting LTC Medicaid Information status Managed Care Organization MDS Minimum Data Set MEPD Medicaid for the Elderly and People with Disabilities MESAV Medicaid Eligibility Service Authorization Verifications Missed Assessment Missed assessment is an assessment not submitted within the Anticipated Quarter or within 92 days of the dates that the assessment covers The Anticipated Quarter is defined as the 92 day antici pated MDS assessment quarter following the 92 day span of the current MDS assessment MN Medical Necessity MQME Medicaid Qualified Medicare Beneficiary NP Nurse Practictioner NPI National Provider Identifier Office of Eligibility Services OIG HHSC Office of Inspector General PA Physicians Assistant PAN Prior Author
30. LTC Nursing Facility Hospice User Guide 2 Choose a document by clicking the corresponding link A new window and application called Adobe Reader will open and display the blank document in Portable Document Format PDF s Woa m Drm IE GT 1 entier Date MINIMUM DATA SET MDS Version 3 0 E RESIDENT ASSESSMENT AND CARE SCREENING Nursing Home Comprehensive NC Item Set e eion information 0100 Facility Provider Numbers National Provider Identifier NPI B CMS Certification Number CCN EIE state Provider Humber 0200 Type of Provider Emur Code Type of provide 1 Nursing home SNF NF 2 Swing Bed 0310 Type of Assessment A Federal OBRA Reason for Assessment 01 Admission assessment required by day 14 Enter Code Note Once open you may begin entering information into the document and save it to your desktop 22 v 2015 0703 LTC Nursing Facility Hospice User Guide 3 Click the Print Icon Ds To print the entire document a Printer Choose the appropriate printer name from drop down box b Print Range Click the AII radio button c Click the OK button To print certain pages instead of the entire document a Printer Choose the appropriate printer name from drop down box b Print Range Click the Pa
31. actions are needed NF 0010 This assessment cannot MDS Signifi An assessment other than a Quarterly with the same effective date be processed because an assess cant Correction is already on file A Significant Correction to a Prior Quarterly cannot ment with the same effective date toa Prior replace it has already been processed andis Quarterly Verify if the MDS Assessment Completion Date on the rejected not a Quarterly Review Assessment assessment is correct If not submit a modification to the federal Continue to submit assessments CMS database to correct it based on the client s MDS assess Ifthe MDS Assessment Complete Date is correct determine ment schedule which Reason for Assessment is appropriate and inactivate the other MDS If the processed assessment is inactivated the rejected assessment can be resubmitted once the inactivation is processed If the rejected assessment is inactivated no further actions are needed NF 0011 This admission cannot 3618 Admit The provider has reached the limit of Swing Bed days allowed for the recipient during 12 month period Medicaid Swing Bed services are limited to 30 days per stay Verify dates and if the submitted date is wrong correct the rejected admission and resubr 116 v 2015 0703 LTC Nursing Facility Hospice User Guide Provider Message layed in History NF 0012 This form cannot be processed because the client is cur rentl
32. check the ELECT box and include only the FROM date An individual or responsible party signature is required on all Elect form types If the form will update information already provided on an existing election document check the UPDATE box include only the FROM date and complete the appropriate fields Forms indicating Update do not require an individual or responsible party signature Complete an update transaction to a document if Ihe contract numbers change because of a change in ownership or a transfer between hospice providers The individual changes location from to community or Nursing Facility There is a change to the principal diagnosis Updates should be submitted when a provider needs to change the information for future services If it is necessary to correct previously submitted information for previous service dates submit a Correction More information about Corrections to Form 3071 can be found in the Corrections section of this User Guide If the form is intended to cancel terminate an individual from the Hospice program check the CANCEL box and include only the TO Date An individual or responsible party signature is required if the cancellation code is 14 Individual Transferred to Another Service Other Than Hospice or 77 Individual Withdrew Was Dissatisfied Or Refused Service When an individual transfers from one hospice provider to another hospice provider the hospice provider currently
33. providing services enters cancel code 77 on Form 3071 and the hospice provider initiating services completes Form 3071 electing hospice The transition from one hospice provider to another begins a new service authorization period because the service authorization date changes to reflect the date of transfer The receiving hospice must complete a new Form 3074 prior to the end of the service authorization period for the transferring hospice On Line 13 enter the principal hospice diagnosis as reported by the certifying physician Additional pertinent coex isting diagnoses are entered on Lines 14 through 16 If there are additional diagnoses to be documented enter them in the Enter Comments Box 17 Document the ICD code for each diagnosis recorded Non specific diagnoses such as Adult Failure to Thrive or Debility will not be accepted as the principal hospice diagnosis The Setting field indicates where the individual is receiving hospice services The setting determines which hospice services are authorized Community type settings are not authorized for Room and Board services An individual who resides in an assisted living facility is considered to be in the Community and the setting should be Home Verify the classification of the facility before indicating the individual is in an NF or an Intermediate Care Facility for Individuals with Intellectual Disabilities ICF IID facility NF and ICF IID facilities must have an asso
34. submit the missing or rejected discharge followed by the admission and discharge pair If the discharge is reflected on the recipient s MESAV contact DADS Provider Claims Services at 512 438 2200 Option 1 for assistance NF 0018 This discharge cannot be processed because the client is currently admitted to Medicare Part A Coinsurance and does not have corresponding Nursing Facility admission missing 3618 Verify that the admission 3618 has been processed 3618 Discharge The recipient has a Service Authorization for Medicare Part A Coin surance as of the submitted discharge date Review the facility s records to determine which admission is prior to this discharge Pull a MESAV and review the Service Authorizations to determine if Coinsurance is authorized for your facility If so submit a 3619 discharge to close the Coinsurance Review the LTC Online Portal to determine the status of the prior 3618 admission If it is rejected verify if the issue still exists and take the necessary actions to process the admission Once the admission has been processed resubmit the rejected discharge If the rejected discharge is reflected on the recipient s MESAV contact DADS Provider Claims Services at 512 438 2200 Option 1 for assistance NF 0019 This discharge cannot be processed because the client is not admitted into your facility If an admission prior to this discharge is rejected t
35. the inactivation will reject with an appropriate error message If the system fails to identify the assessment the inactivation will also reject and be researched manually by DADS With each situation a response will be posted on the LTC Online Portal Note Refer to the MDS 3 0 RAI User s Manual Chapter 5 for detailed instructions on completing an MDS Inactiva tion The Users Manual can be found under Downloads on the CMS website at www cms gov NursingHomeQualityInits 25 NHQIMDS30 asp Note Providers should only submit an inactivation on dually coded assessments afier attempting to submit a modification via CMS An inactivation will affect Medicare as well as Medicaid reimbursement Forms 3618 and 3619 Inactivations Forms 3618 and 3619 inactivations must be submitted directly on the LTC Online Portal after being located by a search using FSI or Current Activity Once the inactivation is submitted and accepted the form is set to status Form Inactivated and is unavailable for any further action 150 v 2015 0703 LTC Nursing Facility Hospice User Guide How to Inactivate 1 Log in to the LTC Online Portal 2 Click the Form Status Inquiry or Current Activity link in the blue navigational bar a Ifusing FSI you may search for Form 3618 or 3619 using SSN Medicaid Number or DLN Click the Search button then click the View Detail link b fusing Current Activity click the DLN link 3 Click the Inact
36. 3618 has been processed 3618 Discharge The corresponding Nursing Facility admission is not in the recipi ent sfile Review the facility s records to determine the admission prior to this discharge Pull a MESAV and review the Service Authorizations to determine if the prior admission has processed and authorized services If the MDS for the admission has not processed you will not have services authorized If the MESAV reflects that the recipient is currently in the facility per an admission prior to the admission that corresponds with this discharge research the recipient s records to identify the discharge between those two admissions Submit that missing or rejected discharge followed by the admission that corresponds with this rejected discharge Resubmit this rejected discharge If this rejected discharge is reflected on the recipient s MESAV contact DADS Provider Claims Services at 512 438 2200 Option 1 for assistance NF 0023 This admission cannot be processed because it is effective during a Service Authorization for a different provider Correct the admission date or contact the other provider to determine proper dates 3619 Admit The recipient has a Service Authorization for a different facility pro cessed admission and discharge for a different provider cover the submitted admission date Contact the prior facility to request that a correcting discharge be subm
37. 48 hours before the MDS 3 0 assessment is accessible on the LTC Online Portal for data entry in Awaiting LTC Medicaid Information status Note The effective date of quarterly review assessments with a date after the 30 day submission period can be adjusted by contacting DADS Provider Claim Services PCS directly to make the adjustment Assessments loaded onto the LTC Online Portal are assigned a DLN and set to status Awaiting LTC Medicaid Information Providers must log in to the LTC Online Portal and use FSI or Current Activity to find the submitted MDS assess ment set to status Awaiting LTC Medicaid Information Complete the LTCMI and submit The MDS assessment must be accepted by the LTC Online Portal and have an LTCMI completed to begin the MN determination process Periodically review the status of the MDS assessment for MN and Medicaid Processing using FSI or Current Activity When an MDS assessment is set to status PE MN Denied but the MN determination on the PE has been over turned the NF can change the status of the MDS assessment For more information see the MDS set to status PE MN Denied section of this User Guide Note Providers should follow the federal MDS 3 0 RAI Users Manual for submission of an assessment If the provider follows the federal guidelines for submission and completes the LTCMI on the LTC Online Portal there will not be a lapse in Texas Medicaid coverage 74 v 2015 0703 LTC Nursing Facility
38. Date of Above Transaction instead because DADS pays for the date of death Confirm the transaction date for the rejected form and submit correction of the date as needed If the date is correct but the form is under the incorrect contract inactivate the form and resubmit with the proper contract If there is not an active contract for the transaction date the submission will have to be held until the contract has been approved v 2015 0703 LTC Nursing Facility Hospice User Guide Provider Message layed in History NF 0075 This discharge cannot be processed because a different Contract Number for the same Ven dor Number is valid as of the form effective date Adjust the effective date or inactivate this discharge and submit for the correct Contract Number Form Assessment 3618 Discharge Suggested Action discharge has been submitted using the incorrect Contract Number The facility has had a Change of Ownership and the dis charge needs to be submitted using the Contract Number that was active on the effective date of the discharge Note The effective date of a discharge is the Date of Above Transaction minus one day Exception For a 3618 discharge marked Deceased use Date of Above Transaction instead because DADS pays for the date of death Confirm the transaction date for the rejected form and submit a correction of the date as needed If the date is correct b
39. History trail Ownership for resolution belongs to the provider The provider workflow is the responsibility of the provider to monitor and manage Documents end up in the provider workflow as a result of the system s processing discovering an error while attempting to process the form or assessment System processing errors including rejection messages are found within the History trail of the form or assessment and the form or assessment is set to status Provider Action Required Once a form or assessment is set to status Provider Action Required the form or assessment will require provider action before processing on that particular form or assessment continues Type of Forms being sent to the provider workflow include 3618 3619 MDS 3 0 and MDSQTR 3 0 Ifa batch error occurs the error will display in the History trail of the form or assessment The form assessment will set to status Provider Action Required Finding Documents Set to Status Provider Action Required Using FSI To find the items in your provider workflow i c those items with system processing errors to be resolved by the provider 1 Click the Form Status Inquiry link in the blue navigational bar v 2015 0703 107 LTC Nursing Facility Hospice User Guide 2 of form Choose Type of Form c g 3618 from the drop down box Note Form 3618 or 3619 MDS 3 0 Minimum Data Set Comprehensive and MDSQTR 3 0 Minimum Data Set Quarterly
40. Hospice User Guide MDS Dually Coded Assessments Dually coded assessments will be retrieved and loaded onto the LTC Online Portal nightly if the retrieval criteria above are present If the assessment is processed successfully for Medicare but fails due to the Medicaid ID Recipi ent name the provider should refer to the MDS 3 0 RAI Users Manual Chapter five for further instructions and guidelines for submitting modifications to key resident identifying information fields The MDS 3 0 RAI User s Manual can be found under Downloads on the CMS website www cms gov NursingHomeQualityInits 25_ NHQIMDS30 asp TopOfPage Dually coded assessments can be submitted as multiple combinations If the individual has been established with MDS RUG for the facility then discharges to the hospital and returns to Medicare the assessment can be dually coded for the appropriate Medicaid assessment due and the proper Medicare assessment due An assessment for an established individual admitting to Medicare can be coded as a Medicaid Quarterly and a Medicare five day assess ment If an assessment is coded for a Medicaid Admission assessment and a Medicare five day assessment and the resident has a current RUG already established the Medicaid admission RUG will not be used unless the individual was out over 30 days or discharged Return Not Anticipated If the RUG is wanted for Medicaid it will require inactivating the assessment at CMS and resubmitt
41. Individual button located in the yellow Form Actions bar Click the OK button when the pop up window appears Press OK to confirm Able to Serve Individual Press Cancel to cancel transaction Cee or v 2015 0703 31 LTC Nursing Facility Hospice User Guide b certify that the NF does not have the ability to serve the individual click the Unable to Serve the Indi vidual button located in the yellow Form Actions bar Click the OK button when the pop up window appears Press OK to confirm Unable to Serve Individual Press Cancel to cancel transaction 3 The following confirmation screen will appear TINAS MEDICAID ae HEALTHCARE PARTNERSHIP TMHP _A STATE MEDICAID CONTRACTOR Current Activity Drafts Your form was submitted successfully You can track this form using the DLN Submit another form Inquiry on a forms Status The corresponding field in Section D of the PL1 Screening Form 00100 will be systematically updated to show either 0 No or 1 Yes Note Once the PE has been submitted by the Local Authority LA Local Mental Health Authority LMHA the NF has 90 days to certify Able to Serve the Individual or Unable to Serve the Individual If afier 90 days none of the listed on the PLI Screening Form in Section D have indicated an ability to serve the individual then a new Screening Form must be submitted For more information abo
42. Intelectual Dsabiity Related Condition Assessment prapopulate recipient information please provide one of the following combinations of information Medicaid CSHCN ID Social Security Number AND Last Name or Social Security Number AND Date of Birth Date of Birth AND Last Name AND First Name Medicaid Number SSN Date of Birth First Name oo Note Hospice providers will have the 3071 and 3074 form types available for submission 3071 Recipient Election Cancellation Discharge Notice 3074 Physician Certification of Terminal Illness To submit a form or screening 1 Login to the LTC Online Portal 2 Click the Submit Form link located in the blue navigational bar 3 of Form Choose from the drop down box 4 If desired enter additional information about an existing recipient This will auto populate the form or screen ing with the recipient s demographical information except gender 5 Click the Enter Form button and the form will display for data entry 6 Enter all required information as indicated by the red dots Note Additional information about required fields marked with a red dot can be found in the Other Basic Inj mation section 14 v 2015 0703 LTC Nursing Facility Hospice User Guide Ed mmm 3618 RESIDENT TRANSACTION NOTICE Current Status DLN 1 Medicaid Recipient No
43. LTC Nursing Facility Hospice User Guide Appendix B Medicaid Eligibility Verification Resident with Pending Medicaid Eligibility 180 LTC Nursing Facility Hospice User Guide uoxinq aeneo uo Buppip Kqiuauissasse ajen2eai ue JN sypuow 9 payne JW 5 uopisaa J a iv pau QI pieoipaw YYSyd o1 4190 you sao a preoipaw Bujpuad uii yuapisay uonexyueA uoneoidde mau aqelleAe aq Jou Iv JN 1281102 JOU iuopisai J 33oN W404 111521 0 JHW 3983U02 NIS3W 10u ING SYS ut JI 504 123002 ty OU J SYILL 4830 JW PLIUOD OU JI SYJLL UON JW 1283u02 uoneoidde eu skep sy ql pre2ipew 1 dawbupus Iv Bupuag 4 ROI Ru IVBupusd sad palyaq sp u mau ou jj jN1221105 pauuyuo JW you NM E i fi 3 ro P pauuyuo dl PIN panoddy NW fassssom repo 3 preoipaw sy Buipuag jsenbay sys pauuguo y 181 v 2015 0703 LTC Nursing Facility Hospice User Guide
44. Part A Coinsurance on this correc tion cannot be processed because Mod tion would create an overlap with Full Medicare dates already on the the new discharge would create an recipient s file if this correction is processed as submitted overlap with an existing Full Medi Review the Medicare Remittances for this Spell of Illness to care period Verify the Full Medicare determine the Full Medicare and Coinsurance dates periods and Service Authorizations Pull a MESAV and compare the Service Authorizations on file and already established and submit any the additional Coinsurance to the remittance dates The system additional modifications has determined that the additional Coinsurance dates would create an overlap with existing Service Authorizations Also consider the Qualifying Stays reported on the processed 3619s These dates create Full Medicare periods which do not appear on the MESAV Submit any additional 3619 corrections to adjust begin or end dates to allow this discharge correction to process NF 0074 This form cannot be 3618 3619 The effective date of this form is outside the provider s contract processed because the submitted Contract Number is not valid as of the form effective date Adjust the effective date or resubmit with the correct Contract Number dates Note The effective date of a discharge is the Date of Above Transaction minus one day Exception For a 3618 discharge marked Deceased
45. ProviderFacing 2 System will allow comments entered by the provider to be seen only by internal state staff The comments will not be seen by the provider 1 ProviderFacing will allow comments entered to be seen by both state staff and the provider In either case the comments will be seen in the History trail of the form or assessment and are for informational purposes only These comments will NOT be used in the system processing of the forms v 2015 0703 111 LTC Nursing Facility Hospice User Guide Submit Form Change Status for form to Submit to SAS Enter the notes below I you would like the provider to see the note please select the provider facing option from the list below cones The provider may choose to enter comments Entering comments is optional Click the Cancel button to cancel the request keeping the form or assessment set to status Provider Action Required or b Click the Change Status button form or assessment is then set to status SAS Request Pending 16 Once one of the actions have been completed Correct this form Inactivate form or Resubmit Form the status of the form or assessment will no longer be set to status Provider Action Required Processing will continue based upon action chosen 17 The provider should repeat all the steps for cach particular Type of Form until there are no m
46. Signature on a Data ie License Type 5tate of T Lic Num State Licens Exclusion Statement Exclusion statement tast Statement m Fest Name Je Sianature on rz Date Signed m v 2015 0703 71 LTC Nursing Facility Hospice User Guide MDS Assessments The LTC MDS a standardized primary screening and assessment tool of health status that forms the founda tion of the comprehensive assessment for all recipients in a Medicare or Medicaid certified LTC facility The MDS contains items that measure physical psychological and psychosocial functioning The items in the MDS give a multidimensional view of the individual s functional capacities and helps staff to identify health problems Assessments that providers may submit to CMS and for Medicaid payment include Admission assessment required by day 14 Quarterly review assessment Annual assessment Significant change in status assessment e Significant correction to prior comprehensive assessment Significant correction to prior quarterly assessment Inactivation Modification MDS 3 0 assessments that are accepted by federal CMS are retrieved by TMHP nightly loaded onto the LTC Online Portal and set to status Awaiting LTC Medicaid Information Once the LTCMI has been successfully completed and submitted on the LTC Online Portal the MN determination process will begin MDS 3 0 Admission assessments are effe
47. The MDS must be submitted to CMS in accordance with the RAI User s Manual whether Medicare Medicaid or private pay status MDS submissions to CMS are not dependent upon the payor source The form must be signed and submitted by the facility administrator within 72 hours of the individual s Admission to or Discharge from the Medicaid Vendor System to be considered timely A facility administrator may authorize a person to sign the form in their absence The authorization must be in writing and on file at the facility The administrator date signed check box is required for Forms 3618 and 3619 58 v 2015 0703 LTC Nursing Facility Hospice User Guide If the facility is temporarily without an administrator a signature is still required Note in the comment section of Form 3618 that the facility is without an Administrator at this time and enter 999999 in field 13 for the State Board License No Note Nursing Facilities are reminded that a Form 3618 Discharge must be submitted after a resident is classified as Hospice and continues to reside in the facility If the individual is classified as Hospice upon admission Form 3618 should not be submitted Hospice providers should only submit Forms 3071 3074 If the individual is Medicare for a non related condition and classified as SNF Skilled Nursing Facility by the Hospice provider Form 3619 is appropriate Nursing Facilities should inactivate any Forms 3618 3619 rejected to the Provid
48. a Medicaid coverage type of P prior eligibility The LTCMI section should include Sle M Purpose Code Coverage Code must be P Fons THF com My Aeon Authorizatie Monthly units Servico Groun Service Code Effective Year month Units available Units Pald croup Template ESL p 1012030 ue Code Barch History S1f Missed Assessment or Prior Start Date This is the prior eligibility start date Slg Missed Assessment or Prior End Date The correction of an existing LTCMI Purpose Code to an E or M invalidates the original time frame If the LTCMI is changed to indicate a PC E or PC M and the assessment had been part of the individual s cycle the original time frame is voided e g set to status Corrected and only the PC E or M dates will be covered More information on Purpose Code E and M can be found at www dads state tx us providers communications 2009 letters IL2009 27 pdf The information below is an excerpt from the Information Letter referenced above 102 v 2015 0703 LTC Nursing Facility Hospice User Guide What is a Purpose Code M and How Do You Complete a Purpose Code M Purpose Code M an MDS submitted if three months prior to application is granted after the individual is certi fied for Medicaid When there is an application for Medicaid the individual s financial eligibility is considered and reviewed based
49. a discharge form prior to this admission Attempting to submit two 3619 admissions a row missing a 3619 discharge Submit the missing discharge then submit the 3619 admission Last form submitted was a discharg Please supply admission form prior to this new discharge Rejection of New Discharge for missing Previous Admission New discharge follows a discharge for same contract i e 11 1 2008 discharge no admission 12 1 2008 discharge submitted Submit an admission form prior to this discharge Attempting to submit two 3619 discharges in a row missing a 3619 admission Submit the missing admission then submit the 3619 discharge 156 2015 LTC Nursing Facility Hospice User Guide System Message displayed at time of submission System Message Clarification System Message Resolution assistance for resolving error Same contract An admission has already been received for the Date of Above Transaction OR Different contract An admission from another provider has already been received for the Date of Above Transaction Rejection of New Admission for Same Date of Above Transaction New admission has same Date of Above Transaction as an admission already received i e 11 1 2008 admission 2008 admission 11 Same contract Possibly attempting to submit a duplicate form OR Different contract A different provider has previously submitted an admissi
50. and the LTCMI is completed on the LTC Online Portal within 91 days of the new MDS assessment Z0500B date If the new MDS assessment is submitted after the expiration of the RUG on file but within the anticipated quarter the gap following the 31 days and prior to the new Z0500B date will automatically be filled with the new calculated RUG If the new MDS is not submitted within the anticipated quarter or the LTCMI is not completed within 91 days of the Z0500B date a gap will be created following the 31 days until the Z0500B date of the new assessment Payment for this gap will be made at the PC E default rate To fill the gap submit an Admis sion Annual or Quarterly MDS assessment including the LTCMI by completing Ihe Sle field on the LTCMI completed as the PC E The Missed or Prior Assessment Start Date S1f The Missed or Prior Assessment End Date S1g Note Ta submit a PC E for a one day gap the Missed Assessment Start Date and the Missed Assessment End Date must be the same 100 v 2015 0703 LTC Nursing Facility Hospice User Guide 2 Missed MDS If an LTCMI is submitted more than 91 days after Z0500B date of the assessment the assess ment will have to be submitted as a PC E Payment for this gap will be made at the PC E default rate Submit the assessment including the LTCMI by completing The Sle field on the LTCMI completed as the PC E Missed or Prior Assessment Start Date 510 Th
51. and with the same date in the Date of Above Transaction field Examples A discharge to the hospital is submitted in error because the admission to the hospital was for observation only and no form should have been submitted If the discharge processes before the mistake is corrected submit a counteracting form indicating an admission in the Transaction field and use the same date in the Date of Above Transaction field A Form 3618 admission is submitted but the resident is classified as Medicare If the admission processes before the mistake is corrected submit a counteracting form indicating Discharge to NF in the Transaction field and use the same date in the Date of Above Transaction field If an admission is submitted under the wrong contract and it processes onto the file a discharge must be submitted for the same incorrect contract using the same Date of Above Transaction Once both forms are available on the LTC Online Portal and are set to status Processed Complete ot Provider Action Required the provider must contact DADS Provider Claims Services The correct admission cannot be submitted until DADS has set the status of both forms with the incorrect contract to Invalid Complete It is beneficial to add a note in the comment section of the counteracting form detailing the desired action Reminder When submitting a counteracting form for an admission that has payment recoupment will occur unless additional processing occu
52. appropriate form to counteract this form Otherwise correct this form and resubmit Note Additional information regarding counteracting forms is available in the Counteracting Forms section of this User Guide Once inactivated a form will not be available for further processing but it may be used as template Forms 3071 and 3074 cannot be inactivated and MDS assessments must be inactivated through CMS in accordance with the MDS 3 0 Resident Assessment Instrument RAI Users Manual Additional information will be given on inactivations in the Inactivations section of this User Guide Note Ifa new PLI Screening Form is submitted for an individual with an existing Screening Form the previous PLI Screening Form and any associated PE will be systematically inactivated Tex MEDICAID amp HEALTHCARE PARTNERSHIP ASIATE MEDICAID CONTRACTOR Home submit For ComentActivity Drafts Vendors Letters PrintableForms 3618 RESIDENT TRANSACTION NOTICE Current Stotus Processed Complete Name Wf DUNS Form Actions use as template Correct this farm Ada nate Note The steps to inactivate will be covered in the Inactivations section of this User Guide Check MN on PE When an MDS assessment is set to status PE MN Denied the Check MN on PE button will be visible under the Workflow Actions section of the yellow Form Actions bar MINIMUM DATA SET MDS Vers
53. chosen Example When performing a Form Status Inquiry on Type of Form 3618 3619 3071 or 3074 or on PLI Screen ing Form or PE the Purpose Code and Reason for Assessment fields will not display because they are only applicable when performing a Form Status Inquiry on MDS assessments 5 Click the Search button and the LTC Online Portal will return any matching submissions records Only 50 records will display at a time To view the next set of records you must choose another page from the Select a page drop down box You may also export the search results to Microsoft Excel 6 Click the View Detail link at the left of the DLN to display the details of the assessment Paes cote ME ae a records tme Pug v 2015 0703 17 LTC Nursing Facility Hospice User Guide Descriptions of the column headings seen above for results for Type of Forms MDS and MDSQTR assessments View Detail The hyperlink used to open the document DLN The unique document locator number assigned to each successful submission Received Date The actual date the assessment was successfully submitted on the LTC Online Portal Exception If your MDS assessment is set to status Awaiting LTC Medicaid Information the date shown in the TMHP received date column is the date that the MDS was loaded onto the LTC Online Portal Once the LTCMI is successfully submitted the date will change to the submission da
54. date the rejected admission is correct If the submitted admission date is wrong correct the rejected admission and resubmit Ifthe admission date is correct contact the recipient s PACE organization NF 0062 This discharge cannot be processed because the client is cur rently authorized for Full Medicaid A prior 3618 discharge and a 3619 admission need to be processed prior to this discharge If the Full Medicaid authorization is for this provider submit the 3618 dis charge prior to the Medicare stay A 3619 admission must be processed prior to this discharge 3619 Discharge The recipient has a Service Authorization for Full Medicaid Code 1 as of the Medicare Part A Coinsurance discharge date Review the facility s records to determine the recipient s admission and discharge date your facility pull a MESAV and compare the Service Authorizations to the facility s records If the recipient should be classified as Medicare on this discharge date Determine if the 3618 discharge to the hospital prior to the Medicare Stay has been submitted If not submit that 3618 discharge If it was rejected resolve the issue and resubmit the 3618 discharge Determine if the 3619 admission to begin Medicare Part A Coinsurance has been submitted If not submit that 3619 admission If it was rejected resolve the issue and resubmit that 3619 admission Once the 3618 discharge and 3619 admission
55. documents to research and review statuses Provide additional information to an assessment Retrieve documents to make corrections or perform inactivations Resolve any forms or assessments set to status Provider Action Required Export search results to Microsoft Excel Note FSI can retrieve information from the previous seven years The search is based on the TMHP Received Date 1 Click the Form Status Inquiry link in the blue navigational bar STRACTOR ITMHP _ STATE MEDICAID CONI submit Form Form Status In Form Select eom SSS Vendor Number e Form status Inquiry EI Medicaid Number 1 Last Name Forn Status ECE CARE Fram Date e Bess Tm TeDatee pom pasa Discharysd Deceased FirstName 1 2 of Form Choose from the drop down box Type of Form labels will display in the Type of Form drop down box on FSI 3071 Election Cancellation Notice of Hospice services 3074 Medicaid Medicare Physician Certification of Terminal Illness 3618 Resident Transaction Notice 3619 Medicare SNP patient Transaction Notice 3652 Client Assessment Review and Evaluation CARE MDS 2 0 Minimum Data Set Comprehensive MDSQTR 2 0 Minimum Data Set Quarterly MDS 3 0 Minimum Dara Set Comprehensive MDSQTR 3 0 Minimum Data Set Quarterly PASARR PASARR Screening PLI PASRR Level
56. for accuracy They must match what is on the individual s Medicaid card if they have onc However the last name cannot contain spaces or special characters e g hyphen If this information is accurate the provider may contact TMHP to have the form restarted If different the incorrect information will need to be corrected and the form or assessment resubmitted Note Correctable fields vary by form or assessment type See the Corrections section of this User Guide gt If the Medicaid card MESAV is incorrect contact the local eli Med ID Check Inactive In this status the Medicaid ID validation was attempted nightly for six months and either failed or the request was canceled ibility worker to have the file corrected Ifthe individual is certified for Medicaid after six months the form or assessment can be reactivated by the provider by clicking on the Reactivate form button 104 v 2015 0703 LTC Nursing Facility Hospice User Guide 3 Pending Medicaid Eligibility validation will result in either Medicaid Eligibility Confirmed If confirmed it continues to next validation Pending Medicaid Eligibility In this status validation attempts will occur nightly until eligibility is found the request is canceled or until six months has expired whichever comes first If Medicaid Eligibility has already been established the provider may contact TMHP to have the form or assessment
57. form OR b Click the Save as Draft button to store the screening form for future use but not submit it The screening form does not have to be complete to save the draft Note Ifthe screening form is successfully submitted a DLN will be assigned and the LTC Online Portal will show Your form was submitted successfully If there are errors they will be displayed in a box at the top of the screen These errors will need to be resolved before the screening form will be successfully submitted Once all errors are resolved click the Submit Form button again to submit the screening form When a PLI Screening Form is submitted via the LTC Online Portal the system will check to see if there is an existing PLI Screening Form on file Ifa previous Screening Form is found and the Date of Assessment is the same as the previously submitted screening form the new screening form will not be accepted If a previous PLI Screening Form is found and the Date of Assessment is prior to the Date of Assessment on the new screening form the new screening form will continue to process and the old screening form will be inactivated A PLI Screening Form and a PE are required prior to submission of an MDS Admission 3 0 A0310A 01 if the assessment indicates Mental Illness Developmental Disability or Intellectual Disability The NF must check the LTC Online Portal for completed PLI Screening Forms to determine if their facility can prov
58. form prior to resubmitting this rejected admission If this form cannot be corrected inactivate the form Note If this is not traditional Medicare document this the comment section and call 512 438 2200 Option 3 or fax the Medicare Replace ments explanation of benefits EOB with a copy of the 3619 to 512 438 3400 attention Medicare Advantage Plan v 2015 0703 121 LTC Nursing Facility Hospice User Guide Provider Message Displayed in History NF 0029 The days of Qualifying Stay have been recorded However the admission for Medicare Part A Coinsurance cannot be processed because the Qualifying Stay days plus any Full Medicare days already documented are less than the 20 days required for this Spell of lines Form Assessment 3619 Admit Admit Mod Suggested For each Medicare Spell of Illness 20 days of Full Medicare coverage are required between one or more providers The recipient has not yet met the 20 day requirement so a Medicare Part A Coinsurance Service Authorization was not created Review the recipient s Medicare remittance to determine the Full Medicare Qualifying Stay dates for this Spell of Illness Check the Dates of Qualifying Stay on the form The dates entered must add up to the 20 day requirement or an additional form must document the remainder of the 20 days of Qualifying Stay Some Full Medicare dates may have already been recorded from
59. hours prior to using FSI or Current Activity for MDS 3 0 assessments submit ted to CMS RN and MD DO licenses are validated against the appropriate licensing state board AIL RN licenses are validated against the appropriate Texas State University RUG Training database for success ful submission License renewals should be completed four to six weeks prior to the date of expiration to ensure that there is no interruption in a users ability to submit documents Access your documents using Form Status Inquiry or Current Activity Print and sign documents prior to submission v 2015 0703 165 LTC Nursing Facility Hospice User Guide Submit additional information within 21 calendar days on the LTC Online Portal when the assessment is set to status Pending Denial need more information or call TMHP at 1 800 626 4117 Option 2 Use the TMHP website to access training materials and other resources The TMHP website is available at www tmhp com Pages LTC Itc_home aspx This User Guide can be found under the Help link located on the blue navigational bar within the LTC Online Portal v 2015 0703 166 LTC Nursing Facility Hospice User Guide Preventing Medicaid Waste Abuse and Fraud Medicaid fraud An intentional deceit or misrepresentation made by a person with the knowledge that deception could result in some unauthorized benefit to himself or some other person It includes any act that constitutes
60. incorrect contact the Medicaid Eligibility Worker Corrections are not allowed to the Name or Number fields on the form once submitted thus it is important to submit the correct information Incorrect entries require inactivation and a new submission v TMHI ASTATE MEDICAID CONTRACTOR submit Form MEE re Current Activity our form was submitted successfully You can track this form using the DLN m 60 v 2015 0703 LTC Nursing Facility Hospice User Guide Bome ERIN ZINN form statusinavry Current Actvty Drafts Vendors Letters PrintableForms Alerts 3618 RESIDENT TRANSACTION NOTICE Current Status SSS T o t Vendor Number sn aa m Ear 1 Medicaid Recent No S diem Address 2 Social Security No Meme Recipient s First Name ety 1 3 Medicare or RR Dur Reciplent s Moe State x 2 3 Name Sf Sene Grop Transaction is M am itted Iecharged T miim Date of above Transaction 19 T certify that to the best of my knowledge the date in Item 11 Date of Above Transaction Is for services provided and the date is not included in the 10096 Medicare Part A reimbursement time frame Administrator State Board License No J Administrator Last Administrator First Is Administrator Signature on
61. is pending Validation attempts occur nightly until eligibility is found the request is canceled or until six months has expired whichever comes first Pending More Info DADS Provider Claims Services needs more information from the provider See the History trail for further details on information required Pending Placement The individual has not been placed in a Nursing Facility On the PLI Screening Form NF Choices section no NF has indicated Admitted To nor has the individual been placed in an alternate setting Pending Placement in NF PE Confirmed When the PL1 Screening Form is in this status the NF is required to review the associated PE which identifies the Recommended Specialized Services for the individual and certify if it is able or unable to serve the individual Pending Review MN determination is pending TMHP nurse review because the assessment was not approved through the automated MN determination process Pending RN License Verification RN License number is pending verification from the Texas BON or the licensing state from which the compact license was issued e PLI Inactive This PLI Screening Form status indicates that the individual is deceased or discharged Processed Complete Form or assessment has been processed and complete Please check MESAV Provider Action Required Form or assessment needs to be reviewed by the provider due to the form or assess ment being rejected by SAS Refer to
62. list of options Determine the Route of Administration RA used to administer each medication The MAR and the physician s orders should identify the RA for each medication Record the RA in column 2 59 3 Freq Frequency Select from the list of options Determine the number of times per day week or month that each medication is given Record the frequency in column 3 59 4 PRN n number of doses as necessary number of times in last 30 days Pro Re Nata PRN means as needed in Latin The PRN n column is only completed for medications that have a frequency as PR Record the number of times in the past 30 days that each medication coded as PR was given Stat medi cations are recorded as a PRN medication Remember if a PRN medication was not given in the past 30 days it should not be listed here Section N on MDS 3 0 assessments reflects the number of medications and section S9 allows for more detailed informa tion to be submitted i e name of medications 510 Comments Optional Enter up to 500 characters if needed It is essential that you include signs and symptoms that present an accurate picture of the resident s condition The comment section can be used for additional qualifying data that indicates the need for skilled nursing care such as Pertinent medical history to understand medication to understand changes in condition Abnormal vital
63. of the denial Nonemergency Prior Authorization and Retroactive Eligibility Retroactive eligibility occurs when the effective date of an individual s Medicaid coverage is before the eligibility add date which is the date the individual s Medicaid eligibility is added to TMHP s eligibility file For individuals with retroactive eligibility prior authorization requests must be submitted after the individual s add date and before a claim is submitted to TMHP For services that are provided to fee for service Medicaid individuals during an individual s retroactive eligibility period i e the period from the effective date to the add date providers must obtain prior authorization within 95 days of the individual s add date and before a claim is submitted for those services to TMHP If an individual s Medicaid eligibility is pending a PAN must be requested before nonemergency transport Ini tially chis request will be denied for Medicaid eligibility When Medicaid eligibility is established the NF requestor 162 v 2015 0703 LTC Nursing Facility Hospice User Guide has 95 days from the date on which the eligibility was added to TMHP s files to contact the TMHP Ambulance Unit and request that authorization be considered Documentation of Medical Necessity Retrospective review may be performed to ensure documentation supports the medical necessity of the transport Documentation to support medical necessity must include on
64. omitted from the submitted value A decimal point and decimal values may not be included on the LTC Online Portal S6i In how many of the falls listed above was the person physically restrained prior to the fall Conditional This is a required field if SGh indicates the resident has fallen Valid range includes 0 zero with a maximum being the number entered in S6h S6j In the falls listed in S6h above how many had the following contributory factors More than one factor may apply to a fall Indicate the number of falls for each contributory factor Conditional S6j1 through S66 are required only if S6h indicates the resident has fallen Valid range includes 1 one with a maximum being the number entered in S6h S6j1 Environmental debris slick or wet floors lighting etc S6j2 Medication s S6j3 Major Change in Medical Condition Myocardial Infarction Ml Heart Attack Cerebrovascular Accident CVA Stroke Syncope Fainting etc S6j4 Poor Balance Weakness S6j5 Confusion Disorientation Sj6 Assault by Resident or Staff 57 For DADS Only RUG S7b For DADS Only RUG When the LTCMI is printed S7b will show the calculated RUG value S8 Resident s Current Address S8a Resident s Address Required Enter the street address where the resident is presently living This information is used to mail MN determination letters S8b City Required Enter t
65. on the month of application If the individual is determined to be Medicaid eligible the worker does consideration the three months prior to the application to determine if the individual may have been financially eligible at an earlier date The Purpose Code M was designed to allow the provider to submit a MDS Purpose Code M to cover those three months so the payment could be made at a RUG value rather than the default PC E rate The retroactive Medicaid is shown on the MESAV as a TP 14 Coverage Code P or TP 11 which are retroactive TP13 SSI coverage To fill a period approved by the financial worker for dates prior to the application the provider has two options 1 Submit an off cycle MDS quarterly assessment including the LTCMI by completing Sle field on the LTCMI completed as the PC M The start date of the approved prior period S1f The end date of the approved prior period S1g 2 Modify an earlier MDS that has not been used for the Medicaid cycle and complete the LTCMI as a PC M by completing Sle field on the LTCMI completed as the PC M The start date of the approved prior period 510 The end date of the approved prior period S1g Note 72 submit a PC M for day the Missed Assessment Start Date and the Missed Assessment End Date must be the same PC M Start and End Date Limitations MDS 3 0 Only applicable for MDS 3 0 Admission Quarterly review and Annual assessments
66. or MDSQTR 3 0 Minimum Data Set Quarterly from the FSI Type of Form drop down box When executing a search using the PASRR Eligibility Type field the From Date and To Date will be disabled but the system will automatically set the date fields to the current date Enter the appropriate choice in the PASRR Eligibility Type drop down box TMH STATE MEDICAID CONTRACTOR Form Status Inquiry Form Select Type of Form 3 0 Minimum Deta Set Comprehensive s Vendor Number for Contract Number Form Status Inquiry DLN Medicaid Number Last Name First Form Status SSN From Date 776208 m Purpose Code Reason for Assessment PASRR Eligibility Type v 2015 0703 45 LTC Nursing Facility Hospice User Guide The search will return all current residents who meet the search criteria Current residents are determined by fields B0650 and B0655 of the Form Select Type of Form 3 0 Minimum Data set comprehensive Vendor Number Form Status Inquiry DLN Medicaid Number Last First Name Form Status ls SSN From Date To Date s m Purpose Code El Reason for Assessment J PASRR Eligibility 2 s Search 6 record s returned Contract 471472014 syama 5 2 2013 7 17 2083 4 23 2014 Interdiscipl
67. review Perform Face to Face Interview with resident Complete and submit a new PE within seven calendar days of the first notification 2 The LA LMHA performs a PE face toface within 72 hours of notification 3 The LA LMHA submits the PE on the LTC Online Portal within seven calendar days of the first notification v 2015 0703 43 LTC Nursing Facility Hospice User Guide How to Perform a PASRR Level 1 Screening Detailed instructions for PLI Screening Form can be found online at www dads state tx us providers pasrr index html How to Submit a PASRR Level 1 Screening Form 1 Login to the LTC Online Portal PLI Screening Forms cannot be submitted by a third party software vendor 2 Click the Submit Form link located in the blue navigational bar of Form Choose PL1 PASRR Level 1 Screening from the drop down box Vendor Number Choose the submitter Vendor Number Contract Number from the drop down box wo ow Click the Form button 6 Enter all required information as indicated by the red dots Remember that the individual must be admitted under Exempted Hospital Discharge or Expedited Admission for submission of the PL1 Screening Form by an and indicated accordingly 7 Click the Print button located in the yellow Form Actions bar to print the screening form in progress 8 From here you have two choices a Click the Submit Form button to submit the screening
68. showing in the History trail will be The Form has failed Auto MN Approval v 2015 0703 53 LTC Nursing Facility Hospice User Guide The flowchart below provides a high level overview of the process used for manual MN determination for a Preadmission PASRR Positive individual Providers can use the LTC Online Portal to check the status of MN determination TMHP reviews PASRR Evaluation to determine medical necessity Pending Denial LA LMHA provides LA LMHA does not provide additional information additional information Y Y Y TMHP TMHP TMHP TMHP nurse physician physician physician approves approves denies approves Y v Individual s physician In denea uir appeal 1 Submissions for individuals who do not have PMN or do not pass auto MN are reviewed by the TMHP nurse for MN determination within five business days of successful submission 2 Once reviewed the submission is either approved meeting MN or placed in a Pending Denial need more information status for up to 21 calendar days FSI or Current Activity can be used to view the status of MN determination whether the PE is set to status Approved Denied Pending Denial need more information 3 The LA LMHA must either add additional information clarifying nursing medical needs through the Add Note feature or by calling TMHP and speaking with a TMHP nurse 4 I
69. signs Previous attempts at outpatient management of medical condition Results of abnormal lab work 90 v 2015 0703 LTC Nursing Facility Hospice User Guide LTCMI Fields S11 Advance Care Planning Advance care planning means planning ahead for how the resident wants to be treated if ill or near death Sometimes when people are in an accident or have an illness that will cause them to die they are not able to talk or to let others know how they feel S11a Does the resident report having a legally authorized representative Required Choose from the drop down box 0 No 1 Yes gt A Legally Authorized Representative LAR is a person authorized by law to act on behalf of a person with regard to a matter and may include a parent guardian or managing conservator of a minor or the guardian of an adult 511 Does resident report having a Directive to Physicians and Family or Surrogates Required Choose from the drop down box 0 No 1 Yes In states other than Texas this document may be referred to as a Living Will Directive to Physician Living Will is a document that communicates resident s wishes about medical treatment at some time in the future when he or she is unable to make their wishes known because of illness or injury S11c Does the resident report having a Medical Power of Attorney Required Choose from the drop down box 0 No 1 Yes 5114 Does the re
70. status for client A provider A transaction date 10 20 08 3618 admit submitted for client A provider A transaction date 10 21 08 Submit allowed Previous admit in ME Check Inactive status so not considered 3618 discharge exists in Processed Complete status for client A provider A transaction date 10 19 08 3618 admit exists in Processed Complete status for client A provider A transaction date 10 19 08 3618 admit submitted for client A provider A transaction date 10 21 08 Submission is allowed because of multiple matching date of above transaction on prior form 154 v 2015 0703 LTC Nursing Facility Hospice User Guide System Message displayed at time of submission System Message Clarification System Message Resolution assistance for resolving error Last form submitted was a discharge Please supply admission form prior to this new discharge Rejection of New Discharge for missing Previous Admission New discharge follows a discharge for same contract 1 2008 discharge no admission 12 1 2008 discharge submitted Submit an admission prior to this discharge Attempting to submit two 3618 discharges in a row missing a 3618 admission Submit the missing admission then submit the 3618 discharge Same contract An admission has already been received for the Date of Above Transaction OR Different contract An admission from another provider h
71. the Log in to My Account button in the blue bar located at the top right hand side of the screen Note You may be prompted to enter your LTC Online Portal User ID and password aes I B p 4 The My Account page will appear navigation ae Welcome to My Account This section allows a user to perform various maintenance activities for their TMHP account Click the appropriate link for access to the maintenance options LTC Online Portal Submit Form Inguire about a form status Manage Provider Accounts Administer Provider Identifier Become a Provider Administrator for a Provider Identifier authorization required Administer Provider Enrollment Transaction Open the provider enrollment application Account Settings My Profile Modify your profile information 10 v 2015 0703 LTC Nursing Facility Hospice User Guide Log In to the LTC Online Portal l Goto www tmhp com 2 Click providers in the green bar located at the top of the screen clients providers Welcome to Texas Medicaid amp Healthcare Partnership Thank you fer visitng the Texas Macicsid 2 Healtheare Partnership TMHP website for Texas Medicaid and other stale heallecere programs As of January t 2004 ACS State Healthcare LLC under contract with the Tenas Haalth and Human Semeac Commission HHSC assumed administraro cf claims processing or Texas Medicaid and
72. the form or assessment History trail for specific error message SAS Request Pending Form or assessment has passed all validations Medicaid ID Medicaid Eligibility Applied Income etc and will be sent from TMHP to DADS for processing Please allow two to four business days for the next status change Submitted Form or assessment has been submitted Submitted to manual workflow Form or assessment needs to be reviewed by DADS Provider Claims Services due to the form or assessment being rejected by SAS Refer to the form or assessment History trail for additional information v 2015 0703 159 LTC Nursing Facility Hospice User Guide Nonemergency Ambulance If you need to transport a fee for service FFS Medicaid recipient by ambulance for a doctor appointment or other nonemergency reason there are some important things to know For the most up to date and detailed information refer to the Texas Medicaid Provider Procedures Manual Volume 1 Section 5 Prior Authorization Medicaid payment for ambulance transportation may be made only for those FFS individuals whose condition at the time of transport is such that ambulance transportation is medically necessary For example it is insufficient that an individual merely has a diagnosis such as pneumonia stroke or fracture to justify ambulance transportation In cach of those instances the condition of the individual must be such that transportation by any other means is medicall
73. the individual never applies for Medicaid the status will be set to Med ID Check Inactive MN Approved Medical Necessity met MN Denied Medical Necessity has not been met View the History trail for detailed status and information about the denial of MN Negative PASRR Eligibility The PLI Screening Form did not indicate that the individual has a diagnosis of Mental Illness Intellectual Disability or Developmental Disability NF Placement Process Exhausted This is a PL1 Screening Form status which occurs when an individual has not been placed in an NF or alternate setting within 90 days of submitted PE Out of State RN License Invalid The state issuing the compact license has indicated the compact RN license is invalid Overturned Doctor Review Assessment was denied medical necessity and then provider supplied more infor mation Assessment is pending Pending Applied Income Applied Income validation is pending Validation attempts occur nightly until applied income is found request canceled or until six months has expired whichever comes first Contact the Medicaid Eligibility Worker Pending Denial needs more information TMHP nurse did not find the assessment to qualify for Medical Necessity Provider has 21 calendar days to submit additional information for consideration Pending Doctor Review MN determination is pending TMHP Doctor Review Pending Medicaid Eligibility Medicaid Eligibility validation
74. the individual s medical record maintained by the NF 3 Severe Physical An illness resulting in ventilator dependence or diagnosis such as chronic obstructive Illness pulmonary disease Parkinson s disease Huntington s disease amyotrophic lateral sclerosis congestive heart failure which result in a level of impairment so server that the individual could not be expected to benefit from specialized services 4 Delirium Provisional admission pending further assessment in case of delirium where an ac curate diagnosis cannot be made until the delirium clears 5 Emergency Provisional admission pending further assessment in emergency situations requiring Protective Services protective services with placement in the NF not to exceed seven days 6 Respite Very brief and finite stay of up to a fixed number of days to provided respite to i home caregivers to whom the individual with MI or IDD is expected to return follow ing the brief NF stay 7 Coma Severe illness or injury resulting in inability to respond to external communication or stimuli such as coma or functioning at brain stem level LTC Nursing Facility Hospice User Guide 2 If the individual does not meet Expedited Admission criteria then the RE follows the Preadmission or Exempted Hospital Discharge process described in diagrams in this section If the individual does meet Expedited Admission criteria then The RE sends the PLI Screening Form
75. to the admitting NF with the individual b The NF submits the PLI Screening Form on the Portal immediately on receipt NOTE If the NF attempts to submit the MDS LTCMI without first submitting the PLI Screening Form the LTCMI will not be accepted 4 The LA LMHA is notified to perform a PE based on the Expedited Category a categories 1 Convalescent Care 2 Terminal Illness or 3 Severe Physical Illness the LTC Online Portal will create an Alert for the LA or LMHA to complete the PE once the PLI Screening Form is successfully submitted on the LTC Online Portal by the b 1 the Expedited Admission category is 4 Delirium or 5 Emergency Protective Services the LTC Online Portal creates the Alert seven calendar days after the NF admission date c If the Expedited Admission category is 6 Respite then the LTC Online Portal creates an Alert 14 calendar days after the NF admission date d If the Expedited Admission category is 7 Coma the LTC Online Portal will alert the LA or LMHA to perform a PE when the MDS indicates the individual is no longer comatose Once notified the LA LMHA performs the PE face to face within 72 hours of notification The LA LMHA then submits the PE on the LTC Online Portal within seven calendar days of the first notifica tion Authorization for payment to the LA LMHA for completion of the PE is setup as a result of successful submission of the PE on the Portal The NF will co
76. track the indi viduals movements as those movements will be tracked on the hospice form 3071 How to Submit Form 3071 Paper copies of forms 3071 and 3074 with dates and signatures must be completed prior to electronic submittals via the TMHP portal The signed and dated originals must be retained in the hospice individual s medical hospice record 1 Log in to the LTC Online Portal 2 Click the Submit Form link located in the blue navigational bar 3 Type of Form Choose 3071 Recipient Election Cancellation Discharge Notice from the drop down box Click the Enter Form button 5 Enter all required information as indicated by the red dots Complete at least one of the following Medicaid number SSN If Election choose Election and enter a From date only Elections must include an individual or respon sible party signature Examples of when to choose ELECTION individual is electing hospice for the first time An individual is re electing hospice after a gap in hospice services individual is transferring from one hospice provider to another The election date will then be the date of transfer The gaining provider must also submit form 3074 to begin a new service authorization period If Update choose Update and enter a From date only Use the comment box box 17 to enter explana tion of the update Examples of when to choose UPDATE Hospice individual has an additional te
77. 0064 This discharge cannot be processed because an admission to Medicare Part A Coinsurance for a different provider has already been processed for the same day This discharge appears to be one of a retroactive pair If an admission prior to this discharge is missing or rejected resubmit the admission and this discharge on the same day 3619 Discharge The recipient has a Service Authorization with a different provider that begins after the submitted discharge date The rejected dis charge and matching admission must be submitted as a retroactive pair Review the facility records to identify the Medicare Part A Coin surance admission date prior to this discharge Determine if the 3619 admission prior to this discharge has been submitted If not submit that 3619 admission If it was rejected resolve the issue and resubmit that 3619 admission Resubmit the rejected 3619 discharge on the same day as the missing or corrected admission v 2015 0703 LTC Nursing Facility Hospice User Guide Provider Message layed in History NF 0065 This discharge cannot be processed because the client is cur rently authorized for Full Medicaid for this provider If a 3618 discharge prior to the Medicare stay and a 3619 admission are missing or rejected resubmit those forms and this discharge on the same day Form Assessment 3619 Discharge Suggested Action The recipient has a Service
78. 1 Screening PASRR Evaluation 16 v 2015 0703 LTC Nursing Facility Hospice User Guide Note This choice will determine the type of document that will display in the FSI results page For example if a provider chooses Type of Form MDS 3 0 Minimum Data Set Comprehensive the results will only display MDS 3 0 Minimum Data Set Comprehensive assessments No MDS 3 0 Quarterly assessments will display in the search results Note You may omit the Type of Form field if you are the original submitter and enter the Document Locator Number DLN of the document you need to retrieve If you are not the original submitter you must choose the Type of Form even if you enter a DLN Note Nursing Facilities NF can only view a PLI Screening Form or PE when they are one of the NF choices on the associated PL1 Screening Form Once the individual is admitted to an NE only the admitting NF will have access to the PLI Screening Form and PE 3 Enter To and From Dates These are required fields Dates are searched against the TMHP Received Date date of successful submission 4 Narrow results by entering specific criteria in the additional fields DLN Last Name First Name SSN Medicaid Number Form Status Purpose Code and Reason for Assessment Note The narrowing search criteria fields that display when performing a Form Status Inquiry will vary based on the Type of Form
79. 18 Remove Open 20 v 2015 0703 LTC Nursing Facility Hospice User Guide 3 From here you have two choices a Click the Open link to open the draft to edit and submit or b Click the Remove link to permanently delete the draft Note The following confirmation prompt message will appear Microsoft Internet Explorer Press OK to confirm that you would like to delete this draft from the portal Press Cancel to keep the draft Click the OK button to delete the draft or Click the Cancel button to keep the draft Note Drafis will display for 60 days only Once a draft has been removed it cannot be retrieved Printable Forms The Printable Forms feature allows the provider to view blank forms or assessments print blank forms or assess ments or interactively complete forms or assessments by saving to your desktop Note All of the forms or assessments listed in the Printable Forms page are interactive with the exception of Forms 3071 and 3074 l Click the Printable Forms link in the blue navigational bar x ee ee TMHP ASTATE MEDICAID CONTRACTOR Form Status Inquiry Current Activity Printable Forms PASRR Level 1 Screening PL1 PASRR Evaluation PE Waiver 3 0 MN and LOC Waiver 3 0 Physician s Signature Page Individual Movement Form 8578 Intellectual Disability Related Condition Assessment ID RC 8578 Assessment v 2015 0703 21
80. 3071 Elect Recertification If this form is a recertification check this box Cert Recert Date Indicate what the effective date is of this certification Verbal Verification If completed within two days of Election the physicians have six months to sign the certification submission cannot occur until signatures are obtained If the form is being completed as an initial certification two physician signatures are required unless the Exclusion Statement is signed IF no verbal verification is given the physician s signatures must be within two days of the Election on an initial certification If no verbal verification is obtained and Form 3074 is not signed within two days of the Election the effective date is the later of the two physician s signatures recertification only requires one physician signature A recertification can be signed up to 30 calendar days prior to the recertification date or within the six month recertification period The Exclusion Statement is only completed if the individual does not have an attending physician for the initial certification error will occur if the license number does not pass validation The form cannot be submitted until all errors are resolved 7 From here you have two choices Click the Submit Form button to submit the form or b Click the Save as Draft button to store the form for future use but not submit it The form does not have
81. 8 Discharge following a 3619 3618 discharge received following a 3619 regardless of contract Submit either a 3619 discharge or 3618 admission as appropriate prior to this 3618 Discharge Scenarios 3619 admit exists in Processed Complete status for client A provider A transaction date 10 20 08 3618 admit submitted for client A provider A transaction date 10 21 08 Submit not allowed 3619 discharge exists in Processed Complete status for client A provider A transaction date 10 20 08 3618 discharge submitted for client A provider A transaction date 10 21 08 Submit not allowed 3619 admit exists in Processed Complete status for client A provider A transaction date 10 19 08 3619 discharge exists in Processed Complete status for client A provider A transaction date 10 19 08 3618 discharge submitted for client A provider A transaction date 10 21 08 Submit not allowed Form 3619 Medicare SN System Message displayed at time of submission F Patient Transaction No System Message Clarification e Edits System Message Resolution assistance for resolving error Last form submitted was an admission Please supply discharge form prior to this new admission Rejection of New Admission for missing Previous Discharge New admission follows an admission for same contract 11 1 2008 admission no discharge 12 1 2008 admission submitted Submit
82. 9 admission If the most recent processed form is a 3618 discharge after the rejected 3619 admission verify that the 3618 discharge was submitted for the correct date If the date is wrong correct the 3618 discharge and resubmit If the 3618 discharge is now prior to the rejected 3619 admission resubmit the rejected 3619 admission NF 0028 This admission cannot be processed because the Qualifying Stay days plus any Full Medicare days already documented add up to more than the 20 days allowed for this Spell of Illness 3619 Admit Admit Mod For each Medicare Spell of Illness only 20 days of Full Medicare cov erage are allowed between one or more providers The recipient will exceed the 20 day limit if the form is processed as submitted Review the recipient s Medicare remittance to determine the Full Medicare Qualifying Stay dates for this Spell of Illness Check the Dates of Qualifying Stay on the form The number of days on the form plus any Full Medicare days already documented for that Spell of Illness cannot exceed 20 days Ifthe Dates of Qualifying Stay on the form are wrong correct the admission and resubmi To determine if the Qualifying Stay dates from the Medicare remittance advice are on file contact DADS Provider Claims Services at 512 438 2200 Option 1 for assistance Ifa different 3619 admission was submitted with incorrect Dates of Qualifying Stay submit a correction for that
83. APLI Screening Form must be submitted on all individuals prior to admission into a Nursing Facility must be submitted and MN determined for all PASRR Positive individuals prior to submission of the MDS LTCMI Monitor document statuses regularly on the LTC Online Portal Ensure all MDS assessment submissions include an accurate Medicaid ID to assist with eligibility validation A current Admission 3618 or 3619 form must be available on the LTC Online Portal with TMHP to complete the MDS LTCMI Submit a 3618 3619 Admission on the LTC Online Portal prior to completing the LTCMI The LTC Online Portal validates that an active admission is on the LTC Online Portal to allow the provider to complete the MDS LTCMI information on an assessment MDS 3 0 submissions to CMS are retrieved nightly by TMHP Once retrieved MDS 3 0 assessments are loaded onto the LTC Online Portal MDS 3 0 submissions must meet the following criteria before being loaded onto the LTC Online Portal A valid Medicaid number or a must be entered into field 3 0 A0700 Reason for Assessment must be one of the following Admission assessment gt Quarterly review assessment gt Annual assessment gt Significant change in status assessment gt Significant correction to prior comprehensive assessment gt Significant correction to prior quarterly assessment Avalid NPI must be entered in field 3 0 A0100A Providers should allow 24 to 48
84. Admission assessment the Admis sion assessment must be completed and submitted to CMS with the information that is available If CMS cannot calculate a RUG because the Admission assessment is incomplete or has errors CMS will still assign a RUG value of which is the default rate If the Admission assessment meets medical necessity and the resident has Medicaid cligibility for the days of services payment can be made for the RUG value calculated by CMS Submission and Retrieval of MDS Assessment Providers should use their current method for submission to CMS either through jRAVEN or another third party software package Validate the acceptance of the MDS 3 0 assessment using the validation report process from federal CMS TMHP receives assessments nightly Only assessments that meet the following criteria will be loaded onto the LTC Online Portal Reason for Assessment Admission assessment A0310A 01 Quarterly review assessment A0310A 02 Annual assessment A0310A 03 Significant change in status assessment A0310A 04 Significant correction to prior comprehensive assessment A0310A 05 Significant correction to prior quarterly assessment A0310A 06 National Provider ID MDS 3 0 A0100A should be entered to locate assessments set to status Awaiting LTC Medicaid Information Medicaid Number MDS 3 0 A0700 contains or a nine digit numeric value Note Once accepted by CMS it may be up to
85. Assessment received after day 31 92 day period 92 day period but on or before day 92 is considered not on time LATE Assessment received within the first 31 days is ON TIME Payment is based on Payment based on CALCULATED RUG RATE CALCULATED RUG RATE PAYMENT CONTINUES EVEN IF NOT RECEIVED BASED PAYMENT STOPS UNTIL PREVIOUS ASSESSMENT ASSESSMENT IS PROCESSED NF Hospice Provider Tips for When to Submit an MDS PC E The following provides information to help NF Hospice providers determine when to submit an MDS PC E PC E can only be submitted on an MDS Admission Annual or Quarterly assessment There typically are two situations when an MDS PC E should be submitted 1 RUG Gap Once the resident has been established as a RUG recipient a PC E will be needed if the next MDS assessment submission completely misses the anticipated assessment quarter Each Z0500B MDS 3 0 estab lishes a 92 day period Z0500B 91 days so the next assessment should be completed and submitted within the 92 day anticipated MDS assessment quarter following the 92 day span of the current MDS assessment The RUG of the current assessment will expire 31 days after the covering quarter Z0500B 91 days unless the next MDS assessment has been successfully completed DADS cannot pay for services on days when a RUG has expired The next MDS assessment will not be considered missed if it has Z0500B date within the anticipated MDS assessment quarter
86. Authorization for Full Medicaid Code 1 with the same provider as of the submitted discharge date Review the facility records to determine the recipient s admission and discharge dates Pull a MESAV and verify the begin date and type of service currently authorized for the recipient If the recipient should be classified as Medicare on this discharge date Determine if the 3618 discharge to the hospital prior to the Medicare stay has been submitted If not submit that 3618 discharge If it was rejected resolve the issue and resubmit that 3618 discharge Determine if the 3619 admission to begin Medicare Part A Coinsurance has been submitted If not submit that 3619 admission If it was rejected resolve the issue and resubmit that 3619 admission Resubmit the rejected 3619 discharge after the missing or corrected forms have been processed If the recipient should not be classified as Medicare on this discharge date Determine if the discharge should be a 3618 discharge instead If so inactivate the rejected form and submit a 3618 discharge to close the recipient s file NF 0066 This discharge cannot be processed because the client is admitted by a different provider If an admission prior to this discharge is missing or rejected the admis sion must be processed prior to this discharge 3619 Discharge The recipient has a Service Authorization with a different provider as of the submitted disch
87. CMI questions Claim Forms Claim Submission R amp S Report PLI Screening Form and PASRR Evaluation PE 1 800 925 9126 Option 1 Medical Necessity Option 2 Technical Support Option 3 Fair Hearing Option 5 LTC Other Insurance Information and Updates LTC Department fax Medicaid Hotline Department of Aging and Disability Services DADS 512 438 3011 Consumer Rights amp Services Hotline 1 800 458 9858 Complaint for LTC Facility Agency Option 2 Information About Facility Option 4 Provider Self Reported Incidents Option 5 Survey Documents DADS literature 6 512 438 3550 Community Services Contracts Unit Support Community Services Contracts Voice Mail Contract Applications Reenrollments and Reporting Changes such as address and telephone number 12 438 3550 Criminal History Checks 512 438 2363 Facility Licensure Certification Reporting Changes such as Service Area and Medical Director 12 438 2630 512 438 3161 ospice dads state tx us 512 438 2546 512 231 5800 1 800 452 3934 512 231 5800 12 231 5800 Home and Community Support Services Unit Hospice Regulatory Requirements Hospice Policy Medicaid Program Support and Special Services Unit Institutional Services Contracting Medication Aide Program Nurse Aide Registry Nurse Aide Training NF Administrator Program NF Polic
88. DS Entering a PC Start and End date cancels any prior service dates the assessment represented If necessary submit an off cycle MDS 3 0 assessment to submit a PC E or M To submit LTCMI corrections 1 Log in to the LTC Online Portal 2 Click the Form Status Inquiry or Current Activity link in the blue navigational bar a If using FSI you may search for an MDS using SSN Medicaid Number or DLN Click the Search button then click the View Detail link b Fusing Current Activity click the DLN link 140 v 2015 0703 LTC Nursing Facility Hospice User Guide 3 Click the Correct this form button Home MINIMUM DATA SET MDS VERSION 3 0 RESIDENT ASSESSMENT AND CARE SCREENING Nursing Heme Comprehensive NC Item Set Current Status Processed Complete Name ces DENS RUG Section B Section Section F Section i Section Section H Section 1 Section J Section Section L Section M Section N i Section Section Section Q Section V Section X Section Z Section LTCML Click the Section LTCMI tab and complete only the fields needing correction mmm MINIMUM DATA SET MDS VERSION 3 0 Current Status RUG RAA Parent DLN ZEND Section D SectionH Section L Section P Section Z 51 Claims Processing Information Sla DADS Vendor Site ID N
89. Form C1 e Datesimed m Note A Form 3618 admitting the individual to Full Medicaid or a Form 3619 Medicare Co insurance must be submitted prior to submission of the MDS LTCMI to be discussed later Form 3619 Medicare Skilled Nursing Facility Patient Transaction Notice Purpose of Form 3619 Form 3619 is for individuals who fall under the Medicare Co insurance category and provides information about the status ofa Medicaid applicant or recipient It provides information to Medicaid for the Elderly and People with Disabil ities MEPD worker about the status of a Medicare Co insurance applicant or individual Form 3619 provides DADS with information to initiate close or adjust Medicare Skilled Co insurance payments The dates of qualifying stay are tracked by DADS Traditional Medicare will pay for up to 100 days stay in an SNE After the first 20 days the facility must look to private pay third party insurance or Medicaid to pay the deductible portion of the remaining days Occasionally Medicare Medicaid eligible individuals may be discharged and readmitted under the same Medicare authorization These individuals are eligible for up to 100 days of skilled nursing care per spell of illness and may use their days in several short term stays or in one long stay v 2015 0703 61 LTC Nursing Facility Hospice User Guide Form 3619 establishes the 20 qualifying days of full Medicare coverage Form 3619 Admission mu
90. Form 3071 and 3074 Corrections Hospice providers must submit Forms 3071 and 3074 corrections directly on the LTC Online Portal fields except the Contract Number can be corrected on the Forms 3071 and 3074 Correction to Forms 3071 and 3074 1 Login to the LTC Online Portal 2 Click the Form Status Inquiry link in the blue navigational bar 3 Search for Form 3071 or 3074 using the individual s SSN Medicaid Number First and Last Name or DLN 4 Click the Search button 5 Click the View Detail link 6 Click the Correct this form button 7 Complete only the fields needing correction 8 Click the Submit Form button Note Ifthe form is successfully submitted a DLN will be assigned and the LTC Online Portal will show Your form was submitted successfull If there are errors they will be displayed in a box at the top of the screen These errors will need to be resolved before the form will be successfully submitted Once all errors are resolved click the Submit Form button again to submit the form 9 Click the DLN link displayed in the Your form was submitted successfully message to return to the form 10 Click the Print button in the yellow Form Actions bar to print the completed form 146 2015 0703 LTC Nursing Facility Hospice User Guide Counteracting Forms A counteracting form is a form submitted indicating the opposite transaction of the incorrect form admission versus discharge
91. Hospital Discharge Process r T 1 2 03 7 1 Portal alerts LA LMHA to Portal alerts LA LMHA to perform PE once PL1 is perform PE 7 days after submitted NF admission date Portal alerts LA LMHA to perform PE 14 days after NF admission date Portal alerts LA LMHA to perform PE once MDS indicates individual is no longer comatose _ LA LMHA performs pra vii hours of 9 notification notification Payment for PE NF conducts IDT with required participants NF certifies on the PL1 Able or Unable to serve the individual gt Placement if NF is unable LA LMHA coordinates to serve 1 The Expedited Admission process starts when an RE performs the PLI Screening and screens for Expedited Admission using the following categories These categories are known by their numbers as well as their names Category CategoryName Description 1 Convalescent Individual is admitted from an acute care hospital to an NF for convalescent care with an acute physical illness or injury which required hospitalization and is expected to remain in the NF for greater than 30 days 2 Terminal Illness idual has a medical prognosis that his or her life expectancy is 6 months or less if the illness runs its normal course An individual s medical prognosis is documented by a physician s certification which is kept in
92. I section is valid contact DADS Provider Claims Services at 512 438 2200 Option 1 for assistance GN 9254 This form cannot be pro All The provider s contract is either not in effect as of the effective date cessed because the provider is not authorized to provide services on the effective date of the form Cor rect the effective date as needed For 3619 admissions resubmit once the Medicare contract is effective in the system of the form or assessment or the provider is not authorized to bill for the type of services covered by the form or assessment Review the facility contract to determine if the contract is in effect and authorizes the type of services covered by the form or assessment If the effective date of the form or assessment is wrong modify the form or assessment and resubmit the rejected form or assessment Ifthe contract is not yet in effect resubmit the rejected form or assessment once the service code is effective in the system For 3619 admissions resubmit the rejected form once the Medicare contract is effective in the system 114 v 2015 0703 LTC Nursing Facility Hospice User Guide Provider Message layed in History NF 0001 This form cannot be pro cessed because the client s Applied Income is not available to DADS Contact the HHSC Eligibility Worker to update the client s Applied Income Once the Applied Income has been updated this form can be resubmitte
93. Inactivate Form Options will vary depend ing on your security the type of document e g PLI Screening Form MDS assessment or Form 3618 3619 3071 or 3074 as well as document status The yellow Form Actions bar is available when an individual document is being viewed in detail Form Actions Cert j ise as template Update Fom Add Note v 2015 0703 25 LTC Nursing Facility Hospice User Guide Print The Print feature is applicable to all document types Forms 3071 3074 3618 3619 and 3652 Minimum Data Set MDS Screening Form and Click the Print button to print completed documents When printing the MDS 3 0 assessment the individual s name will appear on the top left corner of each page The name will be populated based on the information entered in fields A0500A B C and D on an MDS 3 0 assessment Use as template The Use as template feature is only available for a PL1 Screening Form and for Forms 3071 3074 3618 and 3619 It allows a provider to complete a new form or screening by using the information in a completed form or screening asa template Various fields will auto populate be sure to check for accuracy Note Be careful not to confuse this feature with a similarly named feature in TexMedConnect Once you have found and are displaying the form or screening using FSI or Current Activity 1 Click the Use as template button the data i
94. Inactive In this status the Applied Income validation was attempted nightly for six months and failed so the request was canceled Ifthe Applied Income is determined after six months the form or assessment can be reactivated by the provider by clicking the Reactivate form button Note The six month time frame is a cumulative time period meaning the form or assessment has a TOTAL of six months to pass through the Med ID Check ME Check and AI Check validations NOT six months to pass each validation Note Detailed diagrams illustrating the Medicaid Eligibility Verification Workflows can be found in Appendix A and B of this User Guide v 2015 0703 105 LTC Nursing Facility Hospice User Guide The example below shows an assessment that flows successfully Awaiting 5 20 2015 12 00 00 AM Medicaid information Form is 29 2015 3 54 13 Submitted dns 5 28 2015 3 54 15 PM 5728 2015 3 54 15 Tho Form has fad Auto MN Approval Approved 6 1 2015 1 40 19 PM Modicaia 10 6 1 2035 1 40 20 PM ng 1 40 20 Pm Medicaid 10 request submitted 10 Confirmed 6 2 2015 9 50 10 672 2015 9 50 10 Modea 10 co confemed forthe cient 6 2 2015 9 50 10 AM Eligibility 2 2015 9 58 18 TMHP Medicaid Elgibiity request sent Medicaid 6 2 2013 9 98 20 5 2 2015 9 50 26 am TMMP Medicaid elgibity confirmed for this chent pending 6 2 2015 9 50 26
95. MedConnect cen be found in the TexMedConnect User Guide Al user guides and manuals be found the TMHP website www The following are links to online guides to be used in conjunction with TMHP s LTC Online Portal Long Term Care Nursing Facility Hospice Workshop User Guide The Long Term Care LTC Nursing Facility Hospice Workshop User Guide provides step by step instructions for how to use the various features of the portal each form type when to submit the various forms and assessments and managing forms and assessments set to status Provider Action Required LTCMI Nursing Facility 2 0 Instructions The entry of 2 0 LTCMI Long Term Care Mediczid Information can ONLY occur after the submission of tha Federal MDS 2 0 Assessments and retrieval on TMHP s LTC Online Portal This document covers only tha LTCMI partion of the MDS 2 0 Assessments All othar 2 0 Assessment field information can bo found en the Federal CMS website www ems hhs gov LICMI Nursing Facility 3 0 Instructions The entry of 3 0 LTCMI Long Term care Medicaid Information can ONLY occur after the submission of the Federal MDS 3 0 Assessments and retrieval on TMHP LTC Onine Portal This document covers only the LTCMI portion of the MDS 3 0 Assessments Al other 3 0 Assessment field information can bs found on the Federal CMS website www cms hhs gav PASER Screening Instructions PASER Level I Screening Form The PASRR Level T screen
96. Medicare as a non covered service Note QMB individuals are not eligible for Medicaid benefits can contact Medicare for the Medicare prior authori zation guidelines v 2015 0703 163 LTC Nursing Facility Hospice User Guide RUG Training Requirements RUG training is intended for long term care nurses RUG training is designed to give providers the requirements for completing RUG fields in assessments for Texas Medicaid payment Texas State University in cooperation with the OIG has made this training available through the Office of Continu ing Education s online course program To register for the RUG training or for more information visi www txstate edu continuinged professional development PD Online RUG Training html RUG training is valid for two years then it must be renewed by completing the online RUG training via Texas State University RUG training is required for RNs who sign assessments as complete RUG training can take two to seven working days M F 8 5 to process and report completions of RUG training to depending on current volume of enrollments and completions Note RUG training is valid for a period of two years The implementation of the MDS 3 0 assessment did not impact the expiration date of your RUG training certificate 164 v 2015 0703 LTC Nursing Facility Hospice User Guide Reminders LIC Online Portal has 24 7 availability to submit and track documents
97. Name ce 3 Medicare or RR Recipients First ud Retirement Claim No S E Initial Recipient 2 Suffix e Service Group Transaction Correct this form Correct this form allows providers to submit a correction The original form or assess ment with status Provider Action Required will be set to status Corrected and will have a parent DLN to the new child form The new form or assessment replaces the original form or assessment Review the cor rectable fields covered in the Form 3618 and 3619 Corrections section of this User Guide to know when to choose correct vs inactivate Remember correcting an LTCMI to include a Purpose Code E or M will void any prior service dates and change the MDS to be valid for the start to end date only If payment has been made recoupment will occur Inactivate Form Inactivate Form will inactivate the form Forms will set to status Form Inactivated and cannot be corrected or re submitted An example of when this Inactivate Form button would be used is when the provider research indicates the form being submitted is a duplicate Resubmit Form Resubmit Form will set the form or assessment status to SAS Request Pending The form or assessment will process during the nightly batch processing Check the status of the form or assessment within two to four days to determine if the form or assessment processed successfully Status will be set to Processed Complete if success
98. Online Portal in order to meet time frames associ ated with the Alert Alert Descriptions Alert Communication to the Local Authority Local Mental Health Authority Outgoing Alerts Conduct PASRR Level 1 The LA LMHA should perform and submit a PASRR Level 1 Screening for an individual Screening within 7 days of the Alert date Conduct PASRR Evaluation The LA LMHA must perform and submit a PASRR Evaluation for the individual within 7 First Notification calendar days of the first notification This Alert can also be generated when the individual was admitted to a Nursing Facility as an Expedited Admission This is the first notice to the LA LMHA Conduct PASRR Evaluation The LA LMHA must perform and submit a PASRR Evaluation within 7 calendar days of this Second Notification notification This alert is triggered if it has been more than 7 calendar days since the date of the alert of the first notification lt Ifthe LA LMHA has already performed the PASRR Evaluation but has not entered it on the LTC Online Portal the LA LMHA should submit the PASRR Evaluation immediately Complete the IDD Section The IDD Section of the PASRR Evaluation has not been submitted on the LTC Online Portal on the PASRR Evaluation The LA LMHA responsible for the IDD Section of the PASRR Evaluation should complete the IDD Section Complete the Section on The MI Section of the PASRR Evaluation has not been submitted o
99. P that medical necessity was denied by the TMHP physician Ifa hearing is requested additional information may be submitted at any time by the LA LMHA or by the individual s physician either via telephone call to the TMHP nurses or via fax Note The submitter is responsible for checking the status of their submitted forms assessments screenings and evaluations using FSI or Current Activity and supplying additional information if needed Request for Fair Hearing A fair hearing is an informal orderly and readily available proceeding held before an impartial health and human services enterprise hearing officer At the hearing an individual applicant appellant or their representa tive including legal counsel may present the case as they wish to show that any action inaction or agency policy affecting the case should be reviewed The individual the individual s responsible party or in the case of no responsible party the LA LMHA DON or the NF administrator may request a fair hearing on behalf of the individual within 90 days from the effective date of the decision or from the notice of adverse action date whichever is later by calling TMHP at 1 800 626 4117 Option 5 When an individual receives a letter denying MN and giving the individual the right to request a fair hearing the individual must request a fair hearing within ten days of the date of the letter for Medicaid payment to continue until the fair hearing decision M
100. Pending Denial NF provides additional information Y NF does not provide additional information Y Y TMHP TMHP physician physician denies approves TMHP TMHP nurse physician approves approves Y Y MN Individual s phy ian MN approved provides additional denied ig information to appeal Submissions for individuals who do not have PMN or do not pass auto MN are reviewed by the TMHP nurse for MN determination within five business days of successful submission 52 v 2015 0703 LTC Nursing Facility Hospice User Guide 2 Once reviewed the submission is either approved meeting MN or placed in a Pending Denial need more information status for up to 21 calendar days FSI or Current Activity can be used to view the status of MN determination whether the assessment is set to status Approved Denied or Pending Denial need more infor mation If a PE is linked to the MDS as a Resident Review the TMHP nurse must review the PE before the MDS can be set to status Pending Denial need more information 3 The Director of Nursing DON or other licensed nurse within the facility must either add additional informa tion clarifying nursing medical needs through the Add Note feature or by calling TMHP and speaking with a TMHP nurse 4 If the TMHP nurse determines that MN has been met the assessment is approved 5 Ifthe TMHP nurse still cannot determine any l
101. SRR Evaluation PE indicating positive PASRR eligibility click the Create IDT tab displayed on the PLI PASRR LEVEL 1 SCREENING Current Status Individual Placed in PE Confirmed Name e DLN Username PE DLN Submitter Information 0100 Name A0200 Address A Street Address B City C State D ZIP Code Teas v A0300 NPI API A0400 Contract No A0500 Vendor No v 2015 0703 47 LTC Nursing Facility Hospice User Guide 2 The Nursing Facility must complete all required fields as indicated by a red dot next to the field on all sections of the IDT with the exception of the IDT Confirmation section which will be completed by the LA LMHA Nursing Facility required fields are disabled for the LA LMHA haue 6 y m Im 3 ete 3 Specialized Servius Specialized Services Indication Are Specialized Services indicatad a this time coeno wdividus Accoptance Refussl of Specialized 9 he has refused all Specialized Services at this time Services Indianed we Seiad sis azote iat 3 Once completed the Nursing Facility will submit the form by clicking the Submit Form button on the bottom right of the screen 48 v 2015 0703 LTC Nursing Facility Hospice User Guide 4 The following confirmation message will be displayed upon successful submission of the NF portion of the IDT The IDT has been
102. actual admission or discharge date The Last Name must match exactly what is shown on the Medicaid card Note The discharge type Return Anticipated or Return Not Anticipated has an effect on the individuals MDS RUG cycle Return not Anticipated ends the individual s current RUG records This should match the MDS Tracking Form v 2015 0703 59 LTC Nursing Facility Hospice User Guide 6 From here you have two choices a Click the Submit Form button to submit the form or b Click the Save as Draft button to store the form for future use but not submit it The form does not have to be complete to save the draft Note If the form is successfully submitted a DLN will be assigned and the LTC Online Portal will show Your form was submitted successfully If there are errors they will be displayed in a box at the top of the screen These errors will need to be resolved before the form can be successfully submitted Once all errors are resolved click the Submit Form button again to submit the form IMPORTANT Validation is performed on the Medicaid SSN Medicare number and the Last Name of the individual If the Medicaid SSN Medicare number and Last Name do not match processing will not occur The form will be set to status YD Invalid Validations are against the Medicaid Eligibility file Check the individual s Medicaid card or the MESAV and compare to the entry being made If the Medicaid card is
103. al Authority Information 0400 1A MI Contract No 1A MI Vendar No C0600 LA MINPI API No 0700 LA 100 Contract No 0900 LA vendor no 0900 LA ID NPI API No 2015 0703 185 LTC Nursing Facility Hospice User Guide PASRR Level 1 Screening Section D naa Mecca pam ASTATE MEDICAID CONTRACTOR Meme SubmitForm FormStatusinaury Current vendors PASRR LEVEL 1 SCREENING Mursion kaciity Choices D0100 Nursing Enter Contract No and Vendor No and click lookup tool to populate NF inform E Hide NF Information Contract No B Vendor No EL jaa stare Zip code Phone z 3 NF Contact FirstName K NF Contact middie LNF Contact Last NF Contact aT NF ls willing and able to serve NF Admitted the NF Date of Entry individual Individual Ls mem m Comments 186 va0150703 LTC Nursing Facility Hospice User Guide PASRR Level 1 Screening Section E MEDICAID Ls Where this viral ko olive nave about where The individu would like to jive Living Arrangement Options Comments about vith Whom the tike ta jive chock all that apply A Livo alone with support a Grou
104. alifying Stay days cannot split a single admission and discharge pair Two pairs of retroactive 3619s must be submitted instead Verify the Medicare Part A Coinsurance dates through the Medicare Remittance advice Resubmit the rejected 3619 admission for the first day of Coin surance paired with a discharge matching the first day of Full Medicare which will end the Coinsurance Service Authorization the day before the Qualifying Stay included on the admission of the pair Then resubmit the rejected 3619 discharge from Coinsurance paired with an admission beginning after the Full Medicare Qualifying Stay ends v 2015 0703 125 LTC Nursing Facility Hospice User Guide Provider Message Displayed in History NF 0051 This form cannot be pro cessed as a retroactive pair because the discharge of pair is marked as death and subsequent admission has already been processed Verify that the client was discharged and correct the form as needed If the client is deceased contact Provider Claims Services for assistance Form Assessment 3618 3619 Pair Suggested is form has been identified as part of a retroactive pair attempting to process together However a discharge marked Deceased cannot be processed as part of a retroactive pair since there is a subse quent admission on file Review the facility s records to determine the recipient s admission and discharge dates
105. ality purposes the form details Medicaid etc have been hidden in this document 3 Form Status Inquiry A STATE MEDICAID CONTRACTOR Form Select Tyne of Form 351 Resident Transaction Vendor Number it fr Cora Wars Sa 50 Form Status Inquiry OWN Medicaid Number Last Nome 7 First Nome j ES IC Form Status see From Date savons ToDatee m ET 77 4 record s returned u Saes am Lg MN quami xe mm amen Me mum o E ue ee Eo 7 Click the View Detail link to open the form 8 Scroll to the bottom of the page to view the History trail story Form 10 8 2015 9 04 18 AM Submitted Medicaid 10 8 2015 9 04 21 AM ib pening 10 8 2015 Medicaid ID request submitted Det 10 8 2015 9 04 24 AM Confirmed 10 8 2015 TMHP Medicaid 10 SES confirmed for this client d as Pending 10 8 2015 9 04 24 AM Medicaid Eligibility 10 8 2015 Medicaid Eligibility request sent Medicaid 10 8 2015 9 04 25 AM ity Ethene 10 8 2015 TMHP Medicaid eligibility confirmed fer this cent ibas am SAS 10 8 2015 9 04 26 AM Request Pending 10 8 2015 THE The request Is being processed by DADS Please allow 2 4 business days for the next status change d ao a Provider 10 12 2015 5 10 20 AM f
106. amp HEALTHCARE PARTNERSHIP TMHP _A STATE MEDICAID CONTRACTOR Form Status Inquiry Current Activity Drafts Vendors Letters Printableforms Alerts Home When the blue navigational bar above is displayed the Home feature at the far left will take you to My Account From the My Account page providers can perform various maintenance activities for an account such as setting up user accounts changing passwords and other administrative tasks Providers may click the TMHP com link located on the far left side of the My Account page to go back to the www tmhp com home page v F seems TMHP A STATE MEDICAID CONTRACTOR Home SubmitForm Form Status Inquiry Current Activity Drafts Vendors Letters Printableforms Alerts Help Using the TMHP home page providers may Access the LTC Online Portal Access TexMedConnect Submit a prior authorization Access provider manuals and guides Access bulletins and banner messages v 2015 0703 13 LTC Nursing Facility Hospice User Guide Submit Form The Submit Form feature allows providers to submit forms TMHP STATE MEDICAID CONTRACTOR NT onc MESURE Tq Submit Form Form Select of Form e Vendor Number 3618 Resident Transaction Notice 3615 Medicare SNF patient Transacton Notice Pi PASRR Level 1 Screening Waiver 3 0 Medical Necessity and Level of Cere Assessment Individual Movement Form Recipient 8578
107. are processed and reflected on the MESAV resubmit the rejected discharge If the recipient should not be classified as Medicare on this discharge date Determine if the discharge should be a 3618 discharge instead If so inactivate the rejected form and submit a 3618 discharge to close the recipient s file If the recipient is Full Medicaid a different facility determine if the 3619 admission to begin Coinsurance has been submitted If not submit the 3619 admission If it was rejected resolve the issue and resubmit the 3619 admission Then resubmit the rejected 3619 discharge NF 0063 This discharge cannot be processed because the client i admitted to Medicare Part A Coin surance for a different provider If an admission prior to this discharge is missing or rejected that admis sion must be processed prior to this discharge 3619 Discharge The recipient has a Service Authorization for Medicare Part A Coin surance with a different provider as of the submitted discharge date Review the facility s records to identify the Medicare Part A Coin surance admission date prior to this discharge Determine if the 3619 admission prior to this discharge has been submitted If not submit that 3619 admission If it was rejected resolve the issue and resubmit that 3619 admission Resubmit the rejected 3619 discharge after the missing or corrected admission has been processed NF
108. arge date Review the facility s records to identify the Medicare Part A Coin surance admission date prior to this discharge Determine if the 3619 admission prior to this discharge has been submitted If not submit that 3619 admission If it was rejected resolve the issue and resubmit that 3619 admission Resubmit the rejected 3619 discharge after the missing or corrected admission has been processed NF 0067 This discharge cannot be processed because an admission for a different provider has already been processed for the same day This discharge appears to be one of a retroactive pair If an admission prior to this discharge is missing or rejected resubmit the admission and this discharge on the same day 3619 Discharge The recipient has a Service Authorization with a different pro vider that begins after the submitted discharge date The rejected discharge and matching admission and must be submitted as a retroactive pair Review the facility records to identify the Medicare Part A Coin surance admission date prior to this discharge Determine if the 3619 admission prior to this discharge has been submitted If not submit that 3619 admission If it was rejected resolve the issue and resubmit that 3619 admission Resubmit the rejected 3619 discharge on the same day as the missing or corrected admission NF 0068 This discharge cannot be processed because the client already has a subsequent au
109. as already been received for the Date of Above Transaction Rejection of New Admission for Same Date of Above Transaction New admission has same Date of Above Transaction as an admission already received 11 1 2008 admission 11 1 2008 admission Same contract Possibly attempting to submit a duplicate form OR Different contract A different provider has previously submitted an admission for the same Date of Above Transaction date One provider is in error Contact other provider Scenarios 3618 admit exists in Processed Complete status for client A provider A transaction date 10 1 08 3618 admit exists in Processed Complete status for client A provider A transaction date 10 21 08 3618 admit submitted for client A provider A transaction date 10 1 08 Submit not allowed because date already in Processed Complete 3618 admit exists in Processed Complete status for client A provider A transaction date 10 1 08 3618 admit exists in Processed Complete status for client A provider A transaction date 10 21 08 3618 admit submitted for client A provider B transaction date 10 1 08 Submit not allowed because date already in Processed Complete for another provider Same contract A discharge has already been received for the Date of Above Transaction OR Different contract A discharge from another provider has already been received for the Date of Above Transaction Re
110. ate MDS database to adjust the Entry Date to the readmission date following the discharge Swing bed providers are required to submit MDS 3 0 assessments A0200 Type of Provider coded as 2 Swing Bed MDS 3 0 assessments for swing bed providers include assessments listed in items A0310B A0310C A0310D and A0310F These assessments are submitted to CMS however they are not retrieved by TMHP Swing bed provid ers must complete the appropriate MDS 3 0 OBRA required Comprehensive or Quarterly assessments listed in item A0310A in accordance with the MDS 3 0 RAI Users Manual if services provided are eligible for Medicaid reim bursement OBRA required assessments listed in A0310A that meet TMHP guidelines are retrieved by TMHP and the associated LTCMI will have field 1c Service Group auto populated to equal ten 10 based on the vendor contract number provided upon log in MDS Discharge Tracking and Re Entry Tracking forms 3 0 A0310F are used by CMS but are not retrieved and loaded onto the Online Portal The 3618 and 3619 are used by the state for Medicaid processing of recipient movement If the resident expires on the day the MDS Quarterly is due and there is no level of service for the date of death the MDS Quarterly must be submitted in order to receive payment for the date of death v 2015 0703 73 LTC Nursing Facility Hospice User Guide receive a RUG payment when a resident expires prior to completion of an
111. ates LTCMI Corrections PASRR Level 1 Screening Updates Form 3618 and 3619 Corrections Form 3071 and 3074 Corrections Counteracting Forms Modifications MDS 3 0 Inactivations MDS Assessment Forms 3618 and 3619 Inactivations How to Inactivate PASRR Level 1 Screening Inactivations Form 3618 and 3619 Submission Validation Rules and Edits Form 3618 Resident Transaction Notice Edits Form 3619 Medicare SNF Patient Transaction Notice Edits Document Statuses Nonemergency Ambulance Prior Authorization Requirements Prior Authorization Types and Definitions One Time Non repeating Recurring Nonemergency Prior Authorization Process Nonemergency Prior Authorization and Retroactive Eligibility Documentation of Medical Necessity Medicare and Medicaid Clients RUG Training Requirements Reminders Preventing Medicaid Waste Abuse and Fraud How to Report Waste Abuse and Fraud HIPAA Guidelines and Provider Responsibilities iv v 2015 0703 LTC Nursing Facility Hospice User Guide Resource Information Types of Calls to Refer to TMHP Types of Calls to Refer to DADS PASRR Unit Types of Calls to Refer to DSHS PASRR Types of Calls to Refer to DADS PCS Types of Calls to Refer to a Local Authority Local Mental Health Authority Helpful Contact Information
112. be claimed for the add on rate 87 LTC Nursing Facility Hospice User Guide LTCMI Fields S6b Ventilator Res Conditional Choose from the drop down box 1 Less than once a week 2 1to 6 times a week 3 Once a day 4 Twice a day 5 3 11 times a day 6 6 23 hours 7 24 hour continuous This field is only required and available for data entry if O0100F Ventilator or respirator column 2 While a Resident is checked Do not include BiPAP CPAP itor 56 Number of hospitalizations in the last 90 days Required Record the number of times the resident was admitted to hospital with an overnight stay in the last 90 days or since last assessment if less than 90 days Enter 0 zero if no hospital admissions Valid range includes 0 90 S6d Number of emergency room visits in the last 90 days Required Record the number of times the resident visited the Emergency Room ER without an overnight stay in the last 90 days or since the last assessment if less than 90 days Enter 0 zero if no ER visits Valid range includes 0 90 S6e Oxygen Therapy Conditional Choose from the drop down box 1 Less than once a week 2 1 to 6 times a week 3 Once a day 4 Twice a day 5 3 11 times a day 6 6 23 hours 7 24 hour continuous This is a required field is only available for data entry if O0100C Oxygen therapy column 2 While a Resident is checked
113. by the individual s physician either via telephone call to the TMHP nurses or via fax Note The submitter is responsible for checking the status of their submitted forms assessments screenings and evaluations using FSI or Current Activity and supplying additional information if needed Manual Medical Necessity Determination on PASRR Evaluation For a Preadmission PASRR Positive individual Medical Necessity MN determination is made using the associated PE which is submitted by the LA LMHA The initial MDS assessment will inherit the MN determination from the PE if the MDS assessment effective date is within 30 days plus or minus of the date of assessment of the PE The MDS LTCMI will be rejected while waiting for the MN determination on the PE In order to expedite processing TMHP automatically checks submitted evaluations with a Medicaid Number to determine if the individual already has Permanent MN PMN If the individual has PMN the MN is automatically approved The History trail will state Client has permanent MN For individuals who do not have PMN TMHP systems automatically review specific criteria on the PE If the criteria are appropriately met MN is automatically approved If not the provider will see The Form has failed Auto MN Approval displayed in the History trail The PE will then be sent to a nurse for manual MN review The status will be set to Pending Review on the FSI search results however the last message
114. ces to an individual One of those instances is when a PLI Screening Form is set to status Pending Placement in NF PE Confirmed The Able to Serve the Individual and Unable to Serve the Individual feature allows NFs identified in Section D of the PLI Screening Form to certify that the NF has reviewed the recommended specialized services on the PE and determined whether or not the individual can be served by the facility 30 v 2015 0703 LTC Nursing Facility Hospice User Guide PASRR LEVEL 1 SCREENING Current Status Perding Placement in NF PE Confirmed Name DLN Username PE DIN Form Actions Pant Adis Abe to Serve the individuel Unable is Serve the Individual section c lsc Section A ces Nursing Facility Choices 00100 Nursing Enter Contract No and Vendor No and click lookup tool to populate NF information Facilities EL ee Se cost Hide NF Information Contract no B Vendor No 9 D Facility Name E Street Address F city G State H Zip Code Phone NF Contact First Name K NF Contact Middle L NF Contact Last m NF Contact Nome Ls willing and able to serve nF Admitted the P NF Date of Entry Individual Individual 0 Comments 1 Locate the PLI Screening Form using FSI or Current Activity 2 There are two choices To certify the ability to serve the individual click the Able to Serve the
115. cess an MDS LTCMI cannot be submitted prior to Medical Necessity MN Determination on the The initial MDS assessment will inherit the MN determination from the PE if the MDS assessment effective date is within 30 days plus or minus of the date of assessment of the PE Attempting to submit the LTCMI prior to MN determination will result in an error message stating MDS LTCMI cannot be submitted prior to Medical Necessity MN Determination on the PASRR Evaluation you may save the LTCMI and submit after MN on PE is complete Providers have the ability to save the LTCMI and attempt resubmission once the PLI Screening Form and or PE have been submitted on the LTC Online Portal Fi ng Assessments Using Form Status Inquiry l Click the Form Status Inquiry link in the blue navigational bar 2 of Form Choose one of the following options from the drop down box MDS 3 0 Minimum Data Set Comprehensive MDSQTR 3 0 Minimum Data Set Quarterly 76 v 2015 0703 LTC Nursing Facility Hospice User Guide Note The following is an example of an MDS 3 0 Comprehensive assessment Teas MEDICAID e HEALTHCARE PARTNERS TMHP STATE MEDICAID CONTRACTOR Vendors Letters Form Status Inqui Form Select Type of Form MDS 3 0 Mrimum Data Set Comprehensive Vendor Number for Contract Number E Form Status Inquiry DLN Medicaid Number Last Name j First Name j Form Status AI C
116. cessing or call 512 438 2200 Option 3 Ifall the begin and end dates on the MESAV are correct except for the admission the rejected form is attempting to correct the last discharge date will need to be adjusted so the total of the new days added plus the adjusted existing dates equal 80 or less days The rejected admission should then be resubmitted 127 LTC Nursing Facility Hospice User Guide Provider Message Displayed in History NF 0056 This modification cannot be processed because the cor responding adjustment based on the 80 day limit would cancel a later admission that has already been processed Verify the Service Authorizations already established and submit any additional modit cations Form Assessment 3619 Mod Suggested For each Medicare Spell of Illness the state will pay a maximum of 80 days of Medicare Part A Coinsurance to one or more provid ers The recipient will exceed the 80 day limit if this correction is processed as submitted In order to reduce the total to 80 days the system would have to cancel a processed admission Review the facility s records to determine the recipient s admission and discharge dates and identify the Spell of Illness Pull a MESAV and review the Service Authorizations to determine the number of Coinsurance days on file plus the number of new days that would be added by the rejected form Verify the begin and end dates of the Service Aut
117. charge cannot be processed because a later discharge has already been processed If an admission after this discharge is missing resubmit with the submis sion of the matching admission 3619 Discharge discharge is part of a retroactive pair Review the facility s records to determine which admission is after this discharge Pull a MESAV and review the Service Authorizations The discharge and admission should split one of the authorizations when these forms process Once identified the discharge and admission must be submitted on the same day as a pair Ifthe form is not part of a pair it should be a correcting discharge not a new discharge Inactivate this form and correct the transac tion date of the later discharge NF 0044 This form cannot be processed because the other half of the pair of forms failed to process Validate and submit both forms 3618 3619 Pair This form is part of a retroactive pair The other half of the pair failed to process so this form could not be processed alone Determine how to resolve the problem that caused the other half of this pair to be rejected Review the facility s records to determine which transaction is the other half of the pair If the discharge date is before the admission date the pair is creating a gap in a Service Authorization Pull a MESAV and review the Service Authorizations The discharge and admission should split one of the authoriza
118. ciated Level of Service record per facility type The provider must maintain an original Form 3071 on file for reproduction Submission of the form is outlined in the How to Submit Form 3071 section of this User Guide An original can be obtained on the DADS website www dads state tx us forms v 2015 0703 65 LTC Nursing Facility Hospice User Guide This form is also located online at www tmhp com Pages LTC ltc forms aspx Note The effective date of Form 3071 is the hospice election date or the individual signature date whichever occurs last See the Helpful Telephone Numbers section of this User Guide for contact information on hospice claims policy and contracting For hospice forms policy questions should be directed to hospice dads state tx us only addresses techni cal questions related to using the LTC Online Portal for hospice form submission Note Ifthe individual enters the NF under hospice care then there is no need to submit a 3618 or 3619 admission However if the individual has a 3618 or 3619 submitted and enters hospice while remaining in the NE the facility must submit a 3618 or 3619 discharge If the individual has already been admitted to the NF on a 3618 19 and then enters hospice care while remaining in the facility the NF is responsible for discharging them to hospice care on a 3618 19 Once they have discharged the individual they are no longer required to submit 3618 or 3619 forms to
119. ctive based on the Entry Date entered into field 1600 System processing will start the Level record either based on the Entry Date or the completion date Z0500B minus 30 days which ever is later Note Ifthe begin date of the Level record needs to be adjusted because the timeframe between Entry Date and the comple tion date is over 30 days a telephone call is required to DADS Provider Claims Services 512 438 2200 Option 1 for the additional days All other assessment types will be effective based on the completion date Z0500B All assessments without a Purpose Code are valid for 92 days from the completion date Expiration dates on the MESAV also include a 31 day grace period for the next submission An MDS 3 0 Admission assessment is valid in three situations 1 Fora first physical admission into a an Admission assessment is valid Regardless of whether the individual is private pay Medicare or Medicaid the provider should complete an Admission assessment for a first physical Omnibus Budget Reconciliation Act OBRA admission within 14 calendar days of admission to the NE For Texas Medicaid if a resident is active in a NF and discharges to another NF for even onc day then returns to the original NE the readmission to the original NF is considered a first physical admission As soon as another 72 v 2015 0703 LTC Nursing Facility Hospice User Guide provider is introduced the prior NFs MDS cycle for the indivi
120. d Form Assessment MDS 3619 Admit Suggested Action The recipient s Applied Income is not available to DADS Pull a MESAV for the recipient covering the date requested on the form or assessment Note If the recipient does not already have Service Authorizations for your contract this information will not be available on the MESAV If the MESAV does not show an Applied Income for the dates of the form or assessment contact the HHSC Eligibility Worker to update the Applied Income records Once the Applied Income has been updated resubmit the rejected form or assessment If the recipient is already estab lished in your facility you may monitor the MESAV for updated Applied Income If the MESAV does show an Applied Income for the dates of the form or assessment resubmit the rejected form or assessment NF 0002 This assessment cannot be processed because there is no gap in the Level records for this client for the Purpose Code time frame on the assessment MDS Admit Annual Quarterly There is no gap in Level records for the resident during the Purpose Code timeframe Pull a MESAV for the Purpose Code timeframe requested on this assessment and determine if the dates are reflected in the Level section of the resident s MESAV Validate whether a gap in coverage exists If there is a Level record with valid continuous coverage on file a Purpose Code is not needed Inactivate the assessment
121. d Return Antici pated and the individual is in the hospital over 30 days a new MDS 3 0 Admission assessment is due The Entry Date should be the new admission to the facility after the discharge that was over 30 days If the Entry Date is submitted with a date prior to the discharge a modification will be required to adjust the date so the assessment is valid for the dates after readmission Validating the Appropriateness of an Admission Assessment If che Entry Date of an MDS assessment overlaps with an established MDS for the same NE the coding of Admis sion assessment is most likely in error One of the considerations in validating an Admission assessment is the relationship between the Entry Date and the completion dates An Admission assessment should be completed within 14 days of the Entry Date CMS and DADS will accept the assessment if the timeframe is longer but the provider must validate whether an Admission assessment is the appropriate reason for assessment If the Entry Date is two years prior to the completion date this assessment probably should not be an Admission assessment If the Admission assessment is needed because the resident had a Form 3618 discharge indicating Return Not Anticipated the Entry Date should be the new readmission date not an admission prior to the discharge If the provider already submitted the assessment with the Entry Date prior to the discharge date a modification must be transmitted to the st
122. d Provider Lookup TM P other state health care programs ACS a XEROX H Company rose te naw consolated heath coro Looking for a TEXAS MEDICAID with a tear of eubeartractors under he rama provider Taumas oana Cak haro ASIKTE MEDICAID CONTRACTOR 3 Click Long Term Care in the yellow bar uisus pem IE DEI would like to v 2015 0703 5 LTC Nursing Facility Hospice User Guide 4 Click I would like to in the blue bar located at the top of the screen m Log In to LTC Online Portal Log in to ToxMedConnect TexMedConnect Long Term Care Homepage Get started with Tha Texas Deparment cf Aging and Dicabilty DADS admanctore programs provdng LTC Guus SS anc Care to eligible clams The Texas Medicaid amp Hoaltheas Partnerstio Pepe ZEE LTC team supports the LTC provider commurity in submitting clams through the Cams 5 Click the Activate my account link TP vanced search em enc a amicas tumens IMP A STATE MEDICAID CONTIACTOR og In to LTC Online Portal Log In to TexMedConnect I would like to TexMedConnect lick the inks below to parom tasks and access provider applications Se Unsecured Provider Tasks iria The following tasks can be performed without logging to a provider account 6 From here you have two choic
123. d resubmit the rejected admission correction the next day If the Service Authorization being changed should be canceled inactivate this correction and submit a correction to the corre sponding discharge making it a counteracting form to the admission form NF 0047 This assessment modifica tion cannot be processed because it is an invalid change to an existing Purpose Code MDS Mod Admit Annual Quarterly This is a modification of a processed MDS assessment that had a Purpose Code on the LTCMI Once an MDS has been processed as either a PC E or M the form must continue to have a Purpose Code on the LTCMI A modification can change a PC M to a PC E but a PCE cannot be changed to a PC M and a PCE or M cannot be changed to no Purpose Code Review the LTCMI on the prior submission parent form noting the Purpose Code and the dates requested Modify the rejected assessment entering the appropriate Purpose Code and proper dates then resubmit the rejected admission NF 0048 This assessment cannot be processed because more than one assessment was submitted on the same day with the same assess ment effective date MDS Two assessments attempted to process on the same day using the same assessment effective date Validate the effective dates on the MDSs submitted Ifthe assessment effective date is incorrect one MDS submit a modification to the federal CMS database for that ass
124. d A1600 submitted is incorrect submit a modification to CMS in accordance with the RAI Users Manual General Instructions 1 Review the effective date on the form or assessment to ensure it is correct For Forms 3618 and 3619 the effec tive date is the Date of Above Transaction For Minimum Data Set MDS Admission assessments the effective date is the MDS Entry Date 1600 Date For all other MDS assessments the effective date is the MDS assess ment Completion Date Z0500B Date IF the effective date is incorrect take the appropriate action to correct the form or assessment gt 3618 or 3619 Correct the form on the LTC Online Portal and submit MDS Correct the assessment by following the guidelines in the RAI Users Manual and submit the modified MDS to the federal CMS database then complete the Long Term Care Medicaid Information LTCMI section on the LTC Online Portal If the effective date is correct continue to step 2 2 Ifa Form 3619 admission or discharge is rejected and the Date of Above Transaction is prior to the most recent Service Authorization begin date on the individual s Medicaid Eligibility Service Authorization Verifica tion MESAV contact DADS PCS to request manual processing 3 Ifa Form 3618 or 3619 needs to be resubmitted and is set to status Submitted to manual workflow click the Correct this form button add a comment example Resubmit then click the Submit Form button
125. d can cel the Medicare Part A Coinsurance record being modified If the new discharge date is incorrect modify and resubmit 3619 Discharge Mod The effective date of the discharge correction is prior to the Service Authorization it is attempting to close Review the facility s records to determine the recipient s admission and discharge dates and identify the Spell of Illness Pull a MESAV and review the Service Authorizations to determine which Service Authorization ended based on the original discharge date The system has determined that the new discharge date is prior to that begin date Verify the begin and end dates of the Service Authorizations on file based on the actual admissions and discharges that have occurred Also compare the time periods for Medicare Part A Coinsurance to your Medicare remittance indicating what days should be Coinsurance Remember that the discharge date results in a Service Authorization end date one day earlier than the transaction date Verify if the new discharge date is actually part of a retroactive pair rather than a correction If so Correct the discharge date back to the original date Identify the admission that would complete the retroactive pair Submit the rejected discharge and new admission on the same day 128 v 2015 0703 LTC Nursing Facility Hospice User Guide Provider Message layed in History NF 0058 This discharge modi
126. d form or assessment GN 9106 This form cannot be 3618 3619 The recipient s Medicaid eligibility is not available to DADS processed because DADS does not MDS Pull a MESAV for the recipient covering the date requested on the have Long Term Care Financial Eligi form or assessment bility for this client and timeframe Note If the recipient does not already have Service Authorizations for Contact the HHSC Eligibility Worker your contract this information will not be available on the MESAV or SSI office If the MESAV does not show Long Term Care Financial Eligibility for the dates of the form or assessment contact the HHSC Eligibility Worker or Supplemental Security Income SSI office to update the Financial Eligibility records Once the Financial Eligibility has been updated resubmit the rejected form or assessment If the recipient is already estab lished in your facility you may monitor the MESAV for updated Financial Eligibility If the MESAV does show Financial Eligibility for the dates of the form or assessment resubmit the rejected form or assessment GN 9248 This form cannot be pro MDS The submitted Primary Diagnosis International Classification of cessed due to one or more invalid Diseases ICD Code is not valid Diagnosis Codes Correct the Diag Modify the Primary Diagnosis Code on the LTCMI section as nosis Codes and resubmit needed and resubmit the rejected assessment Ifthe Primary Diagnosis Code on the LTCM
127. d no parent child form is created The History trail shows the fields that have been updated listing the previous and new values Fields that can be updated on the PL 1 without changing the form status 0600 Date of Assessment B0100A First Name B0100B Middle Initial BO100C Last Name B0100D Suffix 200 Social Security No B0200B Medicare No 0300 Medicaid No B0400 Birth Date B0600 Gender B0700A Previous Residence B0700B Other Residence Type B0700C Street Address B0700D City B0700E State B0700F ZIP Code 0700 County of Residence B0800A Relationship to Individual B0800B Other Relationship to Individual BO800C First Name 08000 Middle Initial BO800E Last Name 0800 Suffix B0800G Phone Number BO800H Street Address BO80OL City B0800J State BO800K ZIP Code 142 v 2015 0703 LTC Nursing Facility Hospice User Guide Fields that can be updated on the PL1 which will cause the form to be set to status PL1 Inactive B0650 Individual is deceased or has been discharged B0655 Deceased Discharged Date Updates to PASRR Level 1 Screening 1 Login to the LTC Online Portal 2 Click the Form Status Inquiry link in the blue navigational bar 3 Search for the Screening Form using the individual s SSN Medicaid Numbe
128. d specialized services must be documented by the NF in the resident s Com prehensive Care Plan and initiated within 30 days after the date that the services are agreed to in the IDT meeting 46 v 2015 0703 LTC Nursing Facility Hospice User Guide The LA LMHA has 60 days to certify the IDT once the NF has completed the IDT IDT Meeting Steps 1 The meeting must occur within the first 14 days of admission to the NE 2 NF must inform the LA LMHA and the individual the LAR of the date and time of the meeting The LA LMHA can participate in the meeting via telephone physical presence is not required 3 The finalized Specialized Services delivered by the LA LMHA and NF should be included in the residents Comprehensive Care Plan 4 All Specialized Services must be initiated within 30 days after the services are added to the Care Plan 5 Ifan LA LMHA is invited to an IDT meeting and fails to attend the NF should notify the DADS Local Authority Section via email LAservicecoordination dads state tx us IDT Tab on the PL1 The IDT tab on the PLI is where information about the IDT meetings and Specialized Services are captured by the nursing facility Enter the IDT meeting information as required Many of the fields are conditionally required meaning that depending on the information entered in a field other fields may become required fields 1 Upon successful completion of a PASRR Level 1 PL1 Screening and a PA
129. determination letters 531 MD DO ZIP Code Conditional This field is required if S3f License State is NOT Texas Enter the ZIP code of the resident s MD DO mailing address This information is used to mail MN determination letters S3m MD DO Phone Optional This field is optional if S3f License State is NOT Texas Enter the telephone number of the resident s MD DO This information is used to contact MD DO if necessary S4 Licenses Provider Certification On behalf of this facility certify to the completeness of the MDS Assessment S4a RN Coordinator Last Name Required Enter the last name of the RN Assessment Coordinator Providers must enter the same RN Coordinator name as entered in field 20500a of the MDS Assessment 86 v 2015 0703 LTC Nursing Facility Hospice User Guide LTCMI Fields S4b RN Coordinator Required Enter the license number of the RN Coordinator Licenses issued in Texas will be validated against the Texas BON Board of Nursing or Compact License will be validated with the issuing state s nursing board This number is validated to ensure RUG training requirements have been met The license numbers supplied at S4b must be RUG trained as offered by Texas State University The assessment will not be accepted on the LTC Online Portal if the license is not indicated as having completed the RUG training The RUG training is online web bas
130. diagno ses may be entered in the COMMENTS box with the ICD Code included NOTE Diagnoses Debility and Failure to Thrive are no longer accepted as principal terminal diagnoses 6 From here you have two choices a Click the Submit Form button to submit the form or b Click the Save as Draft button to store the form for future use but not submit it The form does not have to be complete to save the draft Note If the form is successfully submitted a DLN will be assigned and the LTC Online Portal will show Your form was submitted successfully If there are errors they will be displayed in a box at the top of the screen These errors will need to be resolved before the form will be successfully submitted Once all errors are resolved click the Submit Form button again to submit the form Note Both the 3071 and 3074 must be submitted and processed prior to receipt of payment v 2015 0703 67 LTC Nursing Facility Hospice User Guide Actions Pent x 3071 Recipient Election ICancellation Discharge Notice Provider Information TEST PROVIDER CM2 m Recipient Information Medicaid Number Last Name Address e City Dope L m First Mame Name cf Facility e Eades Transaction Information Form Type Setinge Medicare Part A il
131. dicaid Number Medicare Number Name or Status When the provider clicks on a column heading for the first time it is sorted in ascending order By clicking on the column heading a second time the sort will change to descending order Sorting will apply only within the form or assessment type where the header being clicked is located MDS 3 0 and MDSQTR 3 0 are separate groups and column headings Drafts TMHP ASTATE MEDICAID CONTRACTOR Home Submit Form Form Status Inquiry Current Activity Drafts Printable Forms The Drafts feature allows access to all drafts saved under the vendor contract number to which the user is linked To access a saved draft 1 Click the Drafts link in the blue navigational bar 2 Click the appropriate vendor number hyperlink under Vendor Numbers A list of drafts saved for the selected vendor contract number will display A E MEDICAID CONTRACTOR Home Submit Form Form Status Inquiry Current Activity Drafts Vendors Letters PrintableForms Alerts Drafts Long Term Gare Gontract Numbers Vendor Numbers for Contract Number for Contract Number for Contract Number Texas Menicaln Hermicaxs Paxmessir TMHP ASTATE MEDICAID CONTRACTOR Home Submit Form Form Status Inquiry Current Activity Drafts Vendors Letters PrintableForms Alerts Drafts Date Created Form Type Description Select 11 7 2013 4 03 22 M RTN3
132. dual determinations of medical necessity regarding nursing facility care These health care professionals consist of physicians and registered nurses 40 19 2403 e states A recipient may establish permanent medical necessity status after completion date of any MDS assessment is approved for medical necessity no less than 184 calendar days after the recipients admission to the Texas Medicaid Nursing Facility Program 50 v 2015 0703 LTC Nursing Facility Hospice User Guide General Qualifications for Medical Necessity Determinations 40 TAC 19 2401 states Medical necessity is the prerequisite for participation in the Medicaid Title XIX Long term Care program This section contains the general qualifications for a medical necessity determination To verify that medical necessity exists an individual must meet the conditions described in paragraphs 1 and 2 of this section 1 The individual must demonstrate a medical condition that A is of sufficient seriousness that the individual s needs exceed the routine care which may be given by an untrained person and B requires licensed nurses supervision assessment planning and intervention that are avail able only institution 2 The individual must require medical or nursing services that A are ordered by the physician B are dependent upon the individual s documented medical conditions C require the skills of a registered nurse or
133. dual is ended and must be restarted if the indi vidual returns to the original NF Discharging to the individual s home to Hospice to another Medicaid service community services or to the hospital is not discharging to another NE 2 If the resident discharges from a NF and the Form 3618 discharge type indicates Return Not Anticipated a new Admission assessment is required if the individual readmits to the NF Remember that the Form 3618 is expected to match the MDS discharge tracking form also submitted for this individual The MDS discharge tracking form would indicate Discharge Return Not Anticipated Although CMS rules allow the use of the Reason for Assessment on the discharge tracking form for any individual whose first physical admission to the NF is less than 14 days a provider should NOT use this reason for assessment if the individual s stay is being paid for by Texas Medicaid This is because if the provider does not complete an OBRA Admission assessment as completely as possible even if the individual is in the provider s building for only one day the provider will not have an MDS assessment for billing purposes If the Form 3618 or MDS tracking form discharge type is marked incorrectly the discharge type can be corrected If the resident is physically discharged from the facility for over 30 days regardless of reason or location CMS requires an Admission assessment For example if the discharge to the hospital was marke
134. e Form Action Use as template Update Form Add Note Add Note The Add Note feature is available for PL1 Screening Form MDS assessments and Forms 3071 3074 3618 and 3619 Add Note located in the yellow Form Actions bar may be used to add additional information not captured at original submission and is not used in system processing Information is added to the History trail of the document not to the document itself c g not added to Comments in the LTCMI section of the assessment If the status is set to Pending Denial need more information and a note is added the document is set to status Pending Review and the additional information will be reviewed by a TMHP nurse To add a note to a submitted document 1 Locate the submission using FSI or Current Activity 2 Click the Add Note button a text box will open Form Action Print Use as template Update Form Add Note 3 Enter additional information up to 500 characters PASRR LEVEL 1 SCREENING Current status Awaiting PE Names DLN Form Actions Cesene Cenom ade Cancel ECCUTENEENENENN sections Section C Section D Section E Section F 4 Click the Save button to save your note or Cancel button to erase your note located under the text box Note Jf unsure why an assessment or screening is set to status Pending De
135. e Missed or Prior Assessment End Date S1g Prior to adding a Purpose Code to an LTCMI validate if payment has been made based on the MDS Entering Purpose Code Start and End date cancels any prior services dates the assessment represented If necessary submit an off cycle MDS 3 0 assessment to submit a Purpose Code E or M Note Once MDS LTCMI has been completed as PC E any future modifications or corrections must also be com pleted as a PC E PC E Start and End Date Li itations MDS 3 0 Only applicable for MDS 3 0 Admission Quarterly review and Annual assessments Start date cannot be prior to September 1 2008 following errors must be fixed before the form will submit v 2015 0703 101 LTC Nursing Facility Hospice User Guide MDS Purpose Code M The Purpose Code M is used when Prior Medicaid Eligibility has been established Prior eligibility can begin up to three months prior to certifica tion of Medicaid Purpose Code M can only be submitted on the Admission assessment Annual assessment or Quarterly review assessment Note A Purpose Code M can only fill a gap for which prior eligibility has previously been established Payment is made at the full calculated RUG rate Check MESAV to ensure eligibil ity code of P or TP11 BEFORE the submission of a PC M Missed Assessment Start and End Dates are used by the provider to identify the Prior Medicaid period The MESAV must reflect
136. e nursing facility care Last Name MD DO License ND DO License state z Military Spec Code The following HD DO information 1 required MD DO s not licensed in Texas S3h MD DO First Hame MO DO Address 5 MO DO city S3k MD DO State 5 0 00 ZIP Code 40 00 Phone 54 Licenses Provider Certification On behalf of this facility T to the completeness of the MDS Assessment Sa RN Coordinator Last Name S b RN Coordinator License S e RN Coordinator Licence State S5 Primary Diagnosis Primary Diagnosis ICD Code 55 Primary Diagnosis ICD Description Additional MM Information umber of hospitalizations In the last 90 days Humber of emergency room visits in the last 90 days Oxygen Therapy z Special Ports Central Lines PICC z developmental level le the resident f S6h Enter the number of times this resident has fallen the last 90 days 561 In how many of the falls listed above was the person physically restrained prior to the fall 558 In the falls listed In 56 above how many had the following contributory factors than one factor may apply to a fall Indicate the number of falls fr each contributory factor Environmental debris slick or wet floors lighting etc Medication s S6j3 Major Change in Medical Condition Myocardial Infarction MI Heart Attack
137. e of Above Transaction Isl 7 Complete only the fields needing correction pud E Mee 1 Medicaid Recipient No 4 O i 2 Social Security No G Name Q Recipient s First Name Medicare or RR Retirement Recents Md ped ta z RedplentNameSuffk Discharged To Hospital Enter Dat Date of Above Transaction m certify that to the best of my knowledge the date in Item 11 Date of Above Transaction is for services provided and the date is not included in the UU Administrator State Board License No J Administrator Last Name Administrator First Name 1s Adminstrator Signature on Date Signed 8 Click the Submit Form button Note Ifthe form is successfully submitted a DLN will be assigned and the LTC Online Portal will show Your form was submitted successfully If there are errors they will be displayed in a box at the top of the screen These errors will v 2015 0703 145 LTC Nursing Facility Hospice User Guide need to be resolved before the form will be successfully submitted Once all errors are resolved click the Submit Form button again to submit the form 9 Click the DLN link displayed in the Your form was submitted successfully message to return to the form 10 Click the Print button in the yellow Form Actions bar to print the completed form
138. e of the following The individual is bed confined before during and after the trip and alternate means of transport is medically contraindicated and would endanger the individual s health i c injury surgery or the use of respiratory equip ment The functional physical and mental limitations that have rendered the individual bed confined must be documented Note Bed confined is defined as an individual who is unable to stand ambulate and sit in a chair or wheelchair The individual s medical or mental health condition is such that alternate means of the transport is medically contraindicated and would endanger the individual s health c g injury surgery or the use of respiratory equipment The individual is a direct threat to himself or herself or others which requires the use of restraints chemical or physical or trained medical personnel during transport for individual and staff safety e g suicidal When physical restraints are needed documentation must include but is not limited to the following of restraint Time frame of the use of the restraint Clients condition Note The standard straps used in an ambulance transport are not considered a restraint Medicare and Medicaid Clients NFs should simultaneously request prior authorization for the nonemergency transport from TMHP for a Medicaid Qualified Medicare Beneficiary MQMB individual in the event the service requested is denied by
139. e terms box at the bottom of the screen to indicate agreement Es Ame m i amp Click the Create Provider Administrator button to create your User Name and Password fa Note The User and Password are used for future log ins to your account Make a copy for your records v 2015 0703 LTC Nursing Facility Hospice User Guide My Account My Account is used to perform various maintenance activities for your account such as setting up user accounts changing passwords and other administrative tasks To access My Account l Goto www tmhp com 2 Click providers in the green bar located at the top of the screen usum clients providers Englich seporel AINT Healthcard Partnership Not yet a provi om Welcome to Texas Medicai Thank you for visiting the Texas Medicaid amp Healthcare Partnership s TMHP Internet website for Texas Medicaid and othar state health care programe As cf January 1 2004 Raporting ACS Stata Healthcare LLC under contract with the Taxes Health and Human Senices Commission HHSC assumed administration of claims processing for Texas Medicaid and Provider Lookup other stete health care programs ACS XEROX company meets its new consolidated heath cate Looking for a TEXAS MEDICAID wh a team of scena under he name 3 Click
140. ecome Full Medicaid during the time period the assessment represents The LTCMI cannot be submitted until an admission either Form 3618 3619 has been submitted v 2015 0703 81 LTC Nursing Facility Hospice User Guide LTCMI Fields Important Ensure that the information entered in the LTCMI does not conflict with information entered in the MDS assessment pp Current Status Avalting LTC Medicaid Information DIN Section Section Section 2 Section Section Section Section V Section x 51 Claims Processing Informatio Sta DADS Vendor Site ID Number Sib Contract Provider Number Ste Service Group Sid Hospice Contract lumber Sie purpose Code a 52 PASARR Information To your krowedge doe the resident have an Inlet assy 535 To your knowledge doas the resident have development a Pind 33 To your kiowlege does the resident have condition of mariai s ese according to the PASARR guidelines S24 1 the resident danger to hinsel nerselz Sae Is the resident a danger to others E SL specialized services Indicated calculte recalculte the value in field S21 5 Physician s Evaluation amp Recommendation Does the MD DO have plans for te eventual discharge ofthis resident 2 Rehabilitative Potential Dig an HD DO certify that this resident requires continues to requir
141. ecto Required 0 12 2015 NF 0013 The admission cannot be processed because the dent is already adritted int 1 a discharge prior to SHO the admission s rejected the rejected discharge must be processed Arst The adinesion can then be resubmitted to SAS Iris isthe ital admission into your acil please contact the pror provide andiequest hak hey submit he missing 9 Find Provider Action Required status on the far left It should be the last line in the History trail 10 Find the rejection message in the white line just below the Provider Action Required 2015 0703 109 LTC Nursing Facility Hospice User Guide 11 Perform the necessary research to resolve the error See the provider workflow rejection messages in the Provider Workflow Rejection Messages section of this User Guide for more information 12 Depending on the provider research providers have one of three options to move the form or assessment out of the provider workflow Based on the reason for rejection there are situations where the Provider Action is to contact DADS Provider Claims Services fie Home submtrom Form status ina aay Drafts Vendors Printable Forms um Custom Vendor Number Contract Number NPI Number 1 Medicaid Recipient No 4 Recipient s Last 5 Address Address 2 Social Security No Name
142. ed The submission of the missing form and the erroring form can occur the same day The missing form will need to be submitted and then the erroring form Providers do not need to wait for the missing form to process overnight Form 3618 Resident Transaction Notice Edits Edit Description System Message displayed at time of submis n System Message Clarification System Message Resolution assistance for resolving error Last form submitted was an admission Please supply discharge form prior to this admission Rejection of New Admission for missing Previous Discharge New admission follows an admission for same contract i e 11 12 2008 admission no discharge 12 16 2008 admission submitted Submit a discharge prior to this admission Attempting to submit two 3618 admissions in a row missing a 3618 discharge Submit the missing discharge then submit the 3618 admission Scenarios 3618 admit exists in Processed Complete status for client A provider A transaction date 10 20 08 3618 admit submitted for client A provider A transaction date 10 21 08 Submission is not allowed without a prior discharge 3618 admit exists in Corrected status for client A provider A transaction date 10 20 08 3618 admit submitted for client A provider A transaction date 10 21 08 Submit allowed Previous admit in corrected status so not considered 3618 admit exists in ME Check Inactive
143. ed training as offered by Texas State University The training is valid for two years The name entered 54 should match the name in section Z0500A Note An error will occur if the license number does not pass validation The assessment will not be considered successfully submit ted until all errors are resolved S4c RN Coordinator License State Required Choose the license state in which the RN Coordinator is licensed from the drop down box S5 Primary Diagnosis S5a Primary Diagnosis ICD Code Required Enter a valid ICD code for the individual s primary diagnosis Use your best clinical judgment S5b Primary Diagnosis ICD Description Optional Click the magnifying glass and the description will be auto populated based on the primary diagnosis ICD Code S6 Additional MN Information S6a Tracheostomy Care Conditional Choose from the drop down box 1 Less than once a week 2 1 to 6 times a week 3 Once a day 4 Twice a day 5 3 11 times a day 6 Every 2 hours 7 24 hour continuous This field is only required and available for data entry if O0100E Tracheostomy care column 2 While a Resident is checked AND the resident is 21 years of age or younger ENTRY TIP This field will be disabled if field 00100E2 Tracheostomy Care is not checked on the MDS The Provider must submit an MDS Modification if field 00100E2 is not checked 56 is to
144. edicaid payment will only continue if the indi vidual was already receiving services If the individual requests a fair hearing later than ten days of the date of the letter Medicaid payment will not be made for days past day ten The individual can request a fair hearing up to 90 calendar days after the date of the letter Form 4803 Acknowledgement and Notice of Fair Hearing serves as a notice of the fair hearing It is sent to the appellant to acknowledge the receipt of a request for a hearing and to set a time date and place for the hearing Form 4803 will be sent to all known parties and required witnesses at least ten calendar days in advance of the hearing The fair hearing is held at a reasonable place and time They are normally scheduled in the order in which requests are received and are usually held via teleconference Appellants may present their own case or bring a friend relative or attorney to present their case DADS Health and Human Services enterprise does not pay attorney fees Appellants may request additional time to prepare for their case by contacting the hearing officer Appellants may request an interpreter at no cost However appellants must notify the hearing officer at least two days before the hearing if they are going to require an interpreter Before and during the hearing appellants and their representatives have the right to examine the documents records and evidence that DADS will use To see medical
145. ejected MDS Ifa 3618 3619 admission has not been submitted because the resident is Hospice review the LTCMI to verify that a Hospice contract number has been entered If not modify the LTCMI on the LTC Online Portal to include the Hospice contract number Ifthe processed date on the admission is prior to the MDS rejection contact DADS Provider Claims Services at 512 438 2200 Option 1 for assistance be processed because you have reached the limit of Swing Bed days for this client for a 12 month period Submit an admission if the client becomes eligible to receive additional Swing Bed services NF 0008 This assessment cannot MDS Quarterly An assessment with the same effective date and a different As be processed because an assess sessment Reason is already on file A Quarterly assessment cannot ment with the same effective date replace it but different Reason for Assess Verify if the MDS Assessment Complete Date on the rejected ment has already been processed assessment is correct If not submit a modification to the federal Continue to submit assessments CMS database to correct it based on the client s MDS assess If the MDS Assessment Completion Date is correct determine ment schedule which Reason for Assessment is appropriate and inactivate the other MDS If the processed assessment is inactivated the rejected assessment can be resubmitted once th processed If the rejected assessment
146. en submitted prior to the submission of the LTCMI the LTCMI will not be accepted on the LTC Online Portal Attempting to submit LTCMI without a PL1 Screening Form will result in an error message stating PASRR Screening PLI not found A PLI is required before MDS LTCMI can be submitted you may save the LTCMI and submit after PLI is submitted Ifa PLI Screening Form has been submitted prior to the submission of the LTCMI but the Vendor Contract number in Section D of the PLI Screening Form do not match the MDS LTCMI Vendor Contract number of the NE the LTCMI will not be accepted on the LTC Online Portal Attempting to submit the LTCMI without a matching Screening Form will result in an error message stating PASRR Screening not found for this Nursing Facility A PLI is required before MDS LTCMI can be submitted you may save the LTCMI and submit after PLI is submitted v 2015 0703 75 LTC Nursing Facility Hospice User Guide For Preadmission PASRR Positive individuals with an active PLI Screening Form the LTC Online Portal will not accept the LTCMI without a PE Attempting to submit the LTCMI without a PE will result in an error message stating PASRR Evaluation PE not found A PE is required before MDS LTCMI can be submitted Please contact your Local Authority to perform the PASRR Evaluation you may save the LTCMI and submit after PE is submitted In addition when a PE is required for the admission pro
147. epartment of Aging and Disability Services DADS www dads state tx us All DADS provider information can be found at www dads state tx us providers index cfm Please choose your particular provider type for available online resources Assisted Living www dads state tx us providers alf index cfm Consumer Rights and Services includes information about how to make a complaint www dads state tx us services crs index html DADS Provider Claims Services https hhsportal hhs state tx us wps portal e Handbooks www dads state tx us news_info publications handbooks index html handbooks Nursing Facility www dads state tx us providers nflindex cfm Nursing Facility MDS Coordinator Support Site http qmweb dads state tx us mdsweb ovr PASRR www dads state tx us providers pasrr index cfm Provider Letters www dads state tx us providers communications letters cfm Resources for DADS Service Providers www dads state tx us providers index cfm Department of State Health Services DSHS www dshs state tx us DSHS Local Mental Health Authority Search www dshs state tx us mhservices search DSHS PASRR Information www dshs state tx us mhsa pasrr Health and Human Services Commission HHSC www hhsc state tx us index shtml HHSC Regions www hhsc state tx us about hhsc Regions Vendor Drug Program www txvendordrug com downloads index asp 172 v 2015 0703 LTC Nursing Fac
148. equired Choose from the drop down box 0 No 1 Yes Ifunknown then reply with 0 No S2f Are specialized services indicated Disabled This field is disabled Click the Determine Specialized Services button to calculate and populate value in S2f 53 Physician s Evaluation amp Recommendation S3a Does the MD DO have plans for the eventual discharge of this resident Conditional Choose from the drop down box 0 No 1 Yes This field is required if Admission assessment SCSA or Recovery of Lost Payment Purpose Code E S3b Rehabilitative Potential Conditional Choose from the drop down box 1 good 2 fair 3 minimal This field is required if Admission assessment SCSA or Recovery of Lost Payment Purpose Code E S3c Did an MD DO certify that this resident requires continues to require Nursing Facility care Conditional Choose from the drop down box 0 No 1 Yes This field is required if Admission assessment SCSA or Recovery of Lost Payment Purpose Code E S3d MD DO Last Name Required Enter the last name of the MD DO S3e MD DO License Conditional This field is required if S3g MD DO Military Spec Code is not populated Enter the license number of the MD DO This number is validated against the Texas Medical Board file Note error will occur if the license number does not pass validation The assessment will not be considered
149. er your existing TMHP User Account click Existing Ussmeme and Activate Existing Provider If you are not a Texas Medicaid Provider Vendor or you would like to return to the previous page click here Retum to TM P com Jf you have difficulty with the account activation process contact the TMHP EDI Helpdesk at 1 868 855 3535 botwoon the business hours of 7 00 am ta 7 00 pm CST 7 Ihe following page will appear Follow the instructions listed at the top of the page and click the Create a Provider Vendor Administrator Account link at the bottom of the page Hame Navigation What happens when T activate a Provider vendor Account 1 User Account is created 2 Texas Medicaid ar CSHCN Services Program provider Vender Account is activated for crine use Tha TMH Usar Acccunt is givon administrative rights to the Pravider Vender Account What is a TMHP User Account A TMH User Account includes usemame and psssvord which required tc log into TMH Applications A User Account can be linked to one or more Provider vendor accounts What do administrative rights allow a User to do When TMHP User Account is given administrative rights to a Texas Medicaid or CSHCN Services Program Provider vendor account the User is alawed to cantra account activity and access protected data pertaining to a particular Provider Facility or Verdor With
150. er Action Required workflow submitted by facilities in error for full Hospice individual Repercussions of Submitting Form 3618 Late Payment to the facility will be delayed Personal needs allowance for Supplemental Security Income SSI individuals will be delayed Can delay the Medicaid Eligibility certification for an individual applying for Medicaid Failure to submit Form 3618 can restrict the individual to only having a reduced number of prescriptions The facility may be subject to sanctions such as vendor hold as a result of contractual noncompliance How to Submit Form 3618 1 Log in to the LTC Online Portal 2 Click the Submit Form link located in the blue navigational bar 3 Type of Form Choose 3618 Resident Transaction Notice from the drop down box 4 Click the Enter Form button 5 Enter all required information as indicated by the red dots Enter at least one of the following Medicaid Recipient No Social Security No or Medicare of RR Retire ment Claim No Ifan Admission from hospital enter the hospital admission date in the field provided between location and Date of Above Transaction Ifan Admission from private pay enter the physical admission date in the field provided next to Private pay Deceased indicates that the individual was pronounced in the facility Location indicates where the individual is admitting from or discharging to Date of Above transaction will be the
151. es 05 3 05 here a create a new TMHP User Account without an existing provider vendor account click the New Username and Enroll link if selected go to step 8 Provider Type step b create a new TMHP User Account with an existing provider vendor account click the New Username and Activate Existing Provider link if selected go to step 7 6 v 2015 0703 LTC Nursing Facility Hospice User Guide va Fame Besson Navigation welcome to the Account Activation portion of TMHe curn Account Activation The following instructions vill help providers choose tha correct option for creating TMHP User Accounts and activating Texas Medicaid or Children with Special Health Care Needs Services Program CSHCN Provider vender Accounts online if you do not have a User Account choose one of the following options To create a TMHP User Account and begi pzas To create a TMHP User Account and act ate an existing Texes Macicaid or CSHCN ServicesfProgram provider vendor account far online usa New Username and activate Existing provider if you do have user account choose ona athe To make changes to an existing enrolment application for Texas Medicaid or the CSHCN Services Program click Existing Enrolmen To activato an existing Texas Medicaid cr CSHCN Sarvices Program Pravidar Vendar acccunt und
152. es such as a need for oxygen or additional monitoring during transport the prior authoriza tion request must be updated Prior Authorization Types and Definitions One Time Non repeating One time nonrepeating requests are reserved for those individuals who require a one time transport The request must be signed and dated by a physician physician assistant PA nurse practitioner NP clinical nurse specialist CNS registered nurse RN or discharge planner with knowledge of the individual s condition Stamped or com puterized signatures and dates are not accepted Without a signature and date the form is considered incomplete Recurring Recurring requests up to 60 days are reserved for those individuals whose transportation needs are not anticipated to last longer than 60 days The request must be signed and dated by a physician PA NP CNS Stamped or computerized signatures and dates are not accepted Without a signature and date the form is considered incom plete The request must include the approximate number of visits needed for the repetitive transport e g dialysis radiation therapy Refer to Form AM 1 Nonemergency Ambulance Prior Authorization Request 2 Pages in the Texas Medicaid Provider Procedures Manual Volume 2 Ambulance Services Handbook v 2015 0703 161 LTC Nursing Facility Hospice User Guide Nonemergency Prior Authorization Process To obtain prior authorization NFs must subm
153. essment and resubmit the other rejected assessment If one of the assessments was submitted in error inactivate the assessment that is not needed and resubmit the other rejected assessment 124 v 2015 0703 LTC Nursing Facility Hospice User Guide Provider Message layed in History NF 0049 This assessment cannot be processed because an admission assessment is not appropriate or the Date of Entry does not corre spond with the correct admission If an admission assessment is not appropriate inactivate this assess ment and submit the appropriate MDS assessment type If the admis sion assessment is appropriate modify the Date of Entry Form Assessment MDS Admit Suggested Action An assessment that covers the Date of Entry is already on file for this resident and provider Ifthe prior 3618 discharge was Return Not Anticipated validate that Return Not Anticipated was correctly marked on the discharge form If it was not correct the discharge and submit Once the correction to Return Not Anticipated is processed ending the Levels per that discharge the rejected MDS can be resubmitted If the discharge was Return Not Anticipated and the form was marked correctly verify that the MDS Entry Date corresponds to the admission following that discharge If the MDS Entry Date corresponds to an earlier admission submit a modifi cation to the federal CMS database to correct the Entry Date If th
154. est form TMHP responds to nonemergency transport prior authorization requests within 2 business days of receipt of requests for 60 days or less NFs should submit all requests for a prior authorization number PAN in sufficient time to allow TMHP to issue the PAN before the date of the intended transport The requesting NF must contact the transporting ambulance provider with the PAN and the dates of service that were approved TMHP reviews all of the documentation it receives An online prior authorization request submitted through the TMHP website is responded to with an online approval or denial Alternately a letter of approval or denial is faxed to the requesting NF The individual is notified by mail if the authorization request is denied or downgraded Reasons for denial include documentation that does not meet the criteria of a medical condition that is appropriate for transport by ambulance or the individual is not Medicaid cligible for dates of services requested Clients may appeal prior authorization request denials by contacting TMHP Client Notification at 1 800 414 3406 Pro viders may not appeal prior authorization request denials nonemergency transport will be denied when a claim is submitted with a prior authorization request form that is completed and signed after the service is rendered In addition a prior authorization request form that is completed and signed after the service is rendered will not be accepted on appeal
155. etes and updates Section E of the PLI Screening Form on the portal after submission by clicking on the Enter Disposition button 42 v 2015 0703 LTC Nursing Facility Hospice User Guide Resident Review Process LA LMHA performs LA LMHA submits La LMHA Is notified PE within 72 hours p PE within 7 days of to perform a RR of notification first notification 1 A Resident Review takes place when an LA LMHA is notified to perform a PE on a resident of an NE The notification is normally generated as an automatic Alert in the LTC Online Portal although the request could come as a manually generated Alert in the LTC Online Portal from DADS DSHS or the NE Resident Review Triggers Trigger Action MDS Significant Change in Status Assessment SCSA is Perform Face to Face Interview with resident submitted Complete and submit a new PE within seven calendar days of the first notification Perform Face to Face Interview with resident Complete and submit a new PE within seven calendar days of the first notification Individual was admitted under Expedited Admission and the Expedited Admission time frame has expired Individual was admitted under Exempted Hospital Dis Perform Face to Face Interview with resident charge and the resident has stayed more than 30 days Complete and submit a new PE within seven calendar days of the first notification NF DADS DSHS or individual LAR requests a
156. evidence before the hearing the appellant must make a v 2015 0703 55 LTC Nursing Facility Hospice User Guide written request to the hearing officer The appellant may bring witnesses and present facts and details about the The appellant may also question or disagree with any testimony or evidence that is presented by the department Appellants have the right to know all the information the hearing officer examines in making the decision The laws and policies which apply to the appellant s case and the reasons for DADS action will be explained The hearing officer will issue a final written order The decision by the hearing officer is DADS final adminis trative decision If the appellant believes the hearing officer did not follow applicable policy and procedures the appellant can submit a request for administrative review within 30 days of the date of the decision The appellant submits the request for administrative review to the hearing officer who will forward the request to the appropriate legal office for review The appellant may have to pay back any overpayments DADS made to the appellant because the appellant did not supply correct and complete information or was overpaid while waiting for the hearing decision MDS set to status PE MN Denied When an MDS assessment is set to status PE MN Denied the Check MN on PE button will be visible under the Workflow Actions section of the yellow Form Act
157. f the TMHP nurse determines that MN has been met the PE is approved 5 Ifthe TMHP nurse still cannot determine any licensed nursing need after additional information has been provided the PE is sent to the TMHP physician for MN determination 6 Ifthe TMHP physician determines that MN has been met the PE is approved 7 IF MN is denied by the TMHP physician notification of denied MN is sent to the individual in a letter 54 v 2015 0703 LTC Nursing Facility Hospice User Guide 8 The individual s physician may submit additional information within 14 business days of the date on the denial letter by faxing additional medical information to the TMHP LTC department 40 TAC 19 2407 Or the LA LMHA may provide additional information by using the Add Note feature of the PE on the LTC Online Portal or by calling and speaking with a TMHP nurse The individual s PE and the additional or new medical information will be reviewed by the TMHP nurse and cither approved or sent to the TMHP physician for a second MN determination The TMHP physician will either approve the PE or uphold the original decision to deny 9 If the LA LMHA or individual s physician does not provide additional information clarifying nursing medical needs within 21 calendar days of Pending Denial need more information the PE is sent to the TMHP physician for review and the steps 5 9 will apply 10 The individual may initiate the appeal process when notified by TMH
158. fica tion cannot be processed because the new discharge date would result in more than 80 days of Medicare Part A Coinsurance for this Spell of Illness Confirm the 80 days of Coinsurance and submit any additional modifications Form Assessment 3619 Discharge Mod Suggested Action For each Medicare Spell of Illness the state will pay a maximum of 80 days of Medicare Part A Coinsurance to one or more providers The recipient will exceed the 80 day limit if this correction is pro cessed as submitted Review the facility s records to determine the recipient s admission and discharge dates and identify the Spell of Illness Pull a MESAV and review the Service Authorizations to determine the number of Coinsurance days on file plus the number of new days that would be added by the rejected later discharge date Verify the begin and end dates of the Service Authorizations on file based on the actual admissions and discharges that have occurred Remember that the discharge date results in a Service Authorization end date one day earlier than the transaction date Submit any corrections needed because of incorrect begin or end dates If these corrections will reduce the total number of Coinsur ance days to 80 days or less the rejected discharge should be resubmitted once the new correction forms have processed If the begin and ends on file are correct and the recipient has a Medicare Replacement policy that allows more tha
159. for traditional Long Term Care LTC TMHP does not pay LTC claims this is done by the comptroller Responsibilities also include the following Determination of MN Provider Education Provide timely processing of claims except for services covered by the STAR PLUS premium and repre sents DADS at Fair Hearings Produce provider procedure manuals updated monthly quarterly LTC Provider Bulletins and Remittance and Status R amp S Reports Maintain the TMHP Call Center Help Desk Monday through Friday 7 00 a m 7 00 p m Central Time excluding holidays Conduct training sessions for providers which includes technical assistance on the TexMedConnect online application Texas State Legislature The state legislature allocates budgetary dollars for Texas Medicaid 2 v 2015 0703 LTC Nursing Facility Hospice User Guide National Provider Identifier NPI Atypical Provider Identifier API Requirements The Health Insurance Portability and Accountability Act HIPAA established the National Provider Identifier NPI as the 10 digit standard unique identifier for health care providers and requires covered health care providers clearinghouses and health plans to use this identifier in HIPAA covered transactions NPI is required on all claims submitted electronically through third party software or through TexMedConnect On the LTC Online Portal NPI is used for security purposes and links pro
160. fraud under applicable federal or state law How to Report Waste Abuse and Fraud Reports may be made through the following website https oig hhsc state tx us This website also gives instruc tions on how to submit a report as well as how to submit additional documentation that cannot be transmitted over the Internet The website also provides information on the types of waste abuse and fraud to report to OIG If you are not sure if an action is waste abuse or fraud of Texas Medicaid report it to OIG and let the investigators decide If you are uncomfortable about submitting a report online there is a telephone number for Recipient Fraud and Abuse reporting 1 800 436 6184 v 2015 0703 167 LTC Nursing Facility Hospice User Guide HIPAA Guidelines and Provider Responsibilities Providers must comply with the Health Insurance Portability and Accountability Act HIPAA It is YOUR respon sibility to comply with HIPAA to seek legal representation when needed and to consult the manuals or speak to your TMHP Provider Representative when you have questions 168 v 2015 0703 LTC Nursing Facility Hospice User Guide Resource Information Types of Calls to Refer to TMHP Call TMHP at 1 800 626 4117 Option 1 about the following forms completion including PASRR Level 1 Screening Form Rejection codes on the forms Management of the Provider Action Required status If the Medicaid Social Securi
161. from the NF prior to 30 days from the admission date the NF indicates the discharge on the PLI Screening Form a If individual is still in residence at the NF after 30 days from the admission date then the Portal alerts the LA LMHA to perform a PE b The LA LMHA performs the PE within 72 hours of notification 5 The LA LMHA submits the PASRR Evaluation PE on the LTC Online Portal within seven calendar days of the first notification by the Portal Authorization for payment to the LA for completion of the PE is setup as a result of successful submission of the PE on the Portal 6 The NF will conduct the IDT with required participants The NF reviews the PE including recommended specialized services and certifies if they are Able or Unable to serve the individual 7 Ifthe NF is unable to serve the individual the LA LMHA works in collaboration with the NF to coordinate placement into another NF or an alternate setting NOTE For more information about certification see the Required Certification of Able or Unable to Serve the Indi vidual section of this User Guide 38 v 2015 0703 LTC Nursing Facility Hospice User Guide Expedited Admission Process performs PLI Does individual fit into a Category for Expedited Admission Yes gt RE sends PL1 to NF with individual on receipt NF submits PLI on Portal immediately RE follows Preadmission or Exempted
162. fully processed 13 If the provider clicks the Correct this form button a parent child DLN relationship will be created 110 v 2015 0703 LTC Nursing Facility Hospice User Guide 14 If the provider clicks the Inactivate Form button the provider will receive the following confirmation window From here you have two choices a Click the OK button to inactivate and the form or assessment status will be set to status Form Inactivated or b Click the Cancel button to cancel the Inactivation request keeping the form or assessment set to status Provider Action Required Li pem LE ed Meme Submitrorm MEEME Curent Drafts Vendors Letters Prntaleforms 8 Carm 3618 RESIDENT TRANSACTION NOTICE Current Status Provider Action Required Names st DENIS tees Form Actions Workflow Actions Dem semssikm Cai Cian Cente Vender Number Contract Number NPI Number Vm e M Recipient Information 1 Medicaid Recipient No 4 Reciplent s Last 1 5 Address Address 2 Social Security No Meme City 3 Medicare or RR ho C State Retirement Claim No Rau TIP Reciplent s Middle Initial Recipient Name 15 If the provider clicks the Resubmit Form button the following screen will appear allowing the provider to add any comments There is an option to select 2 System or 1
163. g a PL1 Screening Form or a Form 3618 3619 3071 or 3074 from the Submit Form link If the provider is creating a new form or screening from a template of a previously submitted form screening using the Use as template button Ifthe provider opens a draft form or assessment from the Drafts link Correct this form The Correct this form feature is available for the LTCMI section of the MDS and for Forms 3071 3074 3618 and 3619 Corrections not allowed if a document is set to status Form Inactivated Invalid Complete SAS Request Pending Corrected Click the Correct this form button to correct a previously submitted LTCMI or form PRETI Form status inqucy NES NC CN T NC 8 a Curam MINIMUM DATA SET MDS VERSION 3 0 RESIDENT ASSESSMENT AND CARE SCREENING Nursing Home Comprehensive NC Item Set Qn Section SectionL Section M Section N Section Section P Section Q Section V Section X Section Z Section LTCMI Note The steps to correct a form or an LTCMI are covered in the Corrections section of this User Guide v 2015 0703 27 LTC Nursing Facility Hospice User Guide Update Form The Update Form feature allows the submitting entity to make corrections to a PLI Screening Form Specific infor mation about updating the PL1 Screening Form can be found in the PASRR Level 1 Screening Updates section of this User Guid
164. ges radio button c Enter the pages to print Example 1 5 will print all pages 1 through 5 1 3 7 will print only pages 1 3 and 7 This is useful for printing only the LTCMI instead of the entire MDS assessment d Click the button Pris pe Puesag 1 tao ad Ceria ein Pap Souse by POF pape t nis Inches p IPs co as tack v 2015 0703 23 LTC Nursing Facility Hospice User Guide Alerts The Alerts link allows you to view system and user generated Alerts Alerts are electronic messages sent to a user notifying them that an action must be taken on a PL1 Screening Form or Refer to the Alerts section in this User Guide for more information p GAM dumis Medio PACS nhan 5 a sas r e lem us Gia e z en u aD us uus a e SZ 5 s EE mem z oo a Sa E umb ams enS amem mem ES mm omu as 24 v 2015 0703 LTC Nursing Facility Hospice User Guide Help The Help feature at the far right in the blue navigational bar will display a Help page consisting of links to online guides that will assist with questions you may have about the LTC Online Portal MEDICAID CONTRACTOR Form StatusInquiry Current Activity Drafts Information regarding claims submissions via Tex
165. hca org jRAVEN see Federal MDS 3 0 Resident Assessment Instrument RAI 3 0 Manual www cms gov NursingHomeQualityInits 25 NHQIMDS30 asp State MDS Policy www dads state tx us providers mds index cfm Stare MDS Clinical Web Page The MDS Mentor www dads state tx us providers MDS NF MDS Coordinator Support Site www dads state tx us providers MDS 174 v 2015 0703 LTC Nursing Facility Hospice User Guide Acronyms A0310A Reason for Assessment MDS 3 0 1600 Admission or Entry Date MDS 3 0 2300 Assessment Reference Date ARD Assessment Reference Date BON Texas Board of Nursing CHOW Change of Ownership CMS Centers for Medicare amp Medicaid Services CNS Clinical Nurse Specialist CPR Cardiopulmonary Resuscitation Central Venous Catheter DADS Texas Department of Aging and Disability Services DLN Document Locator Number DON Director of Nurses DOS Date of Service DSHS Department of State Health Services EDI Electronic Data Interchange EMS Emergency Medical Services ER Emergency Room FSI Form Status Inquiry HHSC Texas Health and Human Services Commission HIPAA The Health Insurance Portability and Accountability Act HMO Health Maintenance Organization HRC Human Resource Code ICF IID Intermediate Care Facility for Individuals with Intellectual Disability IDD Intellectual and Developmental Disabilities
166. he LTCMI prior to submission The saved LTCMI will remain in status Awaiting LTC Medicaid Information Reminder The LTCMI will not be saved to Drafis 5 Successful submission will display the DLN and a message Your form was submitted successfully Li pem TMI STATE MEDICAID CONTRACTOR Home Bubmit another form nquiry on a forms Status Form Status Inquiry Drafts Vendors Letters PrintableForms Alerts our form was submitted successfully You can track this form using the DLN o 6 Unsuccessful submission will result in error messages being displayed at the top of the page you will need to scroll to the top of the page to see the errors E3 numm MINIMUM DATA SET MDS Version 3 0 RESIDENT ASSESSMENT AID CARE SCREENING Nursing Home Comprehenitve NC Set Section C Section G Section H Section D Section Section L Section Section Section Q Section V Section X Section 2 80 v 2015 0703 LTC Nursing Facility Hospice User Guide Circumstances for LTCMI Submission Nursing Facilities are directed to complete the LTCMI when seeking full Medicaid reimbursement when an indi vidual is moving to full Medicaid or continuation of Medicaid payment The LTCMI is not required for Medicare recipients or Co insurance Note DADS recommends completing the LTCMI if the individual could possibly b
167. he admitting NF with the individual b The NF admits the individual submits the Screening Form on the LTC Online Portal and follows the standard admission process The PASRR process ends for this individual Note the NF attempts to submit the MDS LTCMI without first submitting the PLI Screening Form the LTCMI will not be accepted 3 If the PLI Screening is positive a RE or NF faxes the PL1 Screening Form to the LA LMHA this notification starts the 72 hour timer of when the LA LMHA must perform the PE b The LA LMHA submits the PLI Screening Form on the LTC Online Portal immediately upon receipt c The LA LMHA travels to the RE location to perform the PE face to face within 72 hours of notification by the RE d The LA LMHA submits the PE on the LTC Online Portal within seven calendar days of first notification by the RE Authorization for payment to the LA LMHA for completion of the PE is setup as a result of successful submission of the PE on the Portal 4 The NF will conduct the IDT with required participants The NF reviews the PE including recommended specialized services and certifies if they are Able or Unable to serve the individual Note If the NF attempts to submit the MDS LTCMI before the positive Screening Form and PE have been submit ted and before MN determination has been made then the LTCMI will not be accepted For more information about certification see the Required Certificati
168. he city where the resident is presently living This information is used to mail MN determination letters 89 LTC Nursing Facility Hospice User Guide LTCMI Fields S amp c State Required Enter the state where of the resident is presently living This information is used to mail MN determination letters 584 ZIP CODE Required Enter the ZIP code where the resident is presently living This information is used to mail MN determination letters 58 Phone Optional Enter the contact telephone number for the resident if known If the resident is residing in an NF and no other direct contact telephone number is known enter the telephone number of the NF S9 Medications Medication Certification checkbox Required Providers are required to check the Medication Certification checkbox to certify that the resident is taking no medica tions or the medication listed are correct S9 Medications S9 1 Medication Name and Dose Ordered Free form text Identify and record all medications that the resident received in the last 30 days Also identify and record any medica tions that may not have been given in the last 30 days but are part of the resident s regular medication regimen e g monthly B 12 injections Do not record PRN medications that were not administered in the last 30 days 59 2 RA Route of Administration Select from the
169. he list below LProviderracing v Text to be added to form history Css sinn Forms 3618 and 3619 that are set to status Processed Complete Corrected Form Inactivated or have been suc cessfully processed or that contain provider workflow message code GN 9004 anywhere in the History trail of the form cannot be inactivated If a provider attempts to inactivate a Form 3618 or 3619 and one of the above circum stances exists the provider will receive the following error message This form has been successfully processed at DADS and cannot be inactivated If this form is invalid should not have been submitted submit the appropriate form to counteract this form Otherwise correct this form and resubmit To cancel a form that is set to status Processed Complete and has an error in a non cortectable field or one that should not have been submitted providers must submit the appropriate counteracting form Please refer to the Counteracting Forms section of this User Guide for additional information PASRR Level 1 Scree g Inactivations There is no Inactivate Form button for a PLI Screening Form If a new PLI Screening Form is submitted for an individual with an existing Screening Form the previous PL1 Screening Form and any associated PE will be inactivated automatically Upon submission of this new PLI Screening Form a message will appear prompting you to confirm inactivation of the previous PLI Sc
170. he rejected admission must be processed first This dis charge can then be resubmitted 3618 Discharge This admission and discharge pairis either retroactive to the current authorizations or the recipient is currently authorized at a prior y Review the facility records to identify the admission prior to this discharge If the pair is retroactive the admission and discharge must be submitted at the same time A gap in the Service Authorizations must exist for this time period to fill If the recipient has been in your facility previously you may be able confirm this gap by pulling a MESAV and verifying dates Ifthe prior admission form was rejected correct that form and resubmit The admission must be processed before the discharge can process Ifthe prior admission form is missing submit that missing form then resubmit the rejected discharge 118 v 2015 0703 LTC Nursing Facility Hospice User Guide Provider Message layed in History NF 0020 This discharge cannot be processed because a later discharge has already been processed This discharge appears to be one of a retroactive pair If an admission after this discharge is missing or re jected resubmit the admission and this discharge on the same day Form Assessment 3618 Discharge Suggested Action discharge is part of a retroactive pai Review the facility records to identify the admission prior to t
171. heck Inactive From Date e appealed To Date e Eme ml lappreved Purpose Code awaiting LTC Medicaid Information Coach Pending Info Reason for Assessment Coach Review Corrected Cened Form Inactivated 1D Ivald Invalid Complete Med ID Check Inactive Pending Denial need more information Pending Med cad Elgibilty Pending Info Pending Review Pending RN License Verificaten SAS Request Pending ited to manual workflow iaiting for PASARR verification 3 Form Status Choose Awaiting LTC Medicaid Information from the drop down box 4 Enter a date range for the period for which you are searching The system default for the search is within the past month however the date range must include the period in which the assessment was submitted Note It may take up to 48 hours after submission to CMS before the MDS 3 0 assessment is accessible on the LTC Online Portal for data entry in Awaiting LTC Medicaid Information status 5 Click the Search button and the search results will display 6 Click the View Detail link to display the details of the assessment If You Cannot Locate Your MDS Using FSI or Current Activity After confirming the requested date range be sure to verify all of the following MDS was accepted not rejected by CMS via your validation report Avalid Medicaid number or was entered in field A0700 0700 does not contain an N
172. hese dates create Full Medicare periods which do not appear on the MESAV Ifthe end date of an existing Service Authorization needs to be changed submit a correction to that discharge If the submitted admission date would overlap with a reported Qualifying Stay period submit a correction to adjust the Qualifying Stay dates To determine if the Qualifying Stay dates from the Medicare remittance advice correspond with those on file contact DADS Provider Claims Services at 512 438 2200 Option 1 for assistance Ifthe recipient was previously receiving Hospice services verify the dates of service with the Hospice Provider and make correc tions as needed This rejected admission should be resubmitted once the file has been adjusted 126 v 2015 0703 LTC Nursing Facility Hospice User Guide Provider Message his admission modifica tion cannot be processed because the new admission date would result in more than 80 days of Medicare Part A Coinsurance for this Spell of Illness Confirm the 80 days of Coinsurance and submit any additional modifications Form Assessment 3619 Admit Mod Suggested Action For each Medicare Spell of Illness the state will pay a maximum of 80 days of Medicare Part A Coinsurance to one or more providers The recipient will exceed the 80 day limit if this correction is pro cessed as submitted Review the facility s records to determine the recipie
173. his discharge Pull a MESAV and review the Service Authorizations The discharge and admission should split one of the authorizations when these forms process The discharge and admission pair must be submitted at the same time If the form is not part of a pair it should be a correcting discharge not a new discharge Inactivate the rejected discharge and correct the transaction date of the later discharge NF 0021 This discharge cannot be processed because a later admission to another provider has already been processed This discharge appears to be one of a retroactive pair If an admission prior to this discharge is missing or rejected resubmit the admission and this discharge on the same day 3618 Discharge This discharge is part of a retroactive pair Review the facility records to identify the admission prior to this discharge Pull a MESAV and review the Service Authorizations There should be no other authorization during the admission and discharge timeframe when these forms process The admission and discharge pair must be submitted at the same time Ifthe form is not part of a pair it should be a correcting discharge not a new discharge Inactivate the rejected discharge and correct the transaction date of the earlier discharge NF 0022 This discharge cannot be processed because the client does not have a corresponding Nursing Facility admission missing 3618 Verify that the admission
174. horizations on file based on the actual admissions and discharges that have occurred Remember that the discharge date results in a Service Authorization end date one day earlier than the transaction date Submit any corrections needed because of incorrect begin or end dates If these corrections will reduce the total number of Coinsurance days to 80 days or less the rejected form should be resubmitted once the new correction forms have processed If the begin and end dates on file are correct and the recipient has a Medicare Replacement policy that allows more than 80 days state this in the comment section of the 3619 and call 512 438 2200 Option 3 or fax the Medicare Replacement EOBs with a copy for the 3619 to 512 438 3400 attention Medicare Advantage Plan If the Spell of Illness involved another facil and your facility s begin and end dates are right except for the correction review your Medicare Remittance If the Medicare Remittance advice validates that Coinsurance is due for the time period that your 3619s indicate fax them with a copy of the 3619s to 512 438 3400 attention ECF Form Processing or call 512 438 3400 Option 3 Ifall the begin and end dates on the MESAV are correct the rejected form will need to be corrected so the total of the new days added plus the existing dates equal 80 or less days NF 0057 This discharge modifica ion cannot be processed because the new discharge date woul
175. ice Authorization for Full Medicaid Review the facility s records to determine which discharge is prior to this admission Pull a MESAV and review the Service Authorizations to determine the authorized services If the MDS for the recipient has not processed you will not have services authorized If the recipient has an ongoing Service Authorization with a begin date prior to the rejected admission and the current Service Authorization is for Full Medicaid Code 1 a 3618 discharge must be processed prior to resubmitting the rejected 3619 admission If the recipient has a closed Service Authorization for Code 1 with an end date after the rejected 3619 admission Verify that the 3618 discharge was submitted for the correct date If not correct the discharge If the discharge is now prior to the rejected 3619 admission it can be resubmitted If the 3618 discharge is correct there are quite a few 3618 3619s that need to process between the begin and end dates of the Service Authorization Verify all dates and submit the needed forms If the recipient does not have Service Authorizations on the MESAV use the statuses on the LTC Online Portal to determine the forms that have processed Remember authorizations will only display if the MDS has also processed If the most recent processed form is a 3618 admission prior to the rejected 3619 admission a 3618 discharge must be processed prior to resubmitting the rejected 361
176. icensed nursing need after additional information has been provided the assessment is sent to the TMHP physician for MN determination 6 If the TMHP physician determines that MN has been met the assessment is approved 7 IF MN is denied by the TMHP physician notification of denied MN is sent to the individual in a letter 8 The individual s physician may submit additional information within 14 business days of the date on the denial letter by faxing additional medical information to the TMHP LTC department 40 TAC 19 2407 Or the DON or other licensed nurse within the facility may provide additional information by calling and speaking with a TMHP nurse The individual s assessment and the additional or new medical information will be reviewed by the TMHP nurse and either approved or sent to the TMHP physician for a second MN determina tion The TMHP physician will either approve the assessment or uphold the original decision to deny 9 If the NE LA LMHA or individual s physician does not provide additional information clarifying nursing medical needs within 21 calendar days of Pending Denial need more information the assessment is sent to the TMHP physician for review and the steps 5 9 will apply 10 The individual may initiate the appeal process when notified by TMHP that medical necessity was denied by the TMHP physician Ifa hearing is requested additional information may be submitted at any time by the LA LMHA or
177. ide the services the individual will require When a PLI Screening Form is set to status Pending Placement in NF PE Confirmed the NF must certify that it is either willing and able to serve an individual or unable to serve the individual For more information about certification see the Form Actions Available When a Screening Form Requires Certification section of this User Guide 44 v 2015 0703 LTC Nursing Facility Hospice User Guide Using FSI to Identify Residents with Specific PASRR Conditions Nursing Facilities can use FSI to identify residents with specific PASRR conditions This can assist NFs in ideni ing the number of residents in the facility with MI ID or DD The LTC Online Portal will Derive and store the PASRR condition of NF residents as indicated by the latest active PASRR Evaluation PE for the resident at the time of the most recent MDS LTCMI submission An active PE is one that is not set to status Pending Form Completion or Form Inactivated Provide the capability to export the resident based search results to Microsoft Excel Provide a capability to search for residents in the facility based on their PASRR condition by selecting an option from the drop down box in the FSI Display a list of residents when searching by a PASRR condition listed in the PASRR Eligibility Type drop down box of the FSI To use FSI this way you must select MDS 3 0 Minimum Data Set Comprehensive
178. idual s Medicaid ID card Invalid Complete DADS processing deemed this form or assessment invalid Sce the History trail for details Invalid Form Sequence Only applies for Forms 3618 and 3619 Form 3618 3619 sequence is invalid For example Form 3618 needs to be submitted before the MDS can be accepted Check Inactive Medicaid Eligibility validation attempted nightly for six months and failed or the request was canceled The provider may restart the assessment once the reason for the failed validation has been resolved by the Medicaid Eligibility Worker by clicking the Reactivate Form button Med ID Check Inactive Medicaid ID validation attempted nightly for six months and failed or the request was canceled The provider may restart the assessment once the reason for the failed validation has been resolved by the Medicaid Eligibility Worker by clicking the Reactivate Form button Medicaid ID Pending Medicaid ID validation is pending Validation attempts occur nightly until deemed valid invalid or until six months has expired whichever comes first Contact the Medicaid Eligibility Worker to verify individual s name Social Security number and Medicaid ID This status will also apply to private pay 158 v 2015 0703 LTC Nursing Facility Hospice User Guide residents whose assessments are successfully but unnecessarily submitted via LTC Online Portal The assess ment will suspend for six months and if
179. il a new LTCMI is successfully submitted ASTATE MEDICAID CONTRACTOR ome NENDETTTETTTTE Current Activty rafts Letters Printable Forms Alerts MINIMUM DATA SET MDS VERSION 3 0 RESIDENT ASSESSMENT AND CARE SCREENING Nursing Home Comprehensive HC ltem Set Current Status Awaiting LTC Medicaid Information Names cote DLN s RUG RAS form Action asm Section A Section B Section Section D Section E Section F Section Section H Section 1 Section J Section K Ji Section 1 Section M Section N Section Jj Section P Section Q Section v Section Z En Section LTCMI Identification of Record to be Modified Inactivate ems e exi Tr XO150 of Provider F Pr Parent Assessment Drafts Vendors Cam MINIMUM DATA SET MDS VERSION 3 0 RESIDENT ASSESSMENT AND CARE SCREENING Nursing Home Comprehensive NC Item Set me AUDE DAES DINH es RUG RAA Section B Section Section F Section Section H Section J Section Section L Section M Section Section Section Section Q Section Section X Section Z Section LTCMI Parent Assessment History Trail History Pending Changed by System on 10 7 2010 7 00 34 AM tem Corrected hi 02 M 10 7 2010 7 15 34 AM stem Correction req
180. ility Hospice User Guide Other Centers for Medicare amp Medicaid Services www cms gov Department of State Health Services www dshs state tx us National Provider Identifier NPI obtain https nppes cms hhs gov NPPES Inform DADS www dads state tx us providers hipaa forms html Texas Administrative Code www sos state tx us tac index shtml Texas State RUG Training www txstate edu continuinged CE Online RUG Training Federal MDS 3 0 site www cms gov NursingHomeQualityInits 25_NHQIMDS30 asp v 2015 0703 173 LTC Nursing Facility Hospice User Guide Minimum Data Set MDS Quick Reference Guide MDS Telephone Numbers CMSNet Remote User Support Helpdesk Verizon MDS Technical Report Questions MDS Clinical Questions Tiaining MDS RAP Care Plan Trainin CASPER QM QI Clinical Question CASPER QM QI Report Questions jRAVEN Help Desk Swing Bed Automation Technical Swing Bed Clinical MDS 1 888 238 2122 512 438 2396 210 619 8010 512 458 1257 512 467 2242 210 619 8010 512 438 2396 1 800 339 9313 1 800 339 9313 2 010 619 8010 MDS Informational Websites QIES Technical Support Office QTSO www qtso com For validation report messages and descriptions see MDS Federal MDS 3 0 site www cms gov NursingHomeQualityInits 25_NHQIMDS30 asp MDS Software Specifications www cms gov MDS20SWSpecs MDS RAP Care Planning Training www tx
181. illness or injury which required hospitalization and is expected to remain in the NF for greater than 30 days 2 Terminally Individual has a medical prognosis that his or her expectancy is 6 months or less if the illness runs its normal course An individual s medical prognosis is documented by a physician s certification which is kept in the individual s medical record maintained by the nursing facility 3 Severe Physical Iiness An illness resulting in ventilator dependence or diagnosis such as chronic obstructive pulmonary disease Parkinson s disease Huntington s disease amyotrophic lateral sclerosis congestive heart failure which result in a level of impairment so severe that the individual could not be expected to benefit from specialized services Delirium Provisional admission pending further assessment in case of delirium where an accurate diagnosis cannot be made until the delirium clears s Emergency Protective Services Provisional admission pending further assessment In emergency situations requiring protective services with placement in the nursing facility not to exceed 7 days 6 Respite Very brief and finite stay of up to a fixed number of days to provide respite to in home caregivers to whom the individual with MI or ID is expected to return following the brief NF stay 7 Coma Severe illness or injury resulting in inability to respond to external communication or stimuli such as co
182. ime Forms set to the following statuses are excluded from consideration in meeting form sequencing requirements Cor rected Invalid Complete Invalid Form Sequence ID Invalid Form Inactivated Med ID Check Inactive ME Check Inactive ox AI Check Inactive The errors will display at the time of a 3618 or 3619 form submission There are different errors dependent upon the form type therefore the error messages below have been categorized by form type 1 System Message This is the specific error message that will be displayed in the LTC Online Portal at time of submission 2 System Message Clarification Further clarification of the LTC Online Portal error message including basic example of the situation 3 System Message Resolution Assistance with resolving the error For those situations where a form is missing providers will need to submit the missing form in order for the erroring form to pass validations The provider has two options regarding the submissions Ifa submission displays a message that a form is missing the provider can save the form as a draft Submit the missing form and then retrieve the draft and submit to complete both transactions v 2015 0703 153 LTC Nursing Facility Hospice User Guide Ifthe submission displays that a form is missing that form can be adjusted to submit the missing form and then using Use as template the original form can be submitted now that the edit has been resolv
183. in the secure portion of TMHP com Pravider Yendor administrators have the ability to Submit Claims appeal Claim Inquire about claim status verify client eligibility View RBS Reports View PCCM Panal Reports Submit prior authorization raquests This feature is currently unavailable to CSHCN providers but it is coming sacr You can administer a Provider Account three to five days after receiving the TMH enrolment confirmation letter Click the following link activate an account v 2015 0703 7 LTC Nursing Facility Hospice User Guide 8 Choose a Provider Type from the drop down box Note The Provider Types listed are the only two choices in the drop down box that are applicable for this guide Use NF Waiver Programs to submit 3618 3619 LTCMI PASRR Level 1 PL1 Screening Forms and PASRR Evaluations PE Use Long Term Care to access TexMedConnect for submitting claims accessing R amp S Reports performing Medicaid Eligibility Service Authorization Verification MESAV and to submit Hospice Forms 3071 and 3074 va Hoe My Account Ir Navigation Stine Use the following quidelines to determine your selection from the Provider Type menu below Account Avtvation Option 1 If you are a provider enrolled by TMHP choose Acute Care Option 2 If you are a provider enrolled by DADS end would like to view RRS reports and submit 3071s and 3074s choose Long Ter
184. inary Team IDT Meeting The IDT tab on the PLI is where information about the IDT meeting and Specialized Services reviews is captured It is the responsibility of the NF to facilitate and invite the LA LMHA and the individual or the individual legally authorized representative LAR to the IDT meeting This meeting is held at the NF and must be convened within the first 14 days of the resident s admission to the NE Completion of the PASRR Evaluation and participation in the IDT meeting requires the NF to provide the LA LMHA staff with access to the resident and the resident s records It is the responsibility of the LA LMHA to participate in the IDT meeting to finalize the recommended special ized services indicated on the submitted PE The LA LMHA does not have to be physically present at the meeting participation by telephone is permissible The LA is required to provide a service coordinator and service coordination to a Medicaid eligible nursing facility resident with intellectual or developmental disability IDD The LA must also organize a service planning team and facilitate service planning related to specialized services community living options and transition to community living The service planning is separate and distinct from service planning conducted by nursing facility staff The IDT meeting is necessary to finalize and document the specialized services the resident will receive from both the NF and the LA LMHA All finalize
185. ing Stay fields allow for two separate time frames However the dates may be broken up into multiple stays but will need to total 20 days If the dates entered on the form equal less than 20 days the provider must add comments to the form explaining the reason for this Once the comments are added the form may be submitted If additional sets of dates are needed to document the qualifying stay the provider must enter a comment that additional forms are being submitted in order for the form to be accepted into the LTC Online Portal with less than 20 days A second Form 3619 must be completed using the same date of above transaction in order to supply the additional set s of dates This form will also require a comment because it will not document a full 20 days of Qualifying Stay either If the individual has a Medicare Replacement also known as Medicare Advantage plan or Medicare Health Mainte nance Organization HMO the full coverage requirement may vary Please include the following information in the comments section of the Form 3619 Medicare Replacement Name of the insurance carrier Number of Co insurance payment days allowed Daily Co insurance payment amount Repercussions of Submitting Form 3619 Late Payment will be delayed The facility may be subject to sanctions such as vendor hold as the result of contractual noncompliance 62 v 2015 0703 LTC Nursing Facility Hospice User Guide How to Submit F
186. ing form is designed to identify persons who may have indicators of mental illness intellectual disabilities nr developmental disabilities ta determine if a PASRR Evaluation is required The PASPR Level I Screening form must be completed and submitted in the Long Term Care Portal prior to a NF admission PASPR Evaluation The PASRR Evaluation is an in depth evaluation to determine if en individual has a PASRR eligible diagnosis of mental ilness intellectual disability or developmental disability has an interest in alternate placement meets the NF level of care and whether or not the individual wauld benefit from specialized services The PASRR Evaluation must be completed and submitted in the Long Term Care Portal before a NF can certify whether or not the individual can be served in their facility Long Term Care Community Services Waiver Programs Workshop User Guide The Long Term LTC Community Services Waiver Programs Workshop User Guide provides step by step instructions for how to use the various features of the portal information regarding the purpose of the Medical Necessity and Level of Care MN LOC Assessment how to submit the MN LOC Assessment and managing assessments set to status Provider Acton Required Yellow Form Actions Bar Options found in the yellow Form Actions bar may include Print Use as template Correct this form Update Form Add Note Check MN on PE Able to Serve the Individual and
187. ing with a different Medicaid reason for assessment Long Term Care Medicaid Information LTCMI LTCMI is the replacement for the federal MDS Section S and contains state specific items for Medicaid payment Providers must access the LTC Online Portal and retrieve their MDS assessments to successfully complete the LTCMI Providers should complete the LTCMI section as soon as possible in order to submit the MDS assessment into TMHP s workflow for review within the anticipated quarter time frame The anticipated quarter is within 92 days of the date the RN Assessment Coordinator signed the MDS assessment as complete Z0500B This is known as the 92 day timeliness rule Submission of LTCMI To enter the LTCMI the provider must log in to the LTC Online Portal and access their assessments set to status Awaiting LTC Medicaid Information using FSI or Current Activity The LTCMI must be completed with all required data and be successfully submitted on the LTC Online Portal Note The LTC Online Portal allows a 60 day grace period for submission of the LTCMI for Change of Ownership CHOW and new owners Facilities have 60 days from the day the first MDS LTCMI is submitted on the LTC Onling Portal with the new contract number to submit any additional MDS assessments in Awaiting LTC Medicaid Informa tion status whether within the 92 day submission window or not without requiring a Purpose Code PC E LTCMI Rejections Ifa PLI Screening Form has not be
188. ion 3 0 RESIDENT ASSESSMENT AND CARE SCREENING Nursing Home Comprehensive NC item Set Current Status PE MN Denied Name DLN Rus Form Actions error Note For more information see the MDS set to status PE MN Denied section of this User Guide v 2015 0703 29 LTC Nursing Facility Hospice User Guide Form Actions Available When Assessment is Set to Status Awaiting LTC Medicaid Information Current su Form Actions bine RUG RAA Save LTCMI The Save LTCMI feature allows providers to save the LTCMI section so that any entered LTCMI data is not lost until ready to submit To save information entered onto an LTCMI click the Save LTCMI button located in the yellow Form Actions bar Once an LTCMI is saved a message will display at the top of the screen with a date and time indicating that the LTCMI has been saved and it will automatically unlock the assessment allowing other users to access it The assessment will remain in Awaiting LTC Medicaid Information status until it is successfully submitted The assessment can then be accessed by all users who have the same vendor contract number access as the person who originally saved the information by using FSI The LTCMI will not be saved to Drafts The LTCMI has been successfully saved but has not been submitted 10 5 2010 5 02 31 PM Populate LTCMI The Populate LTCMI feature allows providers to use an individ
189. ions bar 1 Locate the MDS assessment using FSI 2 Click the Check MN on PE button on the yellow Form Actions bar MINIMUM DATA SET MDS Version 3 0 RESIDENT ASSESSHENT AND CARE SCREENING HC ltem Set Nursing Home Comprehens Diu Workflow Actions heck NN oc FE Section D Section Section L Section Section P Section X Section 7 Section LTCMI 56 2015 0703 LTC Nursing Facility Hospice User Guide 3 If the MN determination on the PE has been overturned the Change Status confirmation page will be dis played The NF can enter text to be added to the History trail and click the Change Status button Tros a armas mese A STATE MEDICAID CONTRACTOR IChange Status for form to MN Approved Enter the notes below Provider Message Text that will be seen by the provider Please select standard message option from the list below m m ty Approved far the based on PASRA Evaluation E Internal System Message Text that will ONLY be seen by internal users Text to be added to form history renes 4 MDS assessment will be set to status Approved MINIMUM DATA SET MDS Version 3 0 RESIDENT ASSESSMENT AND CARE SCREENING Nursing Home Comprehensive NC Item Set Current Status nue
190. is MDS was only submitted because a current resident admitted from the hospital as Medicare and a dually coded MDS was being submitted there are three options Inactivate the MDS at the federal CMS database and resubmit it as a dually coded form using an appropriate Medicaid Reason for Assessment typically a Quarterly Annual or SCSA This will allow Medicaid to use the MDS for payment Inactivate the MDS at the federal CMS database and resubmit it as Medicare only no Medicaid Reason for Assessment The resubmitted form will not appear on the LTC Online Portal Contact DADS Provider Claims Services at 512 438 2200 Option 1 and request that the MDS be moved to Invalid Complete status because an admission assessment was not appropriate If neither situation above applies contact DADS Provider Claims Services at 512 438 2200 Option 1 for assistance NF 0050 This form cannot be pro cessed as a retroactive pair because the effective date on the discharge of pairis later then the Qualifying Stay begin date on the admission of pair The discharge prior to the Qualifying Stay begin date and a subsequent admission are needed along with this pair to process automatically 3619 Pair is 3619 has been identified as part of a retroactive pair attempt ing to process together The Qualifying Stay dates fall between the admission and discharge dates submitted which is not allowed Full Medicare Qu
191. is discharge has been submitted If not submit that 3618 admission If it was rejected resolve the issue and resubmit that 3618 admission Resubmit the rejected 3618 discharge after the missing or corrected admission has been processed NF 0070 This admission cannot be 3619 Admit The Qualifying Stay dates or transaction date on this admission processed because it would cancel would cancel the previous provider s Service Authorization rather the client s Enrollment with a dif than auto discharge the recipient from the previous provider ferent provider Verify the effective Review the facility s records to determine the recipient s date as well as the Qualifying Stay admission and discharge dates and identify the Spell of Illness date ranges and correct them as Verify the begin and end dates of Qualifying Stay and submit needed corrections as needed Verify the begin date of Medicare Part A Coinsurance and submit a correction as needed Ifthe dates are correct and the Medicare remittance advice validates that Coinsurance is due for the time period that your 3619s indicate fax the remittance advice with a copy of the 3619s to 512 438 3400 attention ECF Form Processing or call 512 438 3400 Option 3 If the Medicare remittance Advice does not correspond to the 3619s submitted the forms will not be processed NF 0073 This discharge modifica 3619 Discharge The additional days of Medicare
192. is required if O0100K Hospice care column 2 While a Resident is checked in this field will allow the Hos the provider will receive an error message stating Hospice Contract Number is invalid Enter the Medicaid Hospice provider contract number assigned by DADS Entering the Hospice provider contract number provider to view the assessment submitted on their behalf by the NF This number will be validated and must contain a valid Hospice provider number to be accepted onto the LTC Online Portal If not valid v 2015 0703 LTC Nursing Facility Hospice User Guide LTCMI Fields Sie Purpose Code Optional E Missed Assessment M Coverage Code must be P Providers should verify that the MESAV Coverage Code is P prior to submitting a Purpose Code M This field is not removable once a Purpose Code has been selected and the assessment successfully submitted on the TMHP LTC Online Portal Sif Missed Assessment or Prior Start Date The first date the facility was not paid Conditional This field is required if Ste Purpose Code E or M This would be the first missed assessment date Check MESAV for gaps Enter the date in mm dd yyyy format of the missed assessment start date Start Date cannot be prior to September 1 2008 Field is correctable 519 Missed Assessment or Prior End Date The last date the facility was not paid Conditional This field is re
193. it a completed Nonemergency Ambulance Prior Authoriza tion Request Texas Medicaid and CSHCN Services Program form by fax to the TMHP Ambulance Unit at 512 514 4205 Prior authorization can also be requested through the TMHP website at www tmhp com The Nonemergency Ambulance Prior Authorization Form must not be modified If the form is altered in any way the request may be denied The form must be filled out by the NF or the physicians staff that is most familiar with the individual s condition The ambulance provider must not assist in completing any portion of this form Refer to Form AM 1 Nonemergency Ambulance Prior Authorization Request 2 Pages in the Texas Medicaid Provider Procedures Manual Volume 2 Ambulance Services Handbook A request for a one day transport may be submitted on the next business day following the transport in some circumstances however every attempt should be made to obtain prior authorization before the transport takes place Authorization requests for one day transports submitted beyond the next business day will be denied A request for a recurring transport must be submitted before the individual is transported by ambulance After a prior authorization request has been approved if the individual s condition deteriorates or the need for equipment changes so that additional procedure codes must be submitted for the transport the requesting NF must submit a new Nonemergency Ambulance Prior Authorization Requ
194. ittances for this Spell of Illness to Service Authorization Verify the determine the Full Medicare and Medicare Part A Coinsurance Full Medicare periods and Service dates Authorizations already established Pull a MESAV and compare the Service Authorizations on file and submit any additional modifi and the Full Medicare Qualifying Stay dates to the remittance cations dates The system has determined that the additional Qualifying Stay dates would create an overlap with existing Service Autho rizations Also consider the Qualifying Stays reported on the processed 3619s These dates create Full Medicare periods which do not appear on the MESAV Submit any additional 3619 corrections to adjust begin or end dates to allow this admission correction to process NF 0078 This admission cannot 3619 Admit The difference between the earliest Qualifying Stay date and the be processed because the earli est Qualifying Stay date is too old compared to the transaction date Verify the Qualifying Stay dates and correct them as needed If the Qualifying Stay dates are correct contact Provider Claims Services for assistance transaction date is too great for this admi automatically Review the Medicare Remittances for this Spell of Illness to determine the Full Medicare and Medicare Part A Coinsurance dates Ifthe dates on the form are correct contact Provider Claims Services and request that the form be processed manually
195. itted for their discharge If the other facility s discharge is incorrect allow seven days for processing time and resubmit the rejected admission If the recipient was in the other provider s facility before and after being in your facility the other facility must submit a retroac tive discharge and admission creating a gap during which the recipient was in your facility An admission and discharge pair will also need to process for your facility to fill the gap Two pairs will need to be processed Coordinate with the other facility v 2015 0703 119 LTC Nursing Facility Hospice User Guide Provider Message be processed alone because a later admission has already been processed This admission is part of a retroactive pair Identify the discharge following this admission and submit as a pair Form Assessment 3619 Admit Suggested The recipient has an existing Service Authorization for your facility processed admission and discharge for your facility cover the sub mitted admission date This admission is missing one of a pair Review the facility s records to determine which discharge is prior to this admission Pull a MESAV and review the Service Authorizations to determine the authorized services If the recipient has a closed Service Authorization for Code 3 with an end date after the rejected 3619 admission the rejected 3619 is part of a retroactive pair Determine
196. ivate Form button 3618 RESIDENT TRANSACTION NOTICE Current Status Precessed Complote Mames Sil peces Form actions 1 Medcaid Recipient dame Recplants Last Name 5 address Address 1 2 Socal Security Ne Recipiente Fest Name y 1 3 Medica or RR Retirement Claim No Recipients Sal _ State Recipient Name suff 1 zo Service Group 2 eat Date uf Physical Admission ta Private Pay m t Admitted Fron oacharged To Hospital Enter Dat m 000 4 Click the OK button when the pop up window asks Are you sure you want to Inactivate this form If so click and enter a note to explain the reason for inactivation Are you sure you want to Inactivate this form Ifso click Ok and enter noteto explain the reason for inactivation Epa erm v 2015 0703 151 LTC Nursing Facility Hospice User Guide 5 When the Change Status window appears enter a note for the inactivation and click the Change Status button The form or screening will be set to status Form Inactivated isis Mesto a Pannen IMHP STATE MEDICAID CONTRACTOR Home Submtform formStatus Current activity ters prntablerorms Alerts Helo hange Status for form ww to Form Inactivated Enter the notes below if you would like the provider to see the note please select the provider facing option from t
197. ization Number PC Purpose Code PDF Portable Document Format PE PASRR Evaluation Level II PLI PASRR Level 1 Screening Preadmission Screening and Resident Review PASRR PASRR is a federal mandate that requires the State of Texas to screen all persons suspected of having Mental Illness MI Intellectual Disabilities ID or Develop mental Disabilities DD prior to admission into a certified Nursing Facility The screening must be submitted to TMHP via the LTC Online Portal PICC Peripherally Inserted Central Catheter PMN Permanent MN PNA Personal Needs Allowance Payments PRN Pro Re Nada or as needed QIES Technical Support Office RA Route of Administration RAE Resident Assessment Instrument includes instructions as to how to complete the MDS assessment RE Referring Entity Resident Assessment Validation and Entry RAVEN Free MDS data entry software that offers users the ability to enter and transmit assessments to CMS CMS provides this free MDS data entry software Providers can download the free software at the federal CMS website indicated on the slide RN Registered Nurse RUG Resource Utilization Group 176 v 2015 0703 LTC Nursing Facility Hospice User Guide SCSA Significant Change in Status Assessment SNF Skilled Nursing Facility SSI Supplemental Security Income TMHP Texas Medicaid amp Healthcare Partnership Texas Administra
198. jection of New Discharge for Same Date of Above Transaction New discharge has same Date of Above Transaction as a discharge already received i e 11 1 2008 discharge 2008 discharge 11 Same contract Possibly attempting to submit a duplicate form OR Different contract A different provider has previously submitted a discharge for the same Date of Above Transaction date One provider is in error Contact other provider Date of Above Transaction is over one year old do you want to continue When submitting a form that is between one and five years old providers will receive this warning message The provider will have an option to select OK or Cancel before the form will continue to process Ifa provider submits a Date of Above Transaction that is equal to or more than five years old the form will not be accepted onto the LTC Online Portal Additionally forms with a future date in the Date of Above Transaction field will not be accepted onto the LTC Online Portal v 2015 0703 155 LTC Nursing Facility Hospice User Guide System Message displayed at time of submission System Message Clarification System Message Resolution assistance for resolving error Previous form was a 3619 A 3619 discharge or 3618 admission as appropriate must be submitted before a 3618 discharge can be submitted Applicable for same or different contract Rejection of 361
199. k the Cancel button if you do not want to delete the alert v 2015 0703 139 LTC Nursing Facility Hospice User Guide Corrections and Updates Corrections can be made to certain fields on LTCMI Forms 3071 3074 3618 and 3619 Updates can be made to certain fields on the PLI Screening Form It is strongly suggested that providers do not make corrections to assess ments that are already in status Processed Complete This may result in payment ceasing Note Forms 3618 and 3619 or the LTCMI section of a MDS assessment that have been set to status Form Inactivated at any time in the history will not allow corrections to the form or assessment The Correct this form button or Update Form button will not be displayed in the yellow Form Actions bar on any form that cannot be corrected or updated This includes submission of these forms or assessments by a third party software vendor for your facility PLI Screening Forms cannot be submitted by a third party software vendor LTCMI Corrections Corrections to the LTCMI section data can be submitted directly on the LTC Online Portal Note PC Purpose Code is identified in field Sle it may be corrected to reflect either an E or M A PC M may be corrected to a PC E However a PC E is unable to be corrected to a PC M Once an assessment is classified as a PC E field Sle is not correctable Prior to correcting adding a PC on LTCMI validate if payment has been made based on the M
200. l necessity after verifying MDS 3 0 0700 Medicaid Number contains a nine digit numeric rather than or N A3618 3619 admission submitted under the wrong contract that process must have a counteracting dis charge submitted and the provider must call to request that DADS PCS set the incorrect form to status Invalid Complete A third form for the same Date of Above Transaction cannot be submitted until the forms with the incorrect contract have been set to status Invalid Complete Resolution of forms in Manual Workflow Assistance with Processed Complete forms which do not appear on MESAV Types of Calls to Refer to a Local Authority Local Mental Health Authority Fora true preadmission when an individual just arrives without paperwork at the NF when not Expedited Admission or Exempted Hospital Discharge For an individual who just arrives at the NF with a PASRR Negative Letter and needs help calling the LA LMHA When the NF needs to follow up after an alert was sent to the LA LMHA to perform and submit a PE for a Resident Review invite the LA LMHA to participate in the Interdisciplinary Team IDT Meeting 170 v 2015 0703 LTC Nursing Facility Hospice User Guide Helpful Contact Information Texas Medicaid amp Healthcare Partnership TMHP General Customer Service Long Term Care LTC Department 1 800 727 5436 1 800 626 4117 General Inquiries MDS not in the LTC Online Portal LT
201. licensed vocational nurse D are provided either directly by or under the supervision of a licensed nurse in an institu tional setting and E are required on a regular basis Note Medical Necessity is not the only prerequisite to qualify for Medicaid eligibility v 2015 0703 51 LTC Nursing Facility Hospice User Guide Manual Medical Necessity Determination Process on MDS The flowchart below provides a high level overview of the process used for manual MN determination Providers can use the LTC Online Portal to check the status of MN determination In order to expedite processing TMHP automatically checks submitted assessments with a Medicaid Number to determine if the individual already has Permanent MN PMN If the individual has PMN the MN is automatically approved The History trail will state Client has permanent MN For individuals who do not have PMN TMHP systems automatically review specific criteria on the assessment If the criteria are appropriately met MN is automatically approved If not the provider will see The Form has failed Auto MN Approval displayed in the History trail The assessment will then be sent to a nurse for manual MN review The status will be set to Pending Review on the FSI search results however the last message showing in the History trail will be The Form has failed Auto MN Approval 1 TMHP reviews assessment to determine medical necessity
202. m Cara Option 3 If you want to submit 36185 26105 MDS MDS Quarterly MN LOC PASRR Lovol 1 Screenings and PASRR Evaluations choose NF Woiver Programs Option 4 If you are attempting ta become a Texas Medicaid GSHGN Services Program provider and currently do nat have a TPL NPI choose Provider Enrollment Provider Teelen Enter your provider number vendor number and vendor password Home meee OOO Uso tho following guidolinos to datermine your soloction trom the Providor Typo monu below accat Activation Option 1 1f you aro provider onrollod by TMHP choose Acuto Caro Option 2 If you are a provider enrolled by DADS and vrould like to vievr R amp S reports and submit 30718 and 90745 choose Long Term Core Option 3 16 you want to submit 36195 2610s MDS NOS Quarterly MN LOC PASRR Level 1 Screenings and PASRR Evaluations choose NF Waiver Programs Option you are attempting to become a Tenas Medicaid or CSHCN Services Program provider and currently do not have a TP1 NPI choose Provider Enrollment Provider Tyee Provide all of the following information Ng d Formerly known as Contract Number Vencer lumber Vender Password Morea Firme enoun as MicroECS password v 2015 0703 LTC Nursing Facility Hospice User Guide 10 Click the Next button 11 Check the 1 agree to thes
203. ma or functioning at brain stem level ETE 188 v2015 0703 TMHP TEXAS MEDICAID HEALTHCARE PARTNERSHIP A STATE MEDICAID CONTRACTOR The LTC Nursing Facility Hospice User Guide is produced by TMHP Training and Organizational Development Services Contents are current as of the time of publishing and subject to change Providers should always refer to Provider Manuals Bulletins and the TMHP and DADS websites for current and authoritative information
204. mprehensive or quarterly MDS 3 0 assessments that are set to status Awaiting LTC Medicaid Information delete an assessment 1 Click the Delete link The provider will receive the following message cho You dekte the oss umha Pata aud Hosta At Sarr lb en a ata ont rosa oe ES 18 2015 0703 LTC Nursing Facility Hospice User Guide 2 From here you have two choices a Click the OK button to delete the assessment The following confirmation message will display MDS assessment was successfully deleted Note Use caution when deleting assessments Once deleted the MDS assessment will no longer be available on the LTC Online Portal but the assessment will not be deleted from CMS If an MDS assessment is deleted from the LTC Online Portal TMHP will not re extract the assessment unless it is modified through CMS or b Click the Cancel button if the assessment should not be deleted Current Activity The Current Activity feature allows providers to view document submissions or status changes that have occured within the last 14 calendar days After 14 days providers must use the FSI query tool to locate a document Current Activity will display MDS 3 0 Comprehensive and MDS 3 0 quarterly assessments in addition to PLI Screening Form and Forms 3071 3074 3618 and 3619 3 Click the Current Activity link in the blue
205. n 80 days state in the comment section of the 3619 and call 512 438 2200 Option 3 or fax the Medicare Replacement EOBs with a copy for the 3619 to 512 438 3400 attention Medicare Advantage Plan If the Spell of Illness involved another facility and your facility s begin and end dates are correct except for the correction review your Medicare Remittance If the Medicare Remittance advice validates that Coinsurance is due for the time period that your 3619s indicate fax them with a copy of the 3619s to 512 438 3400 attention ECF Form Processing or call 512 438 3400 Option 3 Ifall the begin and end dates on the MESAV are correct except for the discharge the rejected form is attempting to correct the last discharge date will need to be adjusted so the total of the new days added plus the adjusted existing dates equal 80 or less days The rejected discharge should then be resubmitted NF 0059 This discharge modifica tion cannot be processed because the new discharge would create an overlap with an existing Service Authorization Verify the Service Authorizations already established and submit any additional modifi cations 3618 3619 Discharge Mod The later discharge date on this correction will create an overlap with existing Service Authorizations if this correction is processed as submitted Review the facility s records to determine the recipient s admission and discharge dates and ide
206. n given delegated authority to provide acute and long term services to support enrolled managed care members Program Provider An entity that provides services under a contract with the Department of Aging and Dis ability Services DADS Program provider is the preferred term for provider agency Program providers are the crucial players in a quality health care program The focus is on providing the best care possible while being reimbursed for allowed services rendered Texas Department of Aging and Disability Services DADS Texas state agency that provides long term services and supports to older persons and individuals with physical intellectual and developmental disabilities DADS also regulates providers of long term services and supports and administers the state s guardianship program Texas Health and Human Services Commission HHSC Provides administrative oversight of Texas health and human services programs including the Medicaid acute care program Children s Health Insurance Plan CHIP State of Texas Access Reform STAR State of Texas Access Reform PLUS STAR PLUS and provides direct administration of some programs Texas HHSC s Office of Eligibility Services OES determines eligibility for Medicaid Texas Medicaid amp Healthcare Partnership TMHP Contracted by the state as the claims administrator to process claims for providers under traditional Medicaid processes and approves claims
207. n is pro cessed as submitted Review the recipient s Medicare remittance to determine the Medicare dates for the Spell of Illness for this admission Pull a MESAV and review the Service Authorizations to determine which authorizations are covered by the Spell of Illness for this admission Validate the dates of the Spell of Illness to see if this admission is part of the prior stay or if it begins a new Spell of Illness more than 60 days between Code 3 Service Authorizations Submit corrections of any earlier 3619s as needed and resubmit this rejected admission accordingly If the prior Spell of Illness was not ended properly submit a 3619 discharge or 3619 correction to adjust the Code 3 to reflect the proper end date of that Spell of Illness Now that the 60 days between Spells of Illness has been resolved resubmit the rejected admission 122 v 2015 0703 LTC Nursing Facility Hospice User Guide Provider Message layed in History NF 0032 This discharge cannot be processed because the client does not have a Service Authorization for Medicare Part A Coinsurance for your facility Either the 3619 admission for your facility has not processed or the discharge date exceeds the client s maximum of 80 days of traditional Coinsurance for all providers for this Spell of Illness Form Assessment 3619 Discharge Suggested Action The corresponding Medicare Part A Coinsurance admi
208. n the LTC Online Portal the PASRR Evaluation The LA LMHA responsible for the MI Section of the PASRR Evaluation should complete the MI Section Alert Communication received by the Nursing Facility Incoming Alerts PL1 Needs Certification The Nursing Facility must review the PE including recommended specialized services and certify on the PL1 Screening Form whether the NF is able or unable to serve the individual Alert System Generated Communication sent to DADS PASRR Unit Outgoing Alerts NF Unable to Serve Ifa Nursing Facility has certified on the PL1 Screening Form that they are unable to serve the individual and the NF has already admitted the individual into the facility an Alert is sent to DADS PASRR Unit by the LTC Online Portal This Alert will appear in the list of Out going Alerts for the NF No action on the part of the NF is necessary LTC Nursing Facility Hospice User Guide Accessing Alerts Follow the steps below to access the Alerts screen 15 2 3 4 5 Go to www tmhp com Click providers on the green bar located at the top of the screen Click Long Term Care on the yellow bar Click the Log In to LTC Online Portal button on the blue bar Enter your User name and Password Click the OK button The Form Status Inquiry FSI page will display by default Click the Alerts link located on the blue navigational bar Thess Manica x
209. n the document will be used to create a new document Note Not all fields will be copied over Enter data into remaining fields not auto populated a Gear 3618 RESIDENT TRANSACTION NOTICE Current Status Provider Action Required Name as anms Form Actions Workflow Actions Crm Ciaran Cramer _ ee es n Vendor Number Contract Number NPI Number 8 1 Medicaid Recipient No 4 Recipient s Last 5 Address Address 2 Social Security No Name Name ce 3 Medicare or RR Recipient s First pan Retirement Claim No Name Recipient s Middle 2 Initial Reese Es Service Group Transaction m 26 v 2015 0703 LTC Nursing Facility Hospice User Guide 3 Click the Print button located in the yellow Form Actions bar to print the document in progress if you want hard copy for your records From here you have two choices a Click the Submit Form button located at the bottom right of the screen if you are ready to submit for processing UK eese b Click the Save as Draft button located in the yellow Form Actions bar to save the document until you ready to submit The Save Draft button will only display in the yellow Form Actions bar in the following circumstances If provider is enterin
210. navigational bar Click the appropriate vendor number if applicable Note The initial Current Activity page will display a list of all vendorlcontract numbers to which the user is linked BG mem TMI STATE MEDICAID CONTRACTOR Form status inqury M T Current Activity The user name is associated with the following Vendor Contract numbers Select the Vendor Contract number to configure a administrator iccount Vendor Numbers for Contract Number ice 193 for Contract Number jo t 4 The results will display a summary of all document submissions or status changes within the last 14 calendar days Tess Memia Puesta STATE MEDICAID CONTRACTOR Home Sobmitform Form Status Inquiry Current Activity Drafts Vendors Letters PrintableTorms Aleris MDS 2 0 Rocoivod SSN Medicaid Medicare Status em 10 7 2010 8 47 11 PM Fendng Review 10 8 2010 9 02 06 AM 1D Invalid Fendng Review status 10 7 2010 5 47 17 PM Fendng Review 10 3 2010 9 02 02 Frocessed Complete 10 9 2010 9 42 44 Overtumad Doctor Review 5 Click the DLN link to display the details of the document v 2015 0703 19 LTC Nursing Facility Hospice User Guide Providers are able to sort the Current Activity results in a variety of ways By clicking on the heading of a column the provider can choose to sort results by DLN Received Date SSN Me
211. nduct the IDT with required participants The NF reviews the PE including recommended specialized services and certifies if they are Able or Unable to serve the individual If the NF is unable to serve the individual the LA LMHA works in collaboration with the NF to coordinate placement into another NF or an alternate setting NOTE For more information about certification see the Required Certification of Able or Unable to Serve the Indi vidual section of this User Guide 40 v 2015 0703 LTC Nursing Facility Hospice User Guide Preadmission Process NF admits N is PL1 PASRR RE sends PL1 to individual submits RE Performs PL1 gt lt Positive or Negative gt NF with gt PL1 on Portal and Negative individual follows standard admissions process I LA LMHA submits NF conducts IDT with RE NF faxes LA LMHA LA LMHA LA LMHA PE on Portal required participants Q2hourtimer 0 Submits gt performs PE X within 7 days of NF certifies on the PLL p coordinates Portal TE hours notification Able or Unable to serve Placement of starts of notification Paymentfor PE tha individual individual in NF 1 The Preadmission Process starts with the RE who performs the initial Screening on paper for the individual seeking NF placement 2 If the PLI Screening is negative The RE sends the PL1 Screening Form to t
212. ng Form Status Inquiry FSI or Current Activity Allows providers to submit additional information LTC Online Portal Security In order to use the LTC Online Portal providers must request access to the LTC Online Portal Your facility may already have an account You may need to contact your facility administrator for user access An administrator account is required for LTC Online Portal access but it is strongly recommended to have multiple administrator accounts in case one administrator is unavailable The administrator account is the primary user account for a provider contract number The administrator account provides the ability to add remove permissions access to LTC Online Portal features for other user accounts on the same provider contract number A user account can be created by an administrator User account permissions and limitations are set by the holder of an administrator account This allows administrators to set the level of access according to employees responsibilities If you already have either an administrator or user account go to www tmhp com Pages LTC Itc_home aspx Click the Log In to LTC Online Portal button Third party vendors are allowed to submit the LTCMI section of an MDS assessment directly on the LTC Online Portal on behalf of a provider Providers using a third party software vendor are still required to obtain LTC Online Portal access for rights to submit the LTCMI section of the as
213. ng NF may be asked for additional information to clarify or complete a request for prior authorization Refer to Texas Medicaid Provider Procedures Manual Volume 1 Section 6 Claims Filing Subsection 6 1 4 Claims Filing Deadlines for the TMHP approved holidays According to 1 TAC 354 1111 nonemergency transport is defined as ambulance transport provided for a Medicaid individual to or from a scheduled medical appointment to or from a licensed facility for treatment or to the individu al s home after discharge from a hospital when the individual has a medical condition such that the use of an ambulance is the only appropriate means of transportation i c alternate means of transportation are medically contraindicated 160 v 2015 0703 LTC Nursing Facility Hospice User Guide According to Human Resource Code HRC 32 024 0 a Medicaid enrolled physician Nursing Facility health care provider or other responsible party is required to obtain authorization before an ambulance is used to transport an individual in circumstances not involving an emergency HRC states that a provider of nonemergency ambulance transport is entitled to payment from the Nursing Facility health care provider or other responsible party that requested the service if payment under the Medical Assistance Program is denied because of lack of prior authorization and the ambulance provider submits a copy of the claim for which payment was denied
214. nial need more information call the TMHP Help Desk 1 800 626 4117 Option 2 to speak with a nurse If Add Note is chosen for any assessment or screening in Pending Denial need more information status the assessment or screening will be reviewed again for medical necessity Af the nurse is unable to approve the assessment or screening with the additional information provided the assessment or screening will be sent to the TMHP Medical Director for review and determination of MN 28 v 2015 0703 LTC Nursing Facility Hospice User Guide Inactivate Form The Inactivate Form feature is used when Forms 3618 and 3619 cannot be corrected and a new form must be sub mitted It can also be used if a Form 3618 3619 was submitted in error However inactivations are not allowed if document is set to status Corrected or Form Inactivated In addition forms 3618 and 3619 that are set to status Processed Complete that contain the message code GN 9004 anywhere in the history of the form cannot be inactivated To cancel a successfully processed form that should not have been submitted and is not correctable viders must submit the appropriate counteracting form If an attempt is made to inactivate a successfully processed form the following message will be displayed to the provider This form has been successfully processed at DADS and cannot be inactivated If this form is invalid should not have been submitted submit the
215. nt s admission and discharge dates and identify the Spell of Illness Pull a MESAV and review the Service Authorizations to determine the number of Coinsurance days on file plus the number of new days that would be added by the rejected earlier admission date Verify the begin and end dates of the Service Authorizations on file based on the actual admissions and discharges that have occurred Remember that the discharge date results in a Service Authorization end date one day earlier than the transaction date Submit any corrections needed because of incorrect begin or end dates If these corrections will reduce the total number of Coinsur ance days to 80 days or less the rejected admission should be resubmitted once the new correction forms have processed Ifthe begin and end dates on file are correct and the recipient has a Medicare Replacement policy that allows more than 80 days of Coinsurance state this in the comment section of the 3619 and call 512 438 2200 Option 3 or fax the Medicare Replace ment EOBs with a copy for the 3619 to 512 438 3400 attention Medicare Advantage Plan Ifthe Spell of Illness involved another facility and your facility s begin and end dates are right except for the correction review your Medicare Remittance If the Medicare Remittance advice validates that Coinsurance is due for the time period that your 3619s indicate fax them with a copy of the 3619s to 512 438 3400 attention ECF Form Pro
216. ntal Retardation regardless of funding source An individual cannot be admitted to the NF through the Preadmission process until a PASRR Level 1 PLI Screen ing Form and a PASRR Evaluation PE have been submitted on the Portal and the NF has certified that they can meet the needs of the individual PLI Screening Forms are submitted directly on the LTC Online Portal and assigned a DLN when successfully sub mitted To check on status information providers can use FSI or Current Activity to access the PL1 Screening Forms and the PEs that were submitted by their own facility The PE is used to perform evaluation to confirm the suspicion documented PL1 Screening Form deter mine if the NF is the appropriate placement for the individual and determine whether the individual could benefit from specialized services The PE can only be performed face to face by the LA LMHA and must be initiated within 72 hours from the first notification to perform the PE and submitted on the Portal within seven calendar days from the first notification to perform the PE Overview of PASRR Processes There are five different PASRR Processes Exempted Hospital Discharge Process Expedited Admission Process Preadmission Process Alternate Placement Process and Resident Review Process Below are diagrams explaining the different processes at a high level v 2015 0703 37 LTC Nursing Facility Hospice User Guide Admission Process Exempted Hos
217. ntify the Spell of Illness Pull a MESAV and compare the Service Authorizations to the later discharge date that would be created by the rejected discharge Consider the Qualifying Stays reported on the processed 3619s These dates create Full Medicare periods which do not appear on the MESAV Ifthe begin date of an existing Service Authorization needs to be changed submit a correction to that admission If the submitted discharge date would overlap with a reported Qualifying Stay period submit a correction to adjust the Qualifying Stay dates To determine if the Qualifying Stay dates from the Medicare remittance advice correspond with those on file contact DADS Provider Claims Services at 512 438 2200 Option 1 for assistance Ifthe recipient is currently receiving Hospice services verify the dates of service with the Hospice Provider and make corrections as needed This rejected discharge should be resubmitted once the file has been adjusted v 2015 0703 129 LTC Nursing Facility Hospice User Guide Provider Message processed because a Nursing Facil ity admission is not appropriate for a PACE client Contact the client s PACE organization Form Assessment 3618 3619 Admit Suggested The recipient has a Service Authorization for PACE the Program for All Inclusive Care for the Elderly as of the admission date Review the facility s records to verify that the transaction
218. on Determine through the LTC Online Portal whether that discharge form has been submitted or not Correct the discharge rejected or submit a discharge if it was missing Resubmit the rejected admission v 2015 0703 117 LTC Nursing Facility Hospice User Guide Provider Message processed because a later admis sion has already been processed This admission occurs in the past and must be one of a pair which will create a separate Service Authorization If the discharge following this admission is missing or rejected both forms must be submitted on the same day Form Assessment 3618 3619 Admit Suggested A later admission is already in the recipient s file This admission will have to be submitted with a matching discharge to process as a retroactive pair Review the facility s records to determine which discharge follows this admission Pull a MESAV and review the Service Authorizations to see if a gap exists for the period that will be created by the admission and discharge pair Ifa gap exists resubmit the rejected admission then submit the following discharge Both forms must be submitted on the same day The system will process both forms as a pair Ifa gap does not exist review the facility s records to determine if a discharge prior to the rejected admission is reflected on the recipient s MESAV If the discharge is not reflected on the recipient s MESAV
219. on for the same Date of Above Transaction date One provider is in error Contact other provider Same contract A discharge has already been received for the Date of Above Transaction OR Different contract A discharge from another provider has already been received for the Date of Above Transaction Rejection of New Discharge for Same Date of Above Transaction New discharge has same Date of Above Transaction as a discharge already received 11 1 2008 discharge 11 1 2008 discharge Same contract Possibly attempting to submit a duplicate form OR Different contract A different provider has previously submitted a discharge for the same Date of Above Transaction date One provideris in error Contact other provider Previous form was a 3618 A 3618 discharge or 3619 admission as appropriate must be submitted before a 3619 discharge can be submitted Rejection of 3619 Discharge following a 3618 3619 discharge received following a 3618 regardless of contract on form Submit either a 3618 discharge or 3619 admission as appropriate prior to this 3619 Discharge Date of Above Transaction is over one year old do you want to continue When submitting a form that is between one and five years old providers will receive this warning message The provider will have an option to select OK or Cancel before the form will continue to process Ifa provider submits a Date of Above
220. on at the top of the page to return to the Alerts list Form Status Inquiry Current Activity Letters C raun m aens Subject Conduct PASRR Evaluation First Notification sent 4 16 2013 An individual exhibiting signs of MI and or IDD requires a PASRR Evaluation This Face to Face assessment must be completed within 7 calerdar days of this notification and the associated PASRR Evaluation must be submitted the TMHP LTC Online Portal Admitting Nursing Facility NPT Verdor No Contract No Individual Medicaid No N Social Security No Medicare No PASRR Level 1 Screening 2015 0703 137 LTC Nursing Facility Hospice User Guide Creating Alerts Nursing Facility users can create alerts to be sent to the LA LMHA 1 2 Click the Alerts link located on the blue navigational bar The Alerts screen displays Click the Create Alert button Lx OPERE TMHP ASTATE MEDICAID CONTRACTOR Home SubmitForm Form Status Inquiry Current Activity Alerts Create Alert Vendor Contract No 9 Alert Subject Drafts Vendors Letters PL1 Screening DLN PE Screening DLN Send Alert To Please enter one of the following valid field combination Medicaid Number and Last Name or Medicare Number and Last Name or Social Security Number AND Last Name Printable Forms 3 Choose the Vendor Contract No from the drop down box
221. on of Able or Unable to Serve the Individual section of this User Guide For more information about LTCMI Rejections see the LTCMI Rejections section of this User Guide 5 The LA LMHA coordinates placement of the individual by working with the RE and the identified NFs on the Screening Form The admitting NF should indicate that the individual has been admitted in Section D of the PLI Screening Form v 2015 0703 41 LTC Nursing Facility Hospice User Guide The Preadmission Process continues with Medical Necessity on PE and MDS MN inheritance See the Medical Necessity and MN Determination Process section of this User Guide for more information Note If the individual is PASRR Negative based on a PL1 Screening then existing procedures for nursing home admissions are followed A PE is not performed unless requested by DADS DSHS NF or the individual LAR If the individual is PASRR Negative based on the PE a letter will be provided to the individual LAR If the individual does not agree with this result then the individual LAR can contact the Evaluator at the LA LMHA stated on the letter A Fair Hearing can be requested More information on Fair Hearings can be found in the Request for Fair Hearing section of this User Guide Note If an individual is discharged to acute inpatient care for less than 30 days it is not necessary to submit a new PL1 Screening Form Alternate Placement Process
222. on the federal CMS database If the expected gap is not reflected on the Level record contact DADS Provider Claims Services at 512 438 2200 Option 1 for assistance If the Purpose Code dates are wrong modify the Purpose Code dates on the LTCMI and resubmit the rejected assessment NF 0003 This assessment cannot be processed because the client does not have 3 month prior Med icaid or 51 eligibility Contact the HHSC Eligibility Worker or SSI office MDS Admit Annual Quarterly There is no 3 month prior Nursing Facility or prior month SSI eligibility for the resident during the Purpose Code timeframe of these two specific flavors of eligibility is required to process an assessment with Purpose Code M Pull a MESAV for the Purpose Code timeframe requested on this assessment and determine if a Level record is needed for the dates requested on the LTCMI If a Level record is needed continue with the steps below If not inactivate the MDS Determine if the MESAV reflects either Prior Coverage P or Type Program 11 in the Medicaid section of the MESAV for the dates requested on the LTCMI If the Prior Coverage P or Type Program 11 verified through the resident s MESAV matches the dates requested on the LTCMI resubmit the rejected assessment If the Prior Coverage P or Type Program 11 dates on the recipi ent s MESAV differ from the dates requested on the LTCMI modify the dates
223. on the LTCMI and resubmit the rejected assessment If the resident s MESAV does not reflect Prior Coverage P or Type Program 11 eligibility for the period requested contact the HHSC Eligibility Worker or SSI office If the resident is ineligible change the purpose code to E ifa Level record is needed v 2015 0703 115 LTC Nursing Facility Hospice User Guide Provider Message Displayed in History NF 0004 This assessment cannot be processed because the client does not have a corresponding Nursing Facility admission miss ing 3618 3619 Verify that the admission 3618 3619 has been processed Form Assessment MDS Suggested Action There is no 3618 3619 admission for the resident that covers one or more days of the assessment period If the resident is a Hospice resi dent a Hospice provider number should be entered on the LTCMI Review the facility s records to determine whether the resident is considered Medicare or Medicaid and what is the admission date to your facility Review the LTC Online Portal to determine the status of the admission 3618 3619 If the 3618 3619 is not processed determine why the form rejected Correct the current 3618 3619 admission or inactivate the rejected form and submit a new 3618 3619 admission If the 3618 3619 is processed compare the processed date to the rejection date of the MDS If the admission was processed after the MDS rejected resubmit the r
224. ore results found Our example was using Form 3618 Note Don t forget there are 6 of Forms that can end up in the provider workflow Form 3618 or 3619 MDS 3 0 Minimum Data Set Comprehensive and MDSQTR 3 0 Minimum Data Set Quarterly Once one Type of Form is chosen with No Results Found continue with the next Type of Form repeating all the steps to clear those set to status Provider Action Required Using Current Activity An alternate method for working documents recently set to status Provider Action Required is to use Current Activity Current Activity will show all documents that have been set to a different status in the last 14 calendar days Once the form or assessment has been set to status Provider Action Required for over 14 calendar days it must be located using Form Status Inquiry Once a form or assessment is being considered for Provider Action Required you may want to perform a resident search to see if the resident has any other forms or assessments are set to status Provider Action Required Current Activity is in the blue navigational bar next to Form Status Inquiry Current Activity mE 4 1 2012 9 23 50 PM 7 KOE A 4 1 2012 3 21 50 PM Awaiting LTC Medicaid Information oes 4 1 2012 3 21 50 PM awaiting LTC Medicaid Information 112 v 2015 0703 LTC Nursing Facility Hospice User Guide Provider Workflow Rejection Messages Below are the
225. orm 3619 1 Log in to the LTC Online Portal 2 Click the Submit Form link located in the blue navigational bar Type of Form Choose 3619 Medicare SNF patient Transaction Notice from the drop down box Click the Enter Form button m Enter all required information as indicated by the red dots Enter at least one of the following Medicaid Recipient No Social Security No or Medicare of RR Retire ment Claim No Indicate either an admission or discharge transaction Medicaid does not pay for Date of Death on Medicare Co insurance individuals Location indicates where the individual is admitting from or discharging to Date of Above transaction will be the actual admission or discharge date Enter the Qualifying stay dates equal to 20 days If Full Medicare is more than two time periods use multiple forms with the same Date of Above Transaction to submit the 20 days of Full Coverage The Last Name must match exactly what is shown on the Medicaid card 6 From here you have two choices Click the Submit Form button to submit the form or b Click the Save as Draft button to store the form for future use but not submit it The form does not have to be complete to save the draft Note Ifthe form is successfully submitted a DLN will be assigned and the LTC Online Portal will show Your form was submitted successfully If there are submission errors they will be displayed in a box at
226. ospice election date Submit an MDS with A0310A 04 Significant Change in Status Assessment with a check in O0100K2 indicating Hospice Care Complete Long Term Care Medicaid Information LTCMI S1d Hospice contract number Form 3071 and 3074 submitted by Hospice provider 2015 0703 95 LTC Nursing Facility Hospice User Guide Current Hospice Residents Once an MDS SCSA is submitted the NF should continue the MDS cycle for Hospice individuals In addition to indicating Hospice Care on the assessment the Hospice contract number on the LTCMI will be required to allow the Hospice provider to view assessments submitted with their contract numbers The Hospice contract number entered on the LTCMI will be validated and must contain a valid Hospice provider number to be accepted onto the LTC Online Portal Hospice providers can view on the LTC Online Portal MDS assessments submitted on their behalf based on the Hospice contract number that is indicated in the LTCMI 514 Hospice Contract Number 514 must be completed correctly in order to view those assessments Hospice nurses are not required to sign off on the assessment for the Hospice individuals Providers can print and sign their assessment prior to submitting The assessment should be signed by the MDS RN Assessment Coordinator 96 v 2015 0703 LTC Nursing Facility Hospice User Guide Resident Returns Prior Discharge Return Not Anticipated Refe
227. p homs 7 place where there Is 24 haur care 17 D Family Home t other F Other Location G Unknown Choe eli that apply A By thomsolvos B With roommate ity D With alot ef friends D cwm E other Other individual G Unknown lemen sposi Home Family Atemate placement Date f Entry E0500 Admission A Admittedtu aefomaton s B Admito tn 0 E0600 A Community Program Community E n B Other Community Program 0700 Name of J Faclity L a 20150703 187 LTC Nursing Facility Hospice User Guide PASRR Level 1 Screening Section F TMHP A STATE MEDICAID CONTRACTOR PASRR LEVEL 1 SCREENING Current status Name Section Admission Category FO100 Exempted Hospit Discharge Has the physician certified that individual is likely to require less than 30 days of NF services For Individuals being admitted from acute care In the hospital E FO200 gt Expedited Admission Does this individual meet any of the following categories for an expedited admission into the nursing facility Please select one category below Not Expedited Admission 1 Convalescent Care Individual is admitted from an acute care hospital to an NF for convalescent care with an acute physical
228. period does not apply to recertification The recertification statements must be signed and dated by the physician prior to the expiration date of the recertification period Medicaid payment will not be made for period where a gap exists in the certification periods This form must be completed in order for the individual to receive Texas Medicaid Hospice services and for the provider to be paid for those services For hospice forms policy questions should be directed to hospice dads tx state us TMHP only addresses techni cal questions related to using the LTC Online Portal for Hospice form submission v 2015 0703 69 LTC Nursing Facility Hospice User Guide How to Submit Form 3074 Paper copies of forms 3071 and 3074 with dates and signatures must be completed prior to electronic submittals via the TMHP portal The signed and dated originals must be retained in the hospice individual s medical hospice record 1 Log in to the LTC Online Portal 2 Click the Submit Form link located in the blue navigational bar 3 of Form Choose 3074 Physician Certification of Terminal Illness from the drop down box 4 Click the Enter Form button 5 Enter all required information as indicated by the red dots 6 Verify the following are complete before submission of the form Complete at least one of the following Medicaid number SSN or Medicare Number Election Start Date is the Election date from the Form
229. pital Discharge Does individual ME submits PL on meet etaria for ne sends LA tN J gt pampre ota ene Discharge No is individual in NF after 30 days NF indicates on PLL that individual was discharged RE follows Preadmission or Expedited Admission Process LAMHA arc PE LA LMHA submits PE NF conducts IDT E required anns pisi anie within 7 days of participants NF certifies on the pirasat Nie m gt gt notification PL1 Able or Unable to serve the gt notification spapinaie tor PE unable to serve Portal alerts LA LMHA to perform 1 The Referring Entity RE performs the PLI Screening and determines if individual is eligible for Exempted Hospital Discharge 2 If the individual does not meet Exempted Hospital Discharge criteria then the RE follows the Preadmission or Expedited Admission process described in a subsequent diagrams 3 If the individual does meet Exempted Hospital Discharge criteria then a The RE sends the PLI Screening Form to the admitting NF with the individual b The NF submits the PLI Screening Form and the date of admission the Portal immediately on receipt NOTE If the NF attempts to submit the MDS LTCMI without first submitting the PLI Screening Form the LTCMI will not be accepted 4 If the individual is discharged
230. plying for Medicaid coverage within 72 hours of admission Federal CMS Resident Assessment Instrument RAI Users Manual requires completion of an admission compre hensive MDS within 14 days of admission MDS 3 0 A0310A 01 Submit the MDS to CMS in accordance with the RAI Users Manual Federal CMS guidelines allow providers up to 14 days to transmit MDS 3 0 assessments Please note waiting will cause a delay in MN determination and payment if the assessment is being used to establish Medicaid state payment Complete the MDS LTCMI on the LTC Online Portal within the covering quarter of the MDS MDS 3 0 Z0500B 91 days Reminder The above timeliness guidelines reflect the requirements of Texas Medicaid only For CMS timeliness guidelines please refer to the RAI Users Manual available at the following link Federal MDS 3 0 site www cms gov NursingHomeQualityInits 25_NHQIMDS30 asp Complete a quarterly assessment within 92 days of the Admission MDS unless a Significant Change in Status Assessment SCSA was completed prior to this v 2015 0703 93 LTC Nursing Facility Hospice User Guide Recipient Transitioning to Full Medicaid MDS Private gt Submit Loaded to Submit Pay Form 3618 LTC Online LTCMI Portal This flow chart displays the process of a private pay individual that is transitioning to Full Medicaid Submission should occur upon notification of application for Medicaid
231. previous 3619 admissions If the Dates of Qualifying Stay on the form are wrong correct the admission and resubr If the Dates of Qualifying Stay on the form are correct submit another form to document the remaining days of Qualifying Stay once that information becomes available To determine if the Qualifying Stay dates from the Medicare remittance advice are on file contact DADS Provider Claims Services at 512 438 2200 Option 1 for assistance Ifa different 3619 admission was submitted with incorrect Dates of Qualifying Stay submit a correction for that form prior to resubmitting this rejected admission If this form cannot be corrected inactivate the form Note If this is not traditional Medicare document this in the comment section and call 512 438 2200 Option 3 or fax the Medicare Replace EOB with a copy of the 3619 to 512 438 3400 attention Medicare Advantage Plan NF 0030 This admi processed because it has not been more than 60 consecutive days since the client was discharged from Medicare cannot begin anew Spell of Illness Review Medicare remittance to determine when Submit a new 3619 based the cli ent s Medicare remittance Medicare Part A Coinsurance is due 3619 Admit For each Medicare Spell of Illness the state will pay a maximum of 80 days of Medicare Part A Coinsurance to one or more providers The recipient will exceed the 80 day limit if the admissio
232. quired if S1e Purpose Code E or M This would be the last missed assessment date Check MESAV for gaps Enter the date in mm dd yyyy format of the missed assessment or 3 month prior Retro Eligibility Coverage code must be P end date Date cannot be greater than date of submission i e today s date End date cannot be prior to the Start Date Field is correctable These dates are used to locate a gap of time If a gap is not found within the range provided the assessment will not be processed Providers can submit a MDS Purpose Code E with a missed assessment date range greater than 92 days This allows providers to submit one MDS Purpose Code E to cover large gaps in dates S2 PASRR Information 52 your knowledge does the resident have an intellectual disability Required Choose from the drop down box 0 No 1 Yes S2b To your knowledge does the resident have a developmental disability Required Choose from the drop down box 0 No 1 Yes S2c To your knowledge does the resident have a condition of mental illness according to the PASRR guidelines Required Choose from the drop down box 0 No 1 Yes 84 v 2015 0703 LTC Nursing Facility Hospice User Guide LTCMI Fields S2d Is the resident a danger to himself herself Required Choose from the drop down box 0 No 1 Yes Ifunknown then reply with 0 No S2e Is the resident a danger to others R
233. r First and Last Name or DLN 4 Click the Search button 5 Click the View Detail link 6 Click the Update Form button E NEP CONTRACTOR 8 PASRR LEVEL 1 SCREENING Current Statussrerm Submitted DU See Form Actions Prine use as template _upaate Add note Triar PE SECTION A SECTION n SECTION G SECTION E SECTION E SECTION aozoo Address A Street Address pr MPI API __ 7 Complete only the fields needing updates 8 Click the Submit Form button v 2015 0703 143 LTC Nursing Facility Hospice User Guide Form 3618 and 3619 Corrections NF providers must submit Forms 3618 and 3619 corrections directly on the LTC Online Portal Correctable Fields on Forms 3618 and 3619 Administrator Signature Date Administrator License Number Comment Section Date of Above Transaction Discharge Type Location Recipient Address Recipient First Name Recipient Middle Initial Dates of Qualifying Stay Form 3619 The correctable fields can be changed even if the form has processed into the system For example if a Medicare resident transfers to Medicaid on the fifth of the month and then it is discovered that the transfer was actually on the eighth of the month instead two corrections should be submitted The original Form 3619 discharge and Form 3618 admission must be corrected to the eighth ra
234. r to Preadmission process for steps associated with PL1 Screening Form and PE Submit a 3618 Admission by day three admitting to full Medicaid Complete an Admission MDS assessment by day 14 Complete a quarterly assessment within 92 days of the Admission MDS unless a SCSA was completed prior to this Refer to Preadmission process for steps associated with PL1 and PE Form 3618 must be signed and electronically submitted within 72 hours of admission Submit MDS 3 0 A0310A 01 Admission MDS assessment required by day 14 Submit MDS 3 0 A0310A 02 Quarterly MDS assessment within 92 days of Admission MDS assessment Unless SCSA MDS 3 0 A0310A 04 Significant Correction of Prior Assessment MDS 3 0 A0310A 05 06 was completed prior to Quarterly MDS assessment v 2015 0703 97 LTC Nursing Facility Hospice User Guide Resident Returns Prior Discharge Return Anticipated Refer to Preadmission process for steps associated with PL1 Screening Form and PE Submit a 3618 within 72 hours of admission If the individual returns after a 30 day absence an MDS 3 0 Admission assessment will be due even if the Discharge indicated Return Anticipated Ifthe individual was admitted to another Nursing Facility an Admission Assessment is required 1 there has been a change in condition submit a SCSA If the previous MDS assessment is less than 92 days old has not expired and the individual ha
235. reening Form and associated PE 152 v 2015 0703 LTC Nursing Facility Hospice User Guide Form 3618 and 3619 Submission Validation Rules and Edits Based on information entered in certain fields and on the sequence in which the form is being submitted validation or front end edits will occur and may result in an error The form will not be accepted until all errors are resolved The system messages will display at the top of the LTC Online Portal submission page If you do not receive the DLN number assigned page after clicking the Submit Form button there are errors that need to be resolved The errors will be displayed at the top of the page and you may need to scroll to the top of the page to see the errors An example of a validation or front end edit occurs when the Date of Above Transaction is greater than one year old or greater than or equal to five years old A front end edit may also require the provider to enter additional information depending upon the message received Sequencing validation edits are based on three levels Form Type Transaction and Date of Above Transaction Form type admission 3618 must be discharged with a 3618 before submitting a 3619 and the reverse Transactions must alternate between admission and discharge Date of above transaction should be chronological unless submitting a form effective retroactive Retroactive forms should be submitted in pairs creating or filling a gap of t
236. rejection messages providers will receive as a result of an error occurring during the nightly batch processing The messages are in order of message number The table contains three columns 1 Provider Message This is the system message that will be displayed in form and assessment History trail 2 Form Assessment What form and assessment can receive this message Some messages only apply to certain types of assessments When only specific types are affected they are shown Otherwise MDS would indicate all types Admission assessment A0310A 01 Annual assessment A0310A 03 Significant change in status assessment A0310A 04 Significant correction to prior comprehensive assessment A0310A 05 Quarterly review assessment A0310A 02 Significant correction to prior quarterly assessment A0310A 06 3 Suggested Action The messages and suggested action button is written assuming that the rejected form assessment is correct in Form Type Transaction and Date of Above Transaction First verify that the rejected form is a valid submission If the Form Type or Transaction is incorrect submit an inactivation of that form and submit the correct type or transaction If the Date of Above Transaction is incorrect submit a correction for the correct date and resolve any missing form issues If the MDS Reason for Assessment is incorrect or the MDS is invalid submit an inactivation to CMS If the Entry Date MDS 3 0 fiel
237. restarted gt Afer Medicaid Eligibility has been established the provider must allow 14 days for the systems to interface AFTER 14 days the provider may call TMHP to have the form or assessment restarted ME Check Inactive In this status the Medicaid Eligibility validation was attempted nightly for six months and failed so the request was canceled If the request is canceled it is because the form was corrected or inactivated and the status changes to those statuses not ME Check Inactive If the individual is certified for Medicaid after six months the form or assessment can be reactivated by the provider by clicking the Reactivate form button 4 Pending Applied Income validation will result in either Applied Income Confirmed the form or assessment will process to SAS Request Pending Pending Applied Income In this status validation attempts will occur nightly until applied income is found the request is canceled or until six months has expired whichever comes first gt If Applied Income has already been established the provider may contact TMHP to have the form or assessment restarted gt After Applied Income has been established the provider must allow 14 days for the systems to interface AFTER 14 days the provider may call TMHP to have the form or assessment restarted Note An Applied Income check will be performed for all 3619 forms submitted on the LTC Online Portal Check
238. rminal diagnosis Change in payment Change in hospice ownership CHOW that results in a new contract number Change in hospice provider Change in hospice individual s location or setting Hospice individual is admitted to a Skilled Nursing Facility SNF bed Hospice individual s admission to a Nursing Facility Medicaid bed Other Please explain 66 v 2015 0703 LTC Nursing Facility Hospice User Guide If terminating the hospice program choose Cancel and enter a To date only If the Cancel Code is 14 or 77 an individual or responsible party signature is required An individual voluntarily revokes hospice service An individual expires individual no longer meets hospice eligibility requirements An individual transfers to another service other than hospice An individual transfers to another hospice provider the losing provider chooses CANCEL Setting indicates where the individual is receiving the hospice services If the individual is in an Assisted Living facility Setting should indicate Home A setting of SNF indicates that the individual is classified as Medicare for a non related condition Hospice services are waived until the Medicare stay is completed Enter the principal terminal ICD Code as stated by the certifying physician in the first box marked by the red dot All other terminal diagnoses may be entered in the remaining boxes Additional pertinent
239. rs at the same time Please coordinate with DADS Provider Claims Services to ensure appropri ate payment v 2015 0703 147 LTC Nursing Facility Hospice User Guide Modifications NF providers submit all MDS Correction requests to CMS in accordance with the RAI Users Manual Corrections that are classified as Modification are retrieved by TMHP for processing In field X0900 on 3 0 corrections select the reason for modification TMHP sets the original assessment to status Corrected and gives the new assessment a DLN thus creating a Parent Child DLN relationship set to status Awaiting LTC Medicaid Information The LTCMI must be completed and submitted at this time The MN will then be determined Note Providers are allowed to submit modifications to an on time MDS without requiring a PC for up to one year For Modifications to an MDS assessment that did not originally meet the timeliness rules a PC E will be required upon submission of the LTCMI Providers must access the LTC Online Portal to retrieve the new assessment complete the LTCMI and submit MDS 3 0 For detailed instructions on completing an MDS 3 0 Modification refer to the MDS 3 0 RAI Users Manual Chapter 5 The Users Manual can be found under Downloads on the CMS website at www cms gov NursingHomeQualityInits 25 NHQIMDS30 asp 148 v 2015 0703 LTC Nursing Facility Hospice User Guide New Assessment Modifications will be considered incomplete unt
240. s Understand the Preadmission Screening and Resident Review PASRR process Understand and differentiate between the Minimum Data Set MDS purpose code E and M Understand the provider workflow process which includes dividing into two sections corrections and updates in provider workflow Understand how to correct modify or inactivate forms or assessments and the consequences of doing so Identify form and assessment statuses and how to resolve issues Understand how to properly request prior authorization for nonemergency ambulance transport Understand Resource Utilization Group RUG training requirements Recognize how to prevent Medicaid waste abuse and fraud Understand Health Insurance Portability and Accountability Act HIPAA guidelines and provider responsibilities Identify additional resources v 2015 0703 t LTC Nursing Facility Hospice User Guide Medicaid Team The following groups and individuals make up the Medicaid Team Together they make it possible to deliver Medicaid services to Texans Centers for Medicare amp Medicaid Services CMS The agency in the Department of Health and Human Services that is responsible for federal administration of the Medicare Medicaid and State Childrens Health Insurance Program CHIP Individuals A person enrolled in a program Individuals are those served by Texas Medicaid Managed Care Organization State contracted entity that has bee
241. s not had a change in condition no additional assessment is required If the previous MDS assessment has expired complete the next scheduled assessment per the federal guidelines Refer to Preadmission process for steps associated with PL1 and PE Resident returns to full Medicaid Form 3618 must be signed and electronically submitted within 72 hours of admission Has the previous assessment expired Has there been a 30 day absence Has resident had a change in condition Federal guidelines will require submission of an MDS 3 0 Admission assessment even if Return Anticipated was selected Complete MDS 3 0 A0310A 04 Significant Submit next MDS as change in status scheduled assessment 98 v 2015 0703 LTC Nursing Facility Hospice User Guide MDS Purpose Code E Missed Assessment Purpose Code E should be used for a missed assessment According to 40 Texas Administrative Code TAC 19 2413 3 Missed MDS assessment An MDS assessment that is received by the state Medicaid claims administrator outside the time period that the MDS assessment covers g Missed MDS assessments When the state Medicaid claims administrator receives a missed MDS assess ment DADS pays the Nursing Facility a default RUG rate for the entire period of the missed MDS assessment if the recipient meets financial eligibility for Medicaid except as provided in paragraph 2 of this TAC s
242. sessment For questions related to this functionality providers are directed to contact their third party software vendors 4 v 2015 0703 LTC Nursing Facility Hospice User Guide If you do not have an account you can create one by following the steps below In order to do so you will need to have Provider contract number assigned by DADS when the provider signs the contract to provide Medicaid services Vendor number four digit number assigned by DADS when the provider signs the contract to submit forms on the LTC Online Portal Vendor password provider must call the Electronic Data Interchange EDI Help Desk at 1 888 863 3638 to obtain their vendor password Please note that it may take three to five business days to receive the password which is randomly generated by TMHP How to Create an LTC Online Portal Administrator Account 1 Goto www tmhp com 2 Click providers in the green bar located at the top of the screen A STATE MEDICAID CONTRACTOR clients providers PT S Welcome to Texas Medicaid amp Healthcare Partnership Thank you for visting he Texas amp Heatheare Pathesshp s webster Mocicaid and other state esca programs As of Jaruars 1 2208 Reporting Fraud AES State Heathcars LLG undar contract win he Tse Heath and Human Sanices Commission HSP sesuma administtin of claims processing ur Texas Medicaid an
243. sident report having an Out of Hospital Do Not Resuscitate Order Required Choose from the drop down box 0 No 1 Yes This form is for use when a resident is not in the hospital It lets the person tell health care workers including Emergency Medical Services EMS workers NOT to do some things if the person stops breathing or their heart stops Ifa resident does not have one of these forms filled out EMS workers will ALWAYS give the person Cardiopulmonary Resuscitation CPR or advanced life support even if the advance care planning forms say not to A person should complete this form as well as the Directive to Physicians and Family or Surrogates and the Medical Power of Attorney form if they do NOT want CPR 512 LAR Address Legally Authorized Representative LAR Address is required if 511a Does the resident report having a legally authorized representative Is indicated as 1 Yes 512 LAR First Name Conditional This field is required if field S11a 1 Yes Enter the first name of the Legally Authorized Representative 512b LAR Last Name Conditional This field is required if field S11a 1 Yes Enter the last name of the Legally Authorized Representative 91 LTC Nursing Facility Hospice User Guide LTCMI Fields S12c Address Conditional This field is required if field S11a 1 Yes Enter the street address of the Legally Authorized Representative
244. sion of LTCMI LTCMI Rejections Finding Assessments Using Form Status Inquiry If You Cannot Locate Your MDS Using FSI or Current Activity Using FSI to Identify Residents with Specific PASRR Conditions How to Submit Long Term Care Medicaid Information LTCMI Circumstances for LTCMI Submission LTCMI Fields Sequencing of Documents Admission as a Full Medicaid Recipient Recipient Transitioning to Full Medicaid Full Medicare Transitioning to Medicaid Current Resident Admitted to Hospice Current Hospice Residents Resident Returns Prior Discharge Return Not Anticipated Resident Returns Prior Discharge Return Anticipated MDS Purpose Code E Missed Assessment NF Hospice Provider Tips for When to Submit an MDS PC E PC E Start and End Date Limitations MDS 3 0 MDS Purpose Code What is a Purpose Code M and How Do You Complete a Purpose Code M PC M Start and End Date Limitations MDS 3 0 Validations Requiring Provider Monitoring Provider Workflow Process Finding Documents Set to Status Provider Action Required Using FSI Using Current Activity Provider Workflow Rejection Messages Specific Instructions 2015 0703 iii LTC Nursing Facility Hospice User Guide Alerts Alert Descriptions Accessing Alert Creating Alerts Deleting Alerts Corrections and Upd
245. son for the failed validation has been resolved by the Medicaid Eligibility Worker by clicking the Reactivate Form button Appealed An individual has appealed the MN determination and the provider has provided more information for consideration Assessment is now awaiting TMHP doctor review or a fair hearing has been requested Awaiting LTC Medicaid Information MDS has been retrieved by TMHP from CMS If LTCMI is submitted assessment will be processed by DADS Awaiting PE A PLI Screening Form has been submitted but the PE for this individual has not been submitted Coach Pending More Info DADS Provider Claims Services is reviewing Coach Review DADS Provider Claims Services is reviewing Corrected Forms are moved into a corrected status when the form is corrected by another form View the History trail to find the child DLN No further actions are allowed on a form or assessment with status Corrected Form Complete A previous valid PASARR Screening has been located and MN has been approved Form Inactivated Assessment form has been inactivated No further actions allowed on the form or assessment ID Invalid Medicaid ID validation failed Cannot be processed until Medicaid ID is corrected Contact Medicaid Eligibility Worker to verify individual s name Social Security number and Medicaid ID A new form or assessment must be submitted with correct information The name entered must match the name shown on the indiv
246. ssion has not processed on the recipient s file Review the facility records to identify the Coinsurance admission date prior to this discharge and the Spell of Illness for this discharge Pull a MESAV and review the Service Authorizations to determine if the 3619 admission has processed and if the Spell of Illness has been authorized If Coinsurance is not authorized use the LTC Online Portal to determine the status of the 3619 admission If the 3619 admission was rejected correct the 3619 admission and resubr If the 3619 admission was never entered submit the missing 3619 admission If Coinsurance is authorized compare the end date of the Service Authorization to the transaction date of the rejected discharge If the transaction date of the rejected discharge is later than the Service Authorization end date by more than one day the discharge exceeds the 80 day limit of Coinsurance An earlier discharge and readmission may be needed prior to the rejected ischarge to allow for additional days before reaching 80 day limit If so submit the missing or rejected forms If the transaction date of the rejected discharge is earlier than the Service Authorization end date the forms may have attempted to process out of order If the admission was processed after the 3619 rejected resubmit the rejected discharge Once the missing or rejected forms are processed resubmit the rejected discharge NF 0033 This dis
247. st be completed on the 21st day to begin Medicare Co insurance Before submitting Form 3619 Admission the individual must have already spent 20 days of Full Medicare Coverage in a Skilled Nursing Bed though the stay does not have to be in the same facility The administrator must sign and submit the form within 72 hours of the individual s Admission to or Discharge from Medicare Co insurance to be considered timely In hospitals acting as temporary Texas Medicaid nursing homes the person responsible such as the Director of Nurses DON may sign as the administrator the 72 hour deadline will still apply A facility administrator may authorize a person to sign the form in their absence The authorization must be in writing and on file at the facility The administrator date signed check box is required for Forms 3618 and 3619 If the facility is temporarily without an administrator a signature is still required Note in the comment section of Form 3619 that the facility is without an administrator at this time and enter 999999 for the State Board License No When Medicaid provides the rest of the payment this is called Medicare Co insurance In order for Medicare Co insurance to begin the individual must meet the following requirements Medicaid financial eligibility Have an Admission Form 3619 on file Have a qualifying stay of 20 days of full Medicare coverage not the three day acute care hospitalization stay The Dates of Qualify
248. success fully submitted until all errors are resolved Physicians are not required to complete the RUG training v 2015 85 LTC Nursing Facility Hospice User Guide LTCMI Fields S3f MD DO License State Required Choose the license state in which the MD DO is licensed from the drop down box 539 MD DO Military Spec Code Conditional This field is required if S3e MD DO License is not populated Enter the Military Spec Code number of the MD DO Fields S3h through 531 MD DO information are required if MD DO is not licensed in Texas S3h MD DO First Name Conditional This field is required if S3f License State is NOT Texas Enter the first name of the resident s MD DO This information is used to mail MN determination letters 531 MD DO Address Conditional This field is required if S3f License State is NOT Texas Enter the street address of the resident s MD DO This information is used to mail MN determination letters S3j MD DO City Conditional This field is required if S3f License State is NOT Texas Enter the city of the resident s MD DO mailing address This information is used to mail MN determination letters S3k MD DO State Conditional This field is required if S3f License State is NOT Texas Enter the state of the resident s MD DO mailing address This information is used to mail MN
249. successfully submitted by the NF and is now pending confirmation by the LA LMHA AERE The has been successfully submitted by the NF and Is now pending confirmation by the LA LMHA PASRR LEVEL 1 SCREENING Current statustindiviual placed in NF PE Confirmed Names e eue Username PE DLN Form actions NE Hd ite ie te Serve the individual Unable to seva Create 107 print 10r update 10T Section A section n Section C 101 Meeting G0100 of TOT Meeting 90200 Date of 1DT meeting m 60300 Individual PASRR Condition The Individual is PASRR positive for 5 An IDT History trail will be displayed at the bottom of the IDT tab and will display a History of all the suc cessfully submitted IDT meetings The History will display Date of IDT Meeting MM DD YYYY as links in chronological order from most recent date of IDT meeting to oldest date of IDT meeting Each IDT will display as a collapsible link and contain the History of that IDT meeting 107 Confirmation 1200 specialized services and Participation LA or LMHA agreed atthe TOT meeting to the specialized services indicated obove Mr Attendonce Type r LA Mr Participation Confirmation Comment nfusert the 107 has been successfully submitted by the NF and snow pending confrmation by the LUN
250. t provider payments Form 3618 is to be submitted for admissions discharges and death Form 3618 must be submitted on the LTC Online Portal MDS Discharge Tracking and Re Entry Tracking forms 3 0 A0310F are not used by Texas Medicaid The individual must reside in a valid Medicaid contracted bed If Form 3618 is submitted it is assumed that the individual is in a contracted bed Providers submit Form 3618 when the individual is being classified as Full Medicaid This can occur upon initial admission or can follow a Medicare stay it can also follow a change in payor source from private pay If the form is submitted for a change from private pay Medicare or Hospice to Medicaid this is the indicator for TMHP to retrieve the MDS for that individual for Medicaid processing A new MDS is not required upon change to Medicaid if the cycle is already established Once the Form 3618 has been submitted the most recent MDS assessment that meets the necessary criteria will be loaded onto the LTC Online Portal and set to status Awaiting LTC Medicaid Information The facility administrator must sign Form 3618 prior to submission In order for a Medicaid recipient to begin Full Medicaid Provider Payment the following must apply The individual must have Medicaid Eligibility Form 3618 will not process until the individual is determined to be eligible The MESAV must be updated to reflect the processing of Form 3618 MDS RUG is authorized Note
251. te SSN MDS 3 0 A0600A Medicaid MDS 3 0 0700 Medicare MDS 3 0 A0600B First Name and Last Name MDS 3 0 A0500A and A0500C Information used to identify the individual associated with the submission Status The status of the assessment at the time of the search RUG The assigned Resource Utilization Group RUG value RN Signature Date Date assessment was completed as identified in field 3 0 Z0500B Purpose Code if applicable Purpose Code E Missed Assessment Purpose Code M Used when three month prior retroactive eligibility has been established Contract Number The nine digit provider number Vendor Number The four digit site identification number Reason for Assessment MDS 2 0 AA8a MDS 3 0 A0310A MDS 2 0 Reason for Assessment Codes MDS 3 0 Reason for Assessment Codes 01 Admission assessment required by day 14 01 Admission assessment required by day 14 02 Annual assessment 02 Quarterly review assessment 03 Significant change in status assessment 03 Annual assessment 04 Significant correction of prior full assessment 04 Significant change in status assessment 05 Quarterly review assessment 05 Significant correction to prior comprehensive assessment 10 Significant correction of prior quarterly assessment 06 Significant correction to prior quarterly assessment Delete Providers are able to delete unwanted or unnecessary co
252. the discharge prior to this admission and submit that discharge and the rejected admission as a pair to create a gap in the Service Authorization on file If the recipient has a closed Service Authorization for Code 1 with an end date after the rejected 3619 admission determine if the end date is correct If the end date is wrong submit a correcting 3618 discharge to change the end date to be prior to the rejected 3619 admission Once the Service Authorization ends prior to the 3619 Admission resubmit the rejected 3619 admission If the end date is correct there is a 3618 retroactive pair that needs to be processed to create a gap for the rejected 3619 admission and corresponding discharge Identify the 3618 discharge prior to the rejected 3619 admission and the 3618 admission prior to the current end date and submit as a retroactive pair Once the gap has been created within the Code 1 resubmit the rejected 3619 admission with the corresponding 3619 discharge 120 v 2015 0703 LTC Nursing Facility Hospice User Guide Provider Message his admission cannot be processed because the client is admitted to Full Medicaid as of the submitted admission date Verify the Medicaid dates and submit the needed 3618s Resubmit the reject ed Medicare Coinsurance admission once the client is discharged from Medicaid Form Assessment 3619 Admit Suggested Action The recipient has an existing Serv
253. the top of the screen These errors will need to be resolved before the form can be successfully submitted Once all errors are resolved click the Submit form button again to submit the form Important Validation is performed on the Medicaid SSN Medicare number and the Last Name of the individual If the Medicaid SSN Medicare number and Last Name do not match processing will not occur The form will be set to status 1D Invalid Validations are against the Medicaid Eligibility file Check the individual s Medicaid card or the MESAV and compare to the entry being made If the Medicaid card is incorrect contact the Medicaid Eligibility Worker Corrections are not allowed to the Name or Number fields on the form once submitted thus it is important to submit the correct information Incorrect entries require inactivation and a new submission v 2015 0703 63 LTC Nursing Facility Hospice User Guide 2 Ma lsmeesdreepant ne C Amama e paeigient LastName LO Roads __ zaupane Pist Nane 7 Recipe Sufie L a mum iere in the rere sertin ier than 20 days of Qualifying Sta eter an th fey mal et of datas are need a seca Form 3619 must be templated ung te same bate of Taney th maina sane at date terry Mat tha bast ar my to em 11 Date of aove nory amp Ter arces fronde and te dte s rot cl
254. ther stata healthcare programs ACS a XEROX What is TM Juss si meme Lag in to My Account Go to TexMedConnact Texas Medicaid Pro dac pem og In to LTC Online Portal Log In to TexMedConnect 5 Enter your User name and Password v 2015 0703 1 LTC Nursing Facility Hospice User Guide 6 Click the OK button After log in Form Status Inquiry FSI will display by default Teas MEDICAID HEALTHCARE PARTNERSHIP TMHP A STATE MEDICAID CONTRACTOR Curent Activity Drafts Vendors Letters Printable forms Alerts Form Status Inquiry Form select TyeotFom S VenicrNumbera Form Status Inquiry DLN Medicaid Number Last Name Fist Name Form Status 8 SeN CARE 1D Fram Date Toce eos PASEREigtilty Discharged sceased i x 12 v 2015 0703 LTC Nursing Facility Hospice User Guide LIC Online Portal Basics Blue Navigational Bar Links All portal features based on your security level will be found in the blue navigational bar located at the top of the portal screen Options found in the blue navigational bar may include Home Submit Form Form Status Inquiry Current Activity Drafts Vendors Letters Printable Forms Alerts or Help Tis MEDICAID
255. ther than submitting new forms Even if the original forms are processed corrections can be submitted TMHP places the original form in a corrected status and gives the new form a DLN creating a Parent Child DLN relationship Ifa form contains incorrect information in a field that is not correctable and the form is set to the status Processed Complete counteracting form will need to be submitted If the form is not set to a Processed Complete status inactivate the form and resubmit with the correct information Please refer to the Counteracting Forms section of this User Guide for additional information Correction to Forms 3618 or 3619 1 Login to the LTC Online Portal 2 Click Form Status Inquiry link in the blue navigational bar Search for Form 3618 or 3619 using the individual s SSN Medicaid Number First and Last Name or DLN Click the Search button We Ae Click the View Detail link 144 v 2015 0703 LTC Nursing Facility Hospice User Guide 6 Click the Correct this form button commu CE CENTEA E 3618 RESIDENT TRANSACTION NOTICE Current Status e Nameisis cete Prt cere ths fur ELT bar E mm prm ciat 1 Medicaid Recipient No 4 Recipients Last Name Dome eser i ty 3 Medicare or Re Retreert T Reciients M state E nt Recipient Nome sufi Dat
256. thori zation This discharge appears to be one of a retroactive pair If an admission prior to this discharge is missing or rejected resubmit the admission and this discharge on the same day 3619 Discharge The recipient has a Service Authorization that begins after the submitted discharge date The rejected discharge and matching admission and must be submitted as a retroactive pair Review the facility records to identify the Medicare Part A Coin surance admission date prior to this discharge Determine if the 3619 admission prior to this discharge has been submitted If not submit that 3619 admission If it was rejected resolve the issue and resubmit that 3619 admission Resubmit the rejected 3619 discharge on the same day as the missing or corrected admission v 2015 0703 LTC Nursing Facility Hospice User Guide Provider Message Displayed in History NF 0069 This discharge cannot be processed because the client is admitted by a different provider If an admission prior to this discharge is missing or rejected the admis sion must be processed prior to this discharge Form Assessment 3618 Discharge Suggested The recipient has a Service Authorization with a different provider as of the submitted discharge date Review the facility s records to verify that the transaction date on the rejected discharge is correct Determine if the 3618 admission prior to th
257. tions when these forms process If the admission date is before the discharge date the pair is filling a gap between or prior to Service Authorizations Pull a MESAV and review the Service Authorizations to see if a gap exists for the period that will be created by the admission and discharge pair Onceresolved resubmit the pair together on the same date v 2015 0703 LTC Nursing Facility Hospice User Guide Provider Message tion cannot be processed because the new admission date of this modification is later than the exist ing enrollment end date Modify the admission date and resubmit this form or inactivate this form and modify the correspond ing discharge form to make it a counteracting form cancelling the admission timeframe Form Assessment 3618 Admit Mod Suggested is admission modification is later than the end date of the Service Authorization it is trying to change Review the facility s records to determine the recipient s admission and discharge dates Pull a MESAV and review the Service Authorizations on file Ifthe correction was not done on the right admission adjust the admission date on this correction back to the original admission date and resubmit Then correct the admission date on the appro priate admission form and submit Ifthe end date of the Service Authorization being modified is not correct submit a discharge correction to adjust the end date an
258. tive Code Z0500B Date RN Assessment Coordinator signed as complete MDS 3 0 v 2015 0703 177 LTC Nursing Facility Hospice User Guide Appendix A Medicaid Eligibility Verification Resident with Medical Eligibility LTC Nursing Facility Hospice User Guide uo ajeAmeay au uo Buppp quauissasse ayeAnea1 JN sypuow 9 Jaye paynie JW 5 3 JI uad aAnoeuppatup Iv Pal aq o1 speou uoneoidde mau jy JN 1201102 you uapisay SeeAn2eat Bulpuag 42949 IW v eAmeupypeu Burpua al pieoipaw I prerpaw YYSvd o1 jddo sao ayqi amp i preoipow YLM uapisay uoneoyueA NNI preoipaw Tv Buipusg oo 1 IW Buipusg dl xpeup euroou parjddy pouuyuo Burpuag asanbay sys pauuguo Iv 3 preorpew axepieAAsenboy pauuguo qi QI popa A panoiddy NW 10 JUaWUSSASS NW Auissa2an uonauoo syuigns OU J Woy 111521 dHW L 1283002 sak JI upxeui aureu Jo siono nojasty pue sg 1e gt 1paW PIe gt IPAW NSS suijuoo 4N 179 2015 070
259. to be complete to save the draft Note If the form is successfully submitted a DLN will be assigned and the LTC Online Portal will show Your form was submitted successfully If there are errors they will be displayed in a box at the top of the screen These errors will need to be resolved before the form can be successfully submitted Once all errors are resolved click the Submit Form button again to submit the form 70 v 2015 0703 LTC Nursing Facility Hospice User Guide Actions Com 3074 Physician Certification of Terminal Illness Provider Information TEST PROVIDER CM2 Recipient Information pen ss JL pm Address city suse E ze Certification Information lelecton Stert Recertification recet Hospice Information Provider TEST PROWOER CHO entra ooooooono raves Number ames Address state eC 2 Verbal Verification within two days of election date Verbal verbal verification verification lest Name Fist Name Verbal Verification signature an E Sane ana iz A Certication Recertfication Physician Signatures TT T pum tending Physician Last Physica First Name Name attending Rs on weswe fe Signature on Data Sioned i License Type State of Num S State Licens Hospice Physican Fst Names Hospice pees ate Sioned
260. ty or Medicare number and the name match the individual s Medicaid ID card and the form is set to status ID Invalid call TMHP to have the form restarted through the system PASRR Level 1 Screening Form submission error messages PASRR Level 1 Screening Form and PASRR Evaluation status questions Call TMHP 1 800 626 4117 Option 2 about the following MN Determination on MDS MN Determination on PE Call TMHP at 1 800 626 4117 Option 3 about the following TMHP LTC Online Portal and TexMedConnect account setup Types of Calls to Refer to DADS PASRR Unit Call DADS PASRR Unit at 1 855 435 7180 about the following Assistance or cooperation from a RE or LA LMHA Assistance with locating information to perform and submit the PLI Screening Form Assistance with locating screenings and evaluations individuals or additional training resources v 2015 0703 169 LTC Nursing Facility Hospice User Guide Types of Calls to Refer to DSHS PASRR Call DSHS PASRR at 1 866 378 8440 about the following Assistance or cooperation from a RE or LA LMHA Assistance with locating information to perform and submit the PLI Screening Form Assistance with locating screenings and evaluations individuals or additional training resources Types of Calls to Refer to DADS PCS Call DADS PCS at 512 438 2200 Option 1 about the following Denials or pending denials of individuals who have established prior permanent medica
261. ty to 11 24 23 AM serve the needs of the individual as documented on the PASRR Evaluation Awaiting 5 19 2014 11 24 23 AM 5 19 2014 Pre admission PL1 submitted Please contact the nearest local authority to conduct a PASRR 11 24 23 AM Evaluation 5 19 2014 The PE was submitted from this form 11 36 27 Pending 5 19 2014 11 45 12 AM Placement in NF Confirmed 5 19 2014 A PE has been submitted for this PL1 The NF must indicate if they are able to serve the individual 11 45 12 AM based on the PE PE 1 UnLock Form Upon opening the document becomes automatically locked by the viewer and will remain locked for 20 minutes if there is no activity or until the viewer clicks the UnLock Form button The UnLock Form button will unlock the document so that a different user can make changes If a document is locked others will not be able to make changes or add additional information You may be asked to unlock a document if you are seeking assistance from TMHP or DADS To unlock a document click the UnLock Form button located at the top right corner of the screen j ec ASTATE MEDICAID CONTRACTOR Current Activity Unlock Form PASRR LEVEL 1 SCREENING Current Status Awaiting Namo DLN Form Actions Print Use as template Update Form Adi Nate EU sections Section c Section p Section E Section
262. ual s previously submitted assessment to populate information on a new LTCMI However it will only populate information from an assessment with the same vendor contract number and it will only populate information if the previous LTCMI was submitted within the last six months The following error will be displayed if there is not a previous assessment available No previous LTCMI for this resident and contract number received within the last 6 months can be found to populate the LTCMI Two important reminders 1 Ifinformation has been entered onto the LTCMI and saved prior to clicking the Populate LTCMI button Populate LTCMI button will not be available m All information will populate into the current LTCMI except for fields S1e Purpose Code S1f Missed Assess ment or Prior Start Date 515 Missed Assessment or Prior End Date and 10 Comments To populate information on a new LTCMI click the Populate LTCMI button located in the yellow Form Actions bar Be sure to review the auto populated information for accuracy and add any new information if needed Once the LTCMI is complete and accurate the provider may choose to save the information by clicking the Save LTCMI button or the assessment may be submitted to TMHP by clicking the Submit Form button Required Certification of Able or Unable to Serve the Individual There are times when a Nursing Facility must certify that it can or cannot provide required servi
263. ubsection Note An On Time MDS assessment is an MDS assessment that is submitted in accordance with the federal MDS submis sion schedule and the state Medicaid claims administrator within 31 days of the completion date A Late MDS assessment is an assessment with Z0500B MDS 3 0 date afier the 31 day submission period but within the 92 days the assess ment represents If a new resident is admitted to the facility and the Admission assessment is submitted more than 91 days after Z0500B MDS 3 0 of that Admission assessment the Admission assessment will have to be submitted as a PC E Payment for this gap will be made at the PC E default rate MDS Purpose Code E is used to recover missed assess ment time frames A missed assessment occurs when an MDS is not submitted within the anticipated quarter time frame The anticipated quarter is the 92 day anticipated MDS assessment quarter following the 92 day span of the current MDS assessment A missed assessment can also occur if the Admission assessment is not submitted within 92 days of the assessment date Purpose Code E can only be submitted on the Admission assessment Annual assess ment or Quarterly review assessment The PC E must be submitted within 365 days from the last uncovered day v 2015 0703 99 LTC Nursing Facility Hospice User Guide DEFAULT RUG 1 0 oa MISSED 92 Days j 92 Days 92 Days 3 Assessment Assessment file for this on file for this
264. uded 100 MEAS Part A embusemen tne rene State Boar No Last name j Signature E mm m Submit Form 3619 for Medicare Co insurance Admission Medicare Co insurance Discharge Form 3619 Discharge is needed if the Co insurance is no longer due to the NF e g the individual discharged from the NE Medicare benefits are exhausted or denied or the individual is deceased In addition type the following information in the comments section of Form 3619 Medicare Replacement Name of the insurance carrier Number of Co insurance payment days allowed under the Medicare replacement policy Daily Co payment amount 64 v 2015 0703 LTC Nursing Facility Hospice User Guide Hospice Form 3071 Election Cancellation Discharge Notice Form 3071 is used to notify DADS of a Texas Medicaid Hospice individual s voluntary election or cancellation of the Texas Medicaid Hospice program or to update changes in the Texas Medicaid Hospice individual s location condition or status Each Form 3071 must be completed by the hospice staff either as an election an update or a cancellation If an individual is discharged from Hospice for any reason and the individual re clects Hospice regard less of the amount of time a new election and a new Physician Certification Form must be completed If the form is intended to elect an individual into the Hospice program
265. uest submitted from MDS database Mi 2015 0703 149 LTC Nursing Facility Hospice User Guide Inactivations MDS Assessment For MDS Inactivations NF providers complete the MDS Correction Request Form ensuring field X1050 on 3 0 corrections reason for inactivation was completed prior to submitting it to CMS TMHP will retrieve all suc cessfully submitted MDS Inactivation Requests from CMS for processing When the inactivation is placed on the LTC Online Portal TMHP will automatically inactivate the associated LTCMI and the assessment will set to status Form Inactivated unless the original assessment has been set to status Processed Complete However the LTCMI will not automatically be inactivated on the LTC Online Portal if the assessment had a previous status of Processed Complete which means it was already processed by the Service Authorization System SAS The assessment status will be set to SAS Request Pending and will be processed by SAS in their nightly batch routines Any MDS assess ment set to status Form Inactivated or Invalid Complete cannot be corrected or resubmitted The inactivation request will be submitted against assessments that have processed If the assessment can be located and the HHSC Office of Inspector General OIG has not addressed the assessment the assessment will be canceled and any associated payments will be recouped If the inactivation is submitted on an assessment that has been chosen by OIG
266. uide Timeout The LTC Online Portal will timeout after 20 minutes of no activity Any information that has been entered will be lost To prevent this timeout from occurring when completing the Section LTCMI tab of an MDS assessment complete and submit within 20 minutes or click on a different tab Section A to reset the timer then click the Section LTCMI tab to return to and complete the LTCMI RUG Value The Resource Utilization Group RUG is used for MDS 3 0 to classify relative direct care resource requirements for Nursing Facility residents and to determine the rate of payment for Nursing Facility Daily Care and Hospice room and boarding fees Once an individual assessment is open the RUG value can be found next to the DLN MINIMUM DATA SET NDS Version 3 0 ita stating Ef la nei wa Section Section Section c Section Section E Section Section G Section Section 1 Section 2 Section K Section L Section M Section Section Section P Section Sectio Section X Section Z 36 v 2015 0703 LTC Nursing Facility Hospice User Guide Preadmission Screening and Resident Review PASRR PASRR is a review process that is federally mandated requiring that all individuals seeking Medicaid certified Nursing Facility NF admissions are screened for Mental Illness Developmental Disability Related Condition or Intellectual Disability Me
267. umber i Sib Contract Provider Number Sle Service Group sid Sie Purpose Code 510 x 52 PASARR Information S2 To your knowledge does the resident have an Intellectual Sisabiity Sab To your knowledge does the resident have developmental ame Gieabiney Sac To your knowledge does the resident have a condition of mental eu 3 Click the Submit Form button The original assessment parent is set to status Corrected and the new assessment child DLN is assigned creating a parent child DLN relationship The new child assessment replaces the parent assessment gt RUG FAR Parent DLN 5 10 8 2010 MHP This form was submitted as a correction for DLN Note Corrections are processed overnight Providers must wait until the following day to see changes 2015 0703 141 LTC Nursing Facility Hospice User Guide PASRR Level 1 Screening Updates NF Providers must submit PLI Screening Form updates directly on the LTC Online Portal Only users with appro priate security permissions can submit updates The PLI Screening Form cannot be updated if the status is Form Inactivated or PLI Inactive or if a matching PE with a DLN is found The PL1 Screening Form can only be updated until an associated PE has been successfully submitted The status of a Screening Form does not usually change upon submission of an update an
268. ut the PASRR admission processes see the Preadmission Screening and Resident Review PASRR section of this User Guide 32 v 2015 0703 LTC Nursing Facility Hospice User Guide Other Basic Information Required Fields Within the LTC Online Portal red dots indicate required fields Fields without the red dot are optional Lj y MEDICAID CONTRACTOR Current Activity Form Status Inquiry Form Select vendor v Form Status Inquiry DLN Medicaid Last Name Firstname pm Form Status E SSN CH H care 10 From Date jeans fe Reus PeSRRElgblty v Discharged Deceased s History Every document will have a History trail of statuses After opening a form or assessment scroll to the bottom The History trail will display list of every processing status that has been held by the document along with any appro priate details Any notes added by the provider or any comments from TMHP or DADS will also be located in the History trail Note Once the individual bas been admitted only the admitting NF will be able to access the PE v 2015 0703 33 LTC Nursing Facility Hospice User Guide Form 5 19 2014 11 Submitted Pending 5 19 2014 11 Placement 5 19 2014 MHP Individual is pending placement Each identified Nursing Facility must indicate ability or inabili
269. ut the form is under the incorrect contract inactivate the form and resubmit with the proper contract If there is not an active contract for the transaction date the submission will have to be held until the contract has been approved NF 0076 This admission assess MDS Admit The submitted MDS admission Entry Date is earlier than the Service ment cannot be processed because Authorization begin date on the recipient s file the Entry Date is earlier than the Verify the Entry Date and submit a modification to the federal Service Authorization begin date CMS database as needed Verify the Entry Date and correct Ifan earlier 3618 or 3619 admission is needed submit a matching it as needed or submit an ear admission and discharge pair then resubmit the rejected MDS lier 3618 3619 admission If the admission 3618 3619 admission and MDS If the 3618 or 3619 admission date and the MDS Entry Date are Entry Date are correct contact Pro correct contact DADS Provider Claims Services at 512 438 2200 vider Claims Services for assistance Option 1 for assistance NF 0077 This admission modifica 3619 Admit The adjusted days of Full Medicare on this correction would create tion cannot be processed because Mod an overlap with Service Authorizations already in the recipient s file the new Full Medicare period would if this correction is processed as submitted create an overlap with an existing Review the Medicare Rem
270. ver the during a Service Authorization for submitted admission date a different provider Correct the Contact the prior facility to request that a correcting discharge admission date or contact the other be submitted for their discharge If the other facility s discharge is provider to determine proper dates incorrect allow seven days for processing time and resubmit the rejected admission Ifthe recipient was in the other provider s facility before and after being in your facility the other facility must submit a retroac tive discharge and admission creating a gap during which the recipient was in your facility An admission and discharge pair will also need to process for your facility to fill the gap Two pairs will need to be processed Coordinate with the other facility NF 0014 This admission cannot 3618 Admit The recipient has a Service Authorization for the same facility be processed because an earlier admission into your facility has already been processed Verify the discharges and admissions for this client and submit the missing discharge Resubmit this admis sion once the previous discharge is submitted processed admission for the same provider covers the submitted admission date Review the recipient s records to find the discharge date between the begin date of the current Service Authorization and this admission form Pull a MESAV to verify the begin date of the most recent Service Authorizati
271. viders to their assessments so that only those associated with that NPI are viewable Without an NPI providers would not be able to locate their assess ments on the LTC Online Portal Note DADS Medically Dependant Children Program MDCP nurses are not required to apply for an NPI They enter an Atypical Provider Identifier API which is assigned by the appropriate region To view a map of the DADS Commu nity Services regions go to www dads state tx us contact regional facility To obtain an NPI go to https nppes cms hhs gov NPPES NPI or API is required on claims and assessment submissions using the following methods Online Portal TexMedConnect Third party software vendor v 2015 0703 3 LTC Nursing Facility Hospice User Guide The LTC Online Portal Providers must use the LTC Online Portal to submit forms screenings evaluations the LTCMI section of the MDS Assessment and the 3071 3074 Hospice forms Benefits of Using the LTC Online Portal Web based application 2 7 system availability TMHP provides LTC Online Portal technical support by telephone at 1 800 626 4117 Option 3 from 7 00 a m 7 00 p m Central Time Monday through Friday excluding holidays Edits are in place to verify the validity of data entered Provides error messages that must be resolved before submission Providers have the ability to monitor the status of forms assessments screenings and evaluations by usi
272. vidual elects hospice and every six months recertification thereafter Physician certification statements are valid for six months and must be renewed cach subsequent six month certification period A hospice individual s principal hospice diagnosis must be verified within two days of the hospice election date as evidenced by verbal verification by the hospice staff or receipt of physician s signature on Form 3074 The physician is allowed to sign and date the initial certification within the six month terminal illness time frame the physician is certifying if a verbal verification is obtained If no verbal verification is obtained the physician s signature must be obtained within two days of the initial election Note Recertification forms must be signed no earlier than 30 calendar days before the recertification date or anytime during the six month recertification period Ifan individual is discharged from hospice services for any reason and that individual re clects hospice regard less of the amount of time a new election and new Physician Certification Form must be completed Note Both the 3071 and 3074 must be successfully submitted and processed prior to receipt of payment Ifthe initial certification statement is signed by the physician after the six month time frame the effective date will be the date the document was signed by the physician Medicaid payment will not be made prior to that date The two day verbal verification
273. which discharge is prior to this admission Pull a MESAV and review the Service Authorizations to determine processed you will not have services authorized If the recipient has an ongoing Service Authorization with a begin date prior to the rejected admission If the current Service Authorization is for Full Medicaid Code 1 a 3618 discharge must be processed prior to resubmitting the rejected 3619 admission If the current Service Authorization is for Medicare Part A Coin surance Code 3 a 3619 discharge must be processed prior to resubmitting the rejected 3619 admission If the recipient does not have Service Authorizations on the MESAV use the statuses on the LTC Online Portal to determine the forms that have processed Remember authorizations will only display if the MDS has also processed If the most recent processed form is a 3618 admission prior to the rejected 3619 admission a 3618 discharge must be processed prior to resubmitting the rejected 3619 admission v 2015 LTC Nursing Facility Hospice User Guide Alerts Alerts are notices to a user to perform an action related to a PLI Screening or PE or when a Resident Review is needed The LTC Online Portal creates alerts automatically when an action needs to take place Nursing Facility users can also create alerts to be sent to the LA LMHA using the LTC Online Portal The Alerts screen should be accessed on a daily basis via the LTC
274. y 512 438 3161 PASRR Unit Policy Questions 855 435 7180 Regulatory Services 512 438 2625 Provider Claims Services Hotlin NF and Hospice Client Service authorizations MESAV updates and unable 12 438 2200 to determine Rate Key issues Option 1 Personal Needs Allowance Payments Option 2 Deductions and Holds Option 3 Third Party Recovery Option 4 Home Community Services Option 5 TX Home Living Option 5 Rehabilitation Therapy and Specialized Services Option 6 v 2015 0703 171 LTC Nursing Facility Hospice User Guide Health and Human Services HHSC HHSC Ombudsman Office Medicaid Benefit Medicaid Fraud Rate Analysis Help Lin Resource Utilization Groups RUGs Information Nurse Specialist Reconsideration amp Texas State University RUG Training Information 1 877 787 8999 1 800 436 6184 512 730 7404 512 491 2074 512 245 7118 512 245 7118 Texas State University Training Online Course Questions Informational Websites Texas Medicaid amp Healthcare Partnership TMHP www tmhp com information www tmhp com Pages TMHP TMHP_HIPAA aspx Long Term Care Division www tmhp com Pages LTC Itc_home aspx NF LTCMI and PASRR information is also available at www tmhp com Pages LTC ltc home aspx Long Term Care Provider News Archives www tmhp com Pages LTC LTC_news_archives aspx Texas D
275. y 21 within 72 hours of Medicare payment to begin Medicare Co insurance up to a maximum of 80 days The entire Medicare stay cannot exceed 100 days The facility must submit a 3619 Discharge on the 101st day or the day of discharge from Medicare Co insur ance and a 3618 Admission on the same day to admit the individual to Full Medicaid 3619 Discharge and 3618 Admission changing to Full Medicaid will be the same date unless the individual physically went out of the facility 94 v 2015 0703 LTC Nursing Facility Hospice User Guide The facility may submit an LTCMI on an MDS assessment for an individual who will be transitioning from Medicare to Medicaid However LTCMI cannot be submitted prior to 3619 Admission The provider has the option to submit the LTCMI either prior to the resident discharging off of Medicare or waiting until the resident is considered Full Medicaid Current Resident Admitted to Hospice Submit a Form 3618 or 3619 as appropriate discharging the individual to Hospice Care CMS states a SCSA should be submitted on a resident who admits to Hospice The MDS 3 0 LTCMI should include the Hospice contract number and Hospice Care should be indicated in O0100K2 Indicate Hospice Care in 3 0 00100K2 Hospice contract number must be entered on the LTCMI Hospice provider submits Forms 3071 and 3074 Form 3618 or 3619 Discharge must be signed and electronically submitted ithin 72 hours of H
276. y contraindicated Ambulance transports must be limited to those situations where the transportation of the individual is less costly than bringing the service to the individual Note Authorization requests for services administered by an individual managed care organization MCO must be submitted to the individual s MCO according to the guidelines that are specific to the plan under which the individual is covered Prior Authorization Requirements Prior authorization is not a guarantee of payment Even if a procedure has been prior authorized reimbursement can be affected for a variety of reasons e g the individual is ineligible on the date of service DOS or the claim is incomplete Providers must verify individual eligibility status before providing services In most instances prior authorization must be approved before the service is provided Prior Authorization for urgent services that are provided after business hours on a weekend or on a holiday may be requested on the next business day TMHP considers providers business hours as Monday through Friday from 8 a m to 5 p m Central Time Prior authorization requests that do not meet these deadlines may be denied To avoid unnecessary denials the request for prior authorization must contain correct and complete information including documentation of medical necessity The documentation of medical necessity must be maintained in the individual s medical record The requesti
277. y in Hospice If the client is no longer enrolled in the Hospice pro gram contact the Hospice provider and request that they discharge the client from the program Once the Hospice discharge is processed resubmit your form If the client is a Hospice recipient inactivate your form Form Assessment 3618 3619 Suggested Action The recipient has a Service Authorization for Hospice as of the effec tive date of the submitted form Review the facility s records to determine if the recipient is Hospice Ifthe recipient is Hospice inactivate the Nursing Facility form Note 3678 3619s should not be submitted on Hospice recipients If the recipient has requested to terminate the Hospice program contact the Hospice provider and request that the provider submit a discharge Form 3071 If the Form 3071 has already been submitted allow 10 days for processing before resubmitting the rejected admission Note If the form rejects again the Hospice provider needs to follow up with DADS Provider Claims Services If the Form 3071 has not yet been submitted allow the time requested by the Hospice provider for processing of the Hospice discharge before resubmitting the rejected admission NF 0013 This admission cannot be 3618 Admit The recipient has a Service Authorization for a different facility pro processed because it is effective cessed admission and discharge for a different provider co

2015 Long Term Care Nursing Facility/Hospice

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