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TDHconnect 3.0 Workbook for Acute Care.book

1. Page 92 PR TDHc3 0AC_02 18 05_v 0 4 Medicaid Claim Status Inquiry 19 Medicaid Claim Status Inquiry Important Before using Claim Status Inquiry CSI you must fax in a CSI request form even though claim status inquiry is a built in function of TDHconnect A blank Claim Status Inquiry Authorization form is included in the back of this workbook Note Rejected claims are not displayed in CSI responses only claims that are in process paid or denied status Contact For claims assistance call the TMHP Contact center at 1 800 925 9126 For LTC claims assistance call the LTC Help Desk at 1 800 626 4117 1 512 335 4729 in Austin 19 1 Create a New CSI Request CSI requests retrieve information on the status of claims that were accepted into the TMHP system regardless of whether the claims were submitted on paper or electronically To create a new CSI request 1 Double click CSI to display the Medicaid Claim Status Inquiry Request Response Summary window TDHconnect Medicaid Claim Status Inquiry File Edit View Reports Tools Navigation Help Cp Es cg kl at X EmB amp eL 3g Lp TDHconnect Medicaid Claim Status Inquiry Request Response Summary Blue Shield 2 CSHCN Status No of Items C Family Planning Completed 0 C Long Term Care Reiected 0 C Medicaid Eligibility Claims n3 ox Transmit 5 Request ERAS Transmission ID Local T
2. m Total Charges 0 00 Dther Insurance Paid 0 00 Net Billed 0 00 Cancel as Template Patient Provider Status Claim Number eerie LN ced esr Patient Provider Claim Diagnosis 1 1 Other Insurance m Total Charges Perform Provider ID Perf Last Name Perf First Name Petm NS fad a pe E 4 Total Charges 0 00 Other Insurance Paid 0 00 Net Billed 0 00 Cancel Page 62 PR TDHc3 0AC_02 18 05_v 0 4 Medicaid and Family Planning Claims 18 2 6 Other Insurance Tab The Other Insurance tab has sub tabs for three other insurance entries and each of these entries has two sub tabs for company and subscriber information 18 2 6 1 Company Sub Tab Patient Provider Status Claim Number ee een nee Patient Provider Claim Diagnosis Details Other Insurance Other Insurance 1 Other Insurance 2 Payment Source Of Payment Save as Template Interactive Page 63 TDHconnect 3 0 Workbook for Acute Care Providers 1 Tolist the client s other insurance open the Other Insurance tab and select the Source of Payment such as Commercial Insurance Patient Provider Status Claim Number GENE CMM EMEN 777 3294 5 ICON Patient Provider Claim Diagnosis Details Other Insurance Other Insurance 1 Dt
3. The Texas Medicaid amp Healthcare Partnership presents 2005 Acute Care TDHconnect 3 0 Workshop Manual v 4 TEXAS MEDICAID amp HEALTHCARE PARTNERSHIP TMHP STATE MEDICAID CONTRACTOR Current Procedural Terminology CPT is copyright 2004 American Medical Association All Rights Reserved fee schedules basic units relative values or related listings are included in CPT The AMA assumes no liability for the data contained herein Applicable FARS DFARS restrictions apply to government use CPT is a trademark of the American Medical Association 10 11 12 13 Table of Contents TDHconn ct 9 0 OVEN D IHR ERA eter op Cah hate 1 TDHconnect 3 0 Hardware and Software Requirement 3 Obtaintig SUpport esce AN RR AU e REY CORRER AER da ed e SERRA EV d eaa a 5 Bali reino Technical Assistance cous bL aed Hato ui pee tih tins dora sede d 5 3 2 ACCESSINS Training RESOUTCES sssaaa sesser pedo ub OR Pai op AU Ede a ed 5 3 9 Get ng Claims Assistance ee GR TORO EC RT 6 Accessing DUOC UEBER COH OI i ool potete tp del ce usa e bep ate xp ie MA 7 41 sme IDHeonnect 30 Online Help taco ta aii eee Pee aa ee 7 4141 Opening the TDEH connect 3 0 Online Help 7 4 1 2 Using the TDHconnect 3 0 Online Help 7 4 2 The TDH
4. Blue Shield 2 CIDE Smith Family Planning Long Term Care Medicaid Provider Medicaid 3 H Medicare Provider IDs C Reference Files Provider ID Group ID No Client A Provider v Reference Codes System Notes John CLIA No State License No 32 PR TDHc3 0AC_02 18 05_v 0 4 Setting Up Reference Files in TDHconnect 3 0 13 3 Downloading Reference Codes Double click Reference Codes to view the various codes such as procedure codes diagnosis codes billing codes and Explanation of Benefits EOB codes included in the TDHconnect software Reference Codes File Edit Reports Security Yiew Tools Communications Navigation Help D a at X 0 u 5 TDHconnect t ea mo Description Billed Amount 9 00 Family Planning CONVERSION FACTOR 0 00 3C Long Term C _ Car THERAPEUTIC ULTRASOUND OF VESSELS OF HEAD AND NECK 0 00 Medicaid C Medicare i Na Fies THERAPEUTIC ULTRASOUND OF HEART 0 00 Cent THERAPEUTIC ULTRASOUND OF PERIPHERAL VASCULAR 000 Provider VESSELS oF Reference Codi OTHER THERAPEUTIC ULTRASOUND 0 00 System IMPLANTATION OF CHEMOTHERAPEUTIC AGENT 0 00 2 PEY z Filter Codes Autofind Column LEE Procedure m Procedure Code x Starts With S Autofind Text Contains
5. EE 3 Select the modem name in the Connect using menu Connect using EMITE 4 Select the location such as new location the From location menu tom location NONE E 5 Click OK Note Itis not neccesary to select modem settings when using DSL cable or a T1 connection Page 28 PR TDHC3 0AC 02 18 05 v 0 4 Setting Up Reference Files in TDHconnect 3 0 13 Setting Up Reference Files in TDHconnect 3 0 ey rhe client and provider reference files are not required to file claims and appeals However they are recommended and can save time when filling File Edit Reports Security out forms and can reduce input errors The tree view containing yellow folders on the left side of the TDHconnect 3 0 System Totals window is referred to as TDH connect TDH t Exol H E Blue Shield connect Explorer CIDC Double click the file names to expand folders C Family Planning C Long Term Care Medicaid Medicare Reference Files System Double click the file names again to collapse folders 13 1 Adding Clients This section describes the steps necessary to add client data Note New clients also can be added through Eligibility or Medicaid Eligibility Service Authorization Verification MESAV responses 1 Expand the Reference Files folder and double click Client The Client Selection window opens in the workspace TDHconnect Client Selection File Edit Repor
6. New Patient Provider Claim Diagnosis Details Other Insurance Admitting Diagnosis Code Description Diagnosis Description t Move Cancel 18 6 5 Details Tab The Details tab has three sub tabs Accommodation Details Ancillary Details and Surgery Details 18 6 5 1 Accommodation Details To enter data for accommodations open the Accommodation Details sub tab Note Use the scroll bar at the bottom of the screen to access fields on the right hand side of the window This window is shown in two graphics to display all of the scrolling area Required fields e Revenue code Rev Code Days Daily Rate The Non covered charges column may be used to report specific non covered amounts Page 76 PR TDHC3 0AC 02 18 05 v 0 4 Medicaid and Family Planning Claims Patient Provider Status New Patient Provider Claim Diagnosis Details Other Insurance eem vene ES Patient Provider Status Claim Number Total Charges Non Covered Charges Dther Insurance Paid Net Billed Claim Number 0 00 0 00 0 00 0 00 Cancel peur mcd ro OD EET Patient Provider Claim Diagnosis Details Other Insurance Non Covered a Charges Total Charges Non Covered Charges Other Insurance Paid Net Bill
7. 2 Double click Security Admin The Loading Users progress dialog box opens Once all users are loaded this dialog box closes and the Security Administration dialog box opens User loading Security Administration User ID User Name Description TexMedNet ID TexMedNet 4 Admmistator 3 Click Add User The Security Wizard Step 1 dialog box opens Follow the step by step instructions in the Security Wizard to add a user 4 f Add User 42 PR TDHc3 0AC_02 18 05_v 0 4 TDHconnect 3 0 System Maintenance 14 5 1 Security Wizard Step 1 Security Wizard Step 1 Note The orange square on the diagram on the Client Information User ID a Full Name i Description Password TexMedNet User ID Password Finish Coe Cee Ca Security Wizard Step 2 of 5 B Step 1 Program Selection Program ptions Selections Step 2 Blue Shield Medicaid Mun CIDC gt Medicare Reference Files Step 3 Finish Coe Cee Ca Security Wizard Step 3 of 5 Program Rights 123456789 Medicaid f Eligibility Hof Claims tof CSI tf ER amp S Appeals Finish left side of the dialog box indicates the current step in the process Fields with bold titles are required fields Enter the User ID Full Name and a De
8. Responses ette de etre eie up ere uta 49 164 Remeve Other TaD tss oh be e tows sayy Dare p oboe v us Qa alec pna 49 16 4 1 Retrieve ERSS Reports in died Ret ae n CUYO OR e eS 50 16 42 Retrieve Reference rtn iera M 50 17 Medicaid E Ie E Ee EH a 51 174 Changes Due to HIPAA acs euis ret dera ferte He ERA done 51 17 2 Beginning the Eligibility Request coiere EE LE bya te en bb naci OC 51 17 3 Creating an Eligibility Template CLARA e CER 52 17 4 Submitting and Retrieving Eligibility Requests 0206123 rex aep EE EA a Ee 53 17 4 1 Submit Retrieve Interactive Requests danke 53 17 4 2 Submit Retrieve Batch Requests dake ivan n o e ORE 53 17 5 Medicaid Elieibilie Responses Bar Op Pe Co Desde tes 53 17 6 Printing Eligibility Reports ny Aare iR a Aa UR PO tad 54 18 Medicaid and Family Planning Claims sae odo va eat weed ee ROS we Rad Od wr ed uis 55 18 1 Changes to Claims Resulting from HIPAA wis cat bebe tee bua AE Debet dona 55 18 2 Filing Professional Clais oa deeft ee Nod ca ee e d ut e E 56 PR TDHCc3 0AC 02 18 05 v 1 0 18 2 11 Patient EAb 5 eet et a eC e e e se eto d REN edt 56 TA sess eiut o bet a re 57 19 2 3 Claim yi Shamita xa
9. Workbook for Acute Care Providers TMHP Activate My Account Home gt Security To activate your account please fill out the information below and click the Activate Account button z User Name 6 15 characters no spaces or special characters Must be different than your EDI Submitter ID First Name no special characters Last Name no special characters x Email Confirm Email Please retype your email Do not cut and paste Password 8 15 characters no spaces or special characters Confirm Password Provider Type Select 6 Complete the following fields all fields must be completed as indicated by the red dot Enter a user name 6 15 alphanumeric characters do not use your EDI Submitter ID Enter a first name Enter a last name Enter an email address Re enter to confirm email address Enter a password 8 15 characters alphanumeric Re enter to confirm password Select provider type Acute Care or Long Term Care Enter one of the following Submitter ID tax ID SSN or license number 7 Scroll down to the General Terms and Conditions GENERAL TERMS AND CONDITIONS 8 Read the general terms and You have entered the secure portion of the Texas Medicaid amp Healthcare Partnership Ib TEHP website Throughout the terms herein reference to THEP means THHP State conditions Use the scroll bar on Healthcare LLC its parent company affiliates s
10. e Select Yes want to restart my computer now to complete the installation now or e Select No will restart my computer later to complete the installation later e Click Finish to close the window Note The installation of TDHconnect 3 0 is not complete until you have restarted your computer Page 15 TDHconnect 3 0 Workbook for Acute Care Providers 6 4 Setting the Dialing Properties in Windows Important Before you can send requests and retrieve responses you must also set the dialing properties and communications settings in TDHconnect 3 0 Note The procedure below does not apply to Windows 2000 Open the Windows Start menu and select Settings Control Panel 2 Double click the Modems icon If you have more than one modem installed or listed in the Modem Properties dialog box select the modem that was set up during TDHconnect 3 0 installation 3 Onthe Modem Properties dialog box click Dial Properties 4 If you must dial a number to access an outside line proceed to step 5 If not skip to step 7 5 Enter 9 in the To access outside lines for local calls dial field 6 Enter9 in the To access outside lines for long distance calls dial field Note Enter a number other than 9 if a different number is required by your service Service pack 5 will have connectivity options Cable DSL 7 Click Apply and click OK in the Dialing Properties window 8 In the Modem Properties window click Close Exit the
11. Patient Provider Claim Diagnosis Details Other Insurance Qty Charges Performing Perf Last Name Perf First Name Perf Suffix Units Provider ID NES a a p Total Charges 0 00 Dther Insurance Paid 0 00 Net Billed 0 00 Lox 18 8 5 Submitting and Retrieving Requests There are two ways to submit Family Planning claims on TDHconnect 3 0 interactive or batch An interactive claim is accepted or rejected online while you wait but must be done one claim at a time A batch of claims takes 24 hours usually overnight to be accepted or rejected and can include one or many claims Note Accepted claims do not guarantee payment only that they are accepted for further processing and will be paid or denied at a later date 18 8 5 1 Submit Retrieve Interactive Requests To submit and retrieve an interactive claim click Interactive Within a few minutes the claim response accepted or rejected is displayed 18 8 5 2 Submit Retrieve Batch Requests Note Clicking OK does not send the request to TMHP Clicking OK stores the request in Completed status on the provider s database only You must do all four steps listed below to send and retrieve batch requests Page 89 TDHconnect 3 0 Workbook for Acute Care Providers Submit a Batch Request 1 gt Fi
12. Professional Eyeglass Dental Inpatient or Outpatient Fie Edt yew Reports Tools Navigatio ew Professional Eyeglass fai Dose W Dental Inpatient Outpatient 1 Note The HIPAA transactions for Professional and Eyeglass claims are now transaction 837 professional Dental claims are transaction 837D dental and Inpatient or Outpatient claims are transaction 8371 institutional 18 2 Filing Professional Claims To start a new Professional claim HIPAA transaction 837P click the New Professional Claim icon or click File gt New gt Professional on theTDHconnect 3 0 menu bar 18 2 1 Patient Tab Click the magnifying glass icon to autopopulate the fields in the client reference files database or enter the fields manually Required fields appear in bold type Patient Provider Status Claim Number New Patient Provider Claim Diagnosis Details Other Insurance Patient Identification Numbers Account No 42 SSN Medicaid No Name Last Name First Name MI Suffix Patient General Information Sex Date of Birth Date of Death v i i Address Street City State ZIP Code 2 56 PR TDHc3 0AC_02 18 05_v 0 4 Medicaid and Family Planning Claims 18 2 2 Provider Tab The Provider tab has two sub tabs Provider Facility and Referring and Other Provider 18 2 2 1 Provider Facility Sub Tab Select the Provider tab Cl
13. Response 2 To print the response click Reports Information Response 3 Click Print on the TDHconnect 3 0 menu bar Interactive 1 Click Reports and Interactive Summary on the TDHconnect 3 0 menu bar Summary 2 Inputa range of beginning and ending transmit dates 3 Click OK A report of eligibility responses is displayed 4 Click Print for a paper copy Batch 1 Selectan interactive or a batch response Report 2 Click Reports and Batch Report The report immediately starts printing a detailed list of all eligibility responses from the row you selected Page 54 PR TDHCc3 0AC 02 18 05 v 0 4 Medicaid and Family Planning Claims 18 Medicaid and Family Planning Claims The Claims program task is used to create view submit change and delete claims or claim information Note See Section 4 of the Texas Medicaid Provider Procedures Manual for related policy information 18 1 Changes to Claims Resulting from HIPAA Under HIPAA the electronic claim request is standard 837 Professional and eyeglass claims are standard 837P dental claims are 837D and inpatient and outpatient claims are 8371 Numerous changes have occurred to the main tabs screens for Patient Provider Claim Diagnosis Details and Other Insurance and some tabs now have sub tabs A claim response for an accepted claim may also be used click Save as Appeal to generate an appeal Important If a claim denies with zero allowed zero paid amounts see R amp S below
14. follow up with a new claim instead of an appeal within 120 days of the R amp S date If your new claim has the same provider number client Medicaid number date of service and billed amount then the new claim can be submitted on TDHconnect 3 0 If one of these fields has changed then the new claim must be filed as a paper claim If a claim rejects not denies but rejects and the claim is beyond the 95 day filing deadline the rejected claims report may be printed and sent to TMHP along with a new paper claim if within 120 days of the rejection See Claim reports at the end of this section Double click Claims to display the Medicaid Claim Request Response Summary window 2 Medicaid Claims File Edit Yiew Reports Tools Navigation Help R A 6 oc en 00 Medicaid Claim Request Response Summary TDHconnect Blue Shield C3 CIDC Status No of Items 1 Family Planning 1 Long Term Care Medicaid Eligibility Claims CSI ER amp S Appeals Medicare C Reference Files System No of No Requests Rejected imm E gt 55 TDHconnect 3 0 Workbook for Acute Care Providers To start a new claim click one of the five icons in the top left corner of the screen yv W A e or click File gt New on the TDHconnect 3 0 menu bar and then the type of claim
15. image Following a restore all changes to the database that occurred after the previous back up are lost Page 37 TDHconnect 3 0 Workbook for Acute Care Providers 14 3 Password Administration Important If the login password is changed or forgotten TMHP s EDI technical support team cannot assist you with accessing TDHconnect 3 0 Write down your new password and save it in a secure location 14 Password Administration Current User To change the password of the user currently logged in 1 Expand the System folder Enter 2 Double click Password Admin The Password Administration dialog box opens Enter New Password 3 Enter the current password enter the new password and enter the new password again to confirm in the appropriate fields Password 4 Click OK to accept the password change L ow Cancel 14 4 Scheduling 1 Expand the System folder File Edit Reports Security view 2 Double click Scheduling The Scheduler dialog box opens The Scheduler dialog box is used to schedule future events such as sending requests to TMHP getting responses from TMHP and TDHconnect C Blue Shield completing database maintenance A CIDC The Scheduler dialog box has the following five tabs L Family Planning C Long Term Care Options L Medicaid e Send Requests C Medicare G e Get Responses L Reference Files p 7 System Database
16. workspace Complete the required fields Once all information has been completed click Save As Template You are prompted to select a name for the template Enter a name and click OK Page 52 PR TDHc3 0AC_02 18 05_v 0 4 Medicaid Eligibility 17 4 Submitting and Retrieving Eligibility Requests There are two ways to submit eligibility requests interactive and batch An interactive request is fast and done online while you wait but it can only be done for one client at a time A batch of requests takes 24 hours usually overnight but may include one or many eligibility requests 17 4 1 Submit Retrieve Interactive Requests To submit and retrieve an interactive eligibility request click Interactive and within a few minutes the eligibility response accepted or rejected is displayed 17 4 3 Submit Retrieve Batch Requests Important Clicking OK does not send the request to TMHP Clicking OK stores the request in Completed status on the provider s database only You must do all four steps listed below to send and retrieve batch requests Submit a batch request 1 Fill out eligibility requests and click OK on each request Requests are stored in Completed status on your database Click Cancel to exit Eligibility Open the TDHconnect 3 0 System Totals window and select the Send Requests tab Select the check box for Medicaid Eligibility in the Send column Click Submit Requests are changed to Submitted status and are sent
17. 5 1 Submit Retrieve Batch Requests Medicaid Appeals Medicaid Appeals Submitting and Retrieving Requests System Adjustments Appeals Claims CSI Program Summary 1 Send Requests Retrieve Responses Program Send Long Term Care LJ CSHCN Family Planning Medicaid Blue Shield CSHCN Family Planning Long Term Care Medicaid Medicare CSHCN Family Planning Retrieve Other Test Mode When finished entering data click OK to save the completed appeal to be submitted to TMHP later Important Clicking OK does not send the request to TMHP Clicking OK stores the request in Completed status on the provider s database only Follow the procedure described in Section 17 4 2 Submit Retrieve Batch Requests on page 53 to send and retrieve batch requests Appeals are only submitted by batch not interactively A batch can contain one or more appeals To submit and retrieve a batch of appeals perform the steps described in the following sections Submit a Batch Request Program Summary 1 1 Fill out the appeal and click OK Repeat as needed for each appeal Send Requests 1 Retrieve Responses Download Retrieve Other Select All 2 Click Cancel to exit The TDHconnect System Totals window is displayed 3 Select the Send Requests tab Page 105 TDHconnect 3 0 Workbook for Acute Care Providers 4 Select the check box for Medicaid Appeals in the Send column 5
18. 81 I9 53 26 biu un Es E LE 83 18 74 D tails Ea DAE cs ete Mo does Acto Rote i s pot 83 15 9 family Planning Claims gs oso ee ve Ete eti ed ee iode able et aha d ades 85 Patent 2 deese ad taf Ferte drum 85 198 2 Provider ci d etiaai bob Sos a dris pas de 85 I5 53 Claim Libr pe que dax emat Rae ee equ ise quads 87 deseos vr IAE Cho PETRUS a e ette te TA x ERI 88 18 8 5 Submitting and Retrieving Requests iret be dor Eee e meh 89 19 2 cE Riri oR CP ONS S Cio eR ese s ae Oc nce M ee uae qug aite Se Mai MM qt 90 Medicaid Glam Status Inquiry eer igh te ate p Prev ebbe o e Ud ret 93 19 1 Create a New CSL Beauest 35 wee sce ap ERU E 93 19 1 14 Providet cium pid tees man VID eet nda 94 I9 p 2 lame os tecta E ais 95 19 2 Submitting and Retrieving Requests ure xe e ra d UR Dee OR RT UR DRE ew 95 19 2 1 Submit Retrieve Interactive Requests os s eod Erden 95 19 2 2 Submit Rettieve Batch Requests ac eso PES n CR d Reel ea 95 19 3 Medicaid CSI Printing Repotts 4 i ees etch Seok t locate hile as a oes 97 20 Medicaid Electronic Remittance amp Status ER amp S elles 99 20 1 Download an amp Report s oues uet tr red e C ae ee e ade abe Sae ola 29 202 Gr
19. An appeal will reject if it contains fewer detail lines than the original claim being appealed An added detail line must be submitted as a separate new day claim Reminders Ifthe appeal requires additional paperwork such as on ambulance claims the appeal must be sent on paper Crossover claims must be submitted on paper along with a Remittance Advice from Medicare Appeals with dates of service prior to October 16 2003 should contain Medicaid local procedure codes if applicable TDHconnect appeals are only by batch there are no interactive TDHconnect appeals Note If a Provider who files eyeglass appeals converts data from TDHconnect 2 0 to TDHconnect 3 0 any rejected eyeglass appeals that were stored in TDHconnect 2 0 will have to be manually re entered in TDHconnect 3 0 before resubmitting the eyeglass appeal 21 2 Three Ways to Complete TDHconnect Appeals There are three ways to complete TDHconnect appeals Create an appeal from an accepted TDHconnect claim Create an appeal from an ER amp S report e Start from a blank TDHconnect appeal Page 101 TDHconnect 3 0 Workbook for Acute Care Providers 21 3 Create an Appeal from an Accepted TDHconnect Claim To create an appeal from an accepted TDHconnect claim perform the following steps 1 Click the Save as Appeal tab at the bottom of an opened claim in the Claims section of TDHconnect Important Remember that the claim being appealed must be finalized paid
20. C Reference Files P Medicaid No Last Name First Name Suffix 9 00 System Interactive Cancel Required fields Claim Number 24 digits Provider ID nine digit and Last Organization Name Client s Medicaid No Last Name and First Name Interactive Claim Request Click Interactive to get an immediate response Since this request deals with just one claim Interactive mode is recommended Batch Claim Request Click OK to save as a batch request to be sent to TMHP later 19 2 Submitting and Retrieving Requests 19 2 1 Submit Retrieve Interactive Requests To submit and retrieve an interactive request such as a Claim Request fill out the request and click Interactive You will receive a response while online 19 2 2 Submit Retrieve Batch Requests Important Clicking OK does not send the request to TMHP Clicking OK stores the request in Completed status on the provider s database only You must follow the procedure described in Section 18 3 2 Submit Retrieve Batch Requests on page 65 to send and retrieve batch requests Page 95 TDHconnect 3 0 Workbook for Acute Care Providers Submit a Batch Request Program Summary ili Send Requests 1 Retrieve Responses 1 Retrieve Other Program Blue Shield CSHCN Family Planning Long Term Care Medicaid Medicare CSI CSHCN Test M Family Planning C Test Mode Long Term Care Medicaid Eligibility C CSHCN g Fa
21. Control Panel window Note Verify that your modem speed range is set between 9600 baud minimum and 28 8k baud maximum Modem speed settings outside of this range may result in transmission reception errors 6 5 Finishing the Installation If TDHconnect 3 0 is still running exit the program Restart your computer to ensure that the installation is complete and that all settings are correctly applied Important After installation download the most recent Service Pack see Section 8 to obtain critical software updates Check www tmhp com for the most recent Service Pack release Note If other applications are added after installing TDHconnect 3 0 the system administrator appropriate technical assistance group should test TDHconnect 3 0 to ensure that the other applications did not disable TDHconnect 3 0 Page 16 PR TDHC3 0AC 02 18 05 v 0 4 Data Conversion 7 Data Conversion Important If the data conversion process stalls or stops during processing and does not complete correctly your old database could become corrupted or you may lose old data TMHP is not liable for any data lost during the conversion process It is your responsibility to take the appropriate steps to back up and save your data before beginning the data conversion process The installation process automatically converts Eligibility Claims Claim Status Inquiry and Electronic Remittance amp Status ER amp S reports data to TDHconnect 3 0 All A
22. Exact Match lt Use the Filter function to view more than the first 50 entries The Autofind Column selection menu contains the code selected in the Codes window Input a code in the Autofind Text field to list matching entries in the Description column in the Codes table above Scroll up or down in the Codes menu and select one of the following code types Procedure Diagnosis Edit Audit EOB EOPS or DRG LTC Providers LTC Procedure LTC Service Group LTC Service Code LTC Billing LTC Item LTC EOB or LTC Crosswalk Press lt F2 gt when the cursor is in a code field in claims or appeals to access codes that can be used to auto populate forms Modifiers and billed amounts can be added to procedure codes and used later to auto populate claim forms To add modifiers or billed amounts to procedure codes select the procedure code using Filter if necessary to locate it select the Modifier field or Billed amount field and enter the data Repeat for each modifier or billed amount to add Click OK when finished Click Cancel to exit Page 33 TDHconnect 3 0 Workbook for Acute Care Providers 13 4 Downloading Updated Reference Codes Retrieve Other Although TDHconnect 3 0 includes built in reference codes these codes change and need to be periodically updated This section describes the steps necessary to download the most recent codes to update the TDHconnect 3 0 database Important Compress the da
23. First Name Group Policy Number and Group Employer Name Patient Provider Status Claim Number ae ee es Patient Provider Claim Diagnosis Details Other Insurance Other Insurance 1 Other Insurance 2 Other Insurance 3 Insurance Policy Holder o ID SSN Last Name First Name MI 3 3 Insurance Policy Information Group Policy Number Group Employer Name o S g g Save as Template Interactive 18 3 Submitting and Retrieving Requests There are two ways to submit Medicaid claims on TDHconnect 3 0 interactive or batch An interactive claim is accepted or rejected online while you wait but must be done one claim at a time A batch of claims takes 24 hours usually overnight to be accepted or rejected and can include one or many claims Note Accepted claims do not guarantee payment only that they are accepted for further processing and will be paid or denied at a later date 18 3 1 Submit Retrieve Interactive Requests To submit and retrieve an interactive claim click Interactive Within a few minutes the claim response accepted or rejected is displayed 18 3 2 Submit Retrieve Batch Requests Note Clicking OK does not send the request to TMHP Clicking OK stores the request in Completed status on the provider s database only You must do all four steps listed below to send and retrieve batch requests Page 65 TDHconnect 3 0 Workbook for Acute Care Providers 18 3 2 1 Sub
24. Insurance Rey Procedure Procedure Mod Diag 4 Da Covered Total BEER ER ERE ME ur Non Covered Charges 0 00 Total Charges 0 00 Other Insurance Paid 0 00 Net Billed 0 00 ok Cancel Page 84 PR TDHC3 0AC 02 18 05 v 0 4 Medicaid and Family Planning Claims 18 8 Family Planning Claims To fill out a Family Planning claim 2017 form double click Family Planning to expand the folder double click Claims and then click the Create New Claim icon on the TDHconnect toolbar or select File gt New from the TDHconnect menu bar The Diagnosis tab and Other Insurance tab is identical on the Professional 837P claim previously covered The Patient tab Provider tab Claim tab and Details tab are described in the following sections 18 8 1 Patient Tab Click the Patient tab to enter patient information Required fields appear in bold text after the appropriate Family Planning Program is selected Patient Provider Status Claim No New Patient Provider Claim Diagnosis Details Dther Insurance Family Planning Program Title X Information Level of Payment Tilex Titex Patient Identification Numbers Account No 2 SSN 2 Medicaid No 2 Family Planning No Name 0 Last Name First Name Ml Suffix U Personal Sex Date of Birth Dat
25. Last Name 49 First Name Ml Suffix System Required fields Service Begin Date Service End Date Provider ID and Last Organization Name Client Medicaid No Last Name and First Name The Service Begin Date and Service End Date may be typed in or use the down arrow to select a range of dates A span of up to three months can be used going back three years The Service End Date can be the current date Click OK to save as a completed batch CSI request to be sent to TMHP later Important Clicking OK does not send the request to TMHP Clicking OK stores the request in Completed status on the provider s database only You must follow the procedure described in Section 18 3 2 Submit Retrieve Batch Requests on page 65 to send and retrieve batch requests Page 94 PR TDHC3 0AC 02 18 05 v 0 4 Medicaid Claim Status Inquiry 19 1 2 Claims Request This request is very useful for quickly finding the status of one claim This request may be sent interactively or as a batch 1 DHeonnect Medicaid Claim Status Claims Request File Edit View Reports Tools Navigation Help 00 TDHconnect Claims Request 2 Blue Shield CSHCN Family Planning Claim Number Long Term Care C Medicaid Eligibility Provider Information E T e Provider ID Last Organization Name First Suffix ER amp S Appeals Medicare Client
26. Provider Identifier Number UPIN Also enter the Last Name and First Name of the referring provider ID type employer ID or social security number and Other ID corresponding to ID type Other fields are optional Patient Provider Status Claim Number Say as ean ean ae Patient Provider Claim Diagnosis Details Other Insurance Billing Provider Provider ID Last Organization Name First Name MI Suffix Address City State ZIP Code ID type Other ID Phone No SEM Provider Facility nd Other Provider Referring Other Provider Provider ID Last Name 2 First Name Ml Suffix DL Ll 538 0 48 ee ID type Other ID ij Cancel Page 58 PR TDHc3 0AC_02 18 05_v 0 4 Medicaid and Family Planning Claims 18 2 3 Claim Tab If an ambulance THSteps medical or authorization number is necessary open the Claim tab and enter the necessary data Note THSteps medical providers after clicking the THSteps indicator field on the Claim tab will select an appropriate Condition Code NU Not Used Indicates the patient had a normal screening an abnormal screen without treatment an abnormal screen initiated treatment was referred to another health agency or to family planning S2 Under Treatment Indicates that the client s screen was abnormal but the condition is under treatment ST New Services Requested Indicates new services requested such as when the client w
27. SSN Date of Birth Sex GO B W Account No Release of Info Indicator Patient Signature Source BH Pharmacy Information Name Phone No E H 3 Select the check box in the Client Status column next to the appropriate program name TIP Page 30 Select the program in the Launch Program for Client menu this example selected Medicaid TDHconnect Client Medicaid File Edit Reports Security View Tools Communications Navigation Help a SAD 475000 E X TDHconnect 5 3 Blue Shield Last Name First Name x7 Doe John Family Planning Long Term Care Client Detail Associated Provider Authorization Diagnosis Other Insurance Miscellaneous Medicaid Medicare Client IDs Reference Files Account No Medicaid No Medical Record No Client co pro dl Iu Provider Reference Codes System y Personal Parent Guardian Name Date of Death Last First SS 0 A faster method to complete the fields in these tabs is to enter only the Account No and the Medicaid No at this time and use the eligibility request to fill out the other fields See Section 17 Medicaid Eligibility on page 51 for more information about determining Medicaid eligibility PR TDHc3 0AC_02 18 05_v 0 4 Setting Up Reference Files in TDHconnect 3 0 e Account No is a 1 20 character alphanumeric field assigned by the provider TMHP
28. Surgery Details Click the Surgery Details sub tab of the Details tab to enter surgery charges Optional fields Surgical Code Procedure Information HCPCS or ICD 9 code Date of Service Patient Provider Status Claim Number New Patient Provider Claim Diagnosis Details Other Insurance Surgical Procedure Date of Code Information Service Principal Total Charges 0 00 Non Covered Charges 0 00 Other Insurance Paid 0 00 Net Billed 0 00 Accommodation Details Ancillary Details Surgery Details 18 7 Outpatient Claims To fill out an outpatient claim HIPAA transaction 8371 double click Claims in the Medicaid folder and then click the Outpatient icon or click File gt New gt Outpatient The Diagnosis tab and Other Insurance tab is identical on the Professional 837P claim previously covered The Patient tab Claim tab and Details tab are described in the following sections Page 80 PR TDHc3 0AC_02 18 05_v 0 4 Medicaid and Family Planning Claims 18 7 1 Patient Tab Required fields Account No Medicaid No and provider defined Medical Record No Last Name and First Name Sex Date of Birth Street Address City State and Zip Code Patient Provider Status Claim Number New Patient Provider Claim Diagnosis Details Other Insurance Patient Identification Numbers Account No 42 SSN 49 Medicaid No Name Last Name Fi
29. TDHconnect Utilities to log off user See Section 10 1 below If the TDHconnect 3 0 icon is clicked more than once to start the program the following message may open TDHconnect is already running TIP This error message commonly occurs following a system event or power failure that resulted in an involuntary shutdown while TDHconnect was running To prevent this error always try to log off TDHconnect before shutting down your computer Use the Windows Task Manager to shut down TDHconnect 3 0 See Using the Windows Task Manager to shut down TDHconnect 3 0 Section 10 2 on page 24 10 1 Using TDHconnect Utilities to Log Off a User 1 Click OK in the error message dialog box The error message dialog box closes Click Start gt Programs gt TDHconnect gt TDHconnect Utilities fm Programs Y Favorites A Documents Settings yp Search E Run 9 Shut Down 72 start Windows XP Professional and Support Microsoft Word TDHconnect 3 ConvertAppeals Internet Explorer 3 0 Microsoft Access TDHconnect Utilities Microsoft Excel amp Version Wizard KS Microsoft Outlook Microsoft PowerPoint E Microsoft Project Microsoft Visio Page 23 TDHconnect 3 0 Workbook for Acute Care Providers 23 TDHconnect Utilities The TDHconnect Utilities program starts 2 Select the Logoff User tab 3 Select the User ID
30. a paper copy Interactive Summary Click Reports and Interactive Summary The Interactive Transmission Report dialog box opens Interactive Transmission Report Enter beginning date for transmission selection 1 x E Enter ending date for transmission selection i Input a range of beginning and ending transmit dates and click OK A report of claim responses is displayed Click Print for a paper copy Error Summary Click a batch claim response has Transmit Type B and a Transmission ID and the No Rejected must be greater than zero Click Reports gt Error Summary A list of rejected claims and errors in the batch is displayed Click Print for a paper copy Claim Detail Double click an interactive or batch claim response Click Reports gt Claim Detail A detailed list of the claim is displayed Click Print for a paper copy Page 90 PR TDHc3 0AC_02 18 05_v 0 4 Medicaid and Family Planning Claims Completed Claims Click Reports and Completed Claims A detailed list of all completed claims immediately starts printing Hejected Claims Click Reports and Rejected Claims A detailed list of all rejected claims immediately starts printing This report can be very useful for working rejected claims Remember that you will not see rejected claims on your R amp S report or on a claim status inquiry Page 91 TDHconnect 3 0 Workbook for Acute Care Providers NOTES
31. all required fields in the corresponding dialog box displayed 21 4 Appeal Fields File Edit View Reports Tools Navigation Help 500 5 TDHconnect Patient Provider Status Adiusted Claim No Blue Shield New a CSHCN i E Family Planning Patient Provider 1 Diagnosis Details Other Insurance 9 21 Long Tem Care Frequency Code Original ICN Original Medicaid Number L Medicaid Eligibilty xi Claims Patient Identification Numbers CSI D Account No 9 SSN New Medicaid No ER amp S S A O Medicare Name 7 Reference Files D Last Name LO First Name MI Suffix System Patient General Information Sex Date of Birth Date of Death n i Address Street City State ZIP Code The fields for appeals are the same as for claims of the same type with one exception the Patient tab has three additional fields not found on claims Frequency Code Select the value of seven to indicate an appeal or eight to void recoup the entire claim To recoup only a detail line on a claim fill out the entire appeal and enter the value 0 zero for the Unit Price field on the Details tab Original ICN Input the 15 or 24 digit claim number of the claim being appealed Original Medicaid Number Input the nine digit client Medicaid number used on the claim being appealed Page 104 PR TDHC3 0AC 02 18 05 v 0 4 21 5 21
32. amp GS reports are available weekly at 6 00 a m central time each Monday To download your ER amp S report 1 Use the check box in the Download column to select ER amp S 2 Click Download 3 Click Process ER amp S only if there is an error downloading the ER amp S Note You cannot view the ER amp S report by using the Retrieve Othertab To generate and view the ER amp S report after it has been downloaded see Section 20 Medicaid Electronic Remittance amp Status ER amp S on page 99 for instructions 16 4 2 Retrieve Reference Codes 1 Use the check boxes in the Download column to select the reference code types to retrieve 2 Click Download Page 50 PR TDHC3 0AC 02 18 05 v 0 4 Medicaid Eligibility 17 Medicaid Eligibility The purpose of an eligibility request is to verify that a client is eligible to receive Texas Medicaid An eligibility request returns very helpful information such as if the client is a member of an HMO has other insurance or is no longer eligible for Medicaid eligibility Refer to the current Texas Medicaid Provider Procedures Manual for related policy information 17 1 Changes Due to HIPAA Under HIPAA the electronic eligibility request is standard 270 and the electronic eligibility response is standard 271 The following items have changed The last name and the suffix are now in separate fields on eligibility requests and responses so separate the suffix field even if the paper 3087 shows t
33. click Claims in the Medicaid folder then click the Dental icon in the upper left hand corner of the screen or click File gt New gt Dental Note The Patienttab Providertab and Other Insurance tab are identical on the professional 837P claim previously covered The Claim tab and Details tab are described below 18 5 1 Claim Tab Note Dental claims require dental specific information on the Claim tab Patient Provider Status Claim Number New Patient Provider Claim Details Other Insurance Date of Current Condition Auto Accident Authorization No Employment Related Ortho Related Diagnosis Code Exception to Periodicity E Accident State Emergency Trauma Related v Emergency Trauma or Exception to Periodicity Comments Cancel 18 5 2 Details Tab Dental claims require dental specific information on the Details tab Note Use the scroll bar at the bottom of the screen to access fields on the right hand side of the window This window is shown in two graphics to display all of the scrolling area Page 70 PR TDHc3 0AC_03 11 05_v 0 4 Medicaid and Family Planning Claims Patient Provider Status Claim Number New Patient Provider Claim Details Other Insurance Date of Procedure Procedure Remarks semien POS ode 1D LEE Pe wer see aw Unit Price To
34. from an ER amp S report perform the following steps 1 Open the Appeals window by double clicking Appeals on the left side of the TDHconnect System Totals window Page 102 PR TDHC3 0AC 02 18 05 v 0 4 Medicaid Appeals 2 Click File gt From ER amp S or click the icon on the TDHconnect 3 0 menu bar to create an appeal from an ER amp S report The ER amp S Search window appears TDHconnect Medicaid Appeals ER amp S Search File Edit View Reports Tools Navigation Help a tres TDHconnect Search Criteria Blue Shield Claim No e Provider ID Patient No Claim Status CSHCN Family Planning Paid Y ji icd Cycle Start Date Cycle End Date Claims CSI Tiai 45 Cycle Date Claim No Provider ID Palient No Medicare L Reference Files C System quur Ej Important If you have not signed up to receive ER amp S reports you may do so by filling out ER amp S agreement and faxing it in to the Electronic data interchange department of TMHP 3 Inthe ER amp S Search window enter search criteria to find the claim to be appealed and click Search Click the claim being appealed and click Create 5 Fill out any missing information required on the appeal The fields for Appeals are the same as for claims of the same type with one exception the Patienttab has three additional fields not found on claims See Section 21
35. m to 7 00 p m Central Time select one of the following methods For Medicaid CSHCN and Family Planning technical issues call 1 888 863 3638 For Long Term Care technical issues call 1 800 626 4117 Fax 1 512 514 4230 or 1 512 514 4228 3 2 Accessing Training Resources The TMHP EDI Help Desk does not provide training To obtain training call your TMHP provider relations representative or attend one of the training workshops provided by TMHP Provider Relations Contact get contact information for your training specialist call the TMHP Contact Center at 1 800 925 9126 or visit the TMHP website at www tmhp com For CSHCN Customer Service call 1 800 568 2413 For Long Term Care Customer Service call the TMHP LTC Help Desk at 1 800 626 4117 For Medicaid and Family Planning information call the TMHP Contact Center at 1 800 925 9126 For workshop and other information visit the TMHP website at www tmhp com TIP For other Medicaid customer service numbers refer to the Telephone and Addresses Guide in the current Texas Medicaid Provider Procedures Manual Page 5 TDHconnect 3 0 Workbook for Acute Care Providers 3 3 Getting Claims Assistance For answers to questions about Medicaid Family Planning and CSHON electronic or paper claims call the TMHP Contact Center at 1 800 925 9126 For links to Frequently Asked Questions FAQs and Medicaid workshop schedules visit the TMHP website at www tmhp com For a
36. mE 0 0 0 0 Request status the number of csl 0 0 0 0 Completed Submitted Accepted d a Rejected requests Long Term Care q 5 MESAY 0 0 0 0 Claims 0 0 0 0 0 0 0 05 16 1 1 Batch Request Status Important It is critically important to download all submitted claims and appeals to see if any were rejected and work them immediately Files are not available after 30 days Completed A request Eligibility Claim Appeal or Claim Status Inquiry was entered into TDHconnect and passed all the local edits but it has not been submitted to TMHP Completed requests convert to Submitted status after being sent to TMHP in a batch Incomplete displayed in Claims section only The request was entered into TDHconnect but did not pass all the local edits and is not ready to submit to TMHP Incomplete requests convert to Completed status after completion Submitted The request has been transmitted to TMHP for processing see Section 16 2 Send Requests Tab on page 48 Submitted requests convert to Processed status after the response is downloaded from TMHP Processed displayed in later sections Twenty four hours after submitting a request download the request to see if it was accepted or rejected Accepted Electronically submitted requests that have passed the acceptance edits at TMHP have been assigned an ICN a unique claim number and are processing in the TMHP system Note An Accepted cl
37. of Bill Optional fields Authorization Number Discharge Hour Occurrence Codes and dates Condition Codes Patient Provider Status Claim Number New Patient Provider Claim Diagnosis Details Other Insurance Admission Information General Date Hour Authorization Number Type of Bill 3 fa Discharge Hour Occurence Codes Condition Codes a 18 7 4 Details Tab Click the Details tab to enter details information Note Use the scroll bar at the bottom of the screen to access fields on the right hand side of the window This window is shown in two graphics to display all of the scrolling area Required fields Date of Service Diagnosis reference Diag Ref Quantity Qty Total Charges Page 83 TDHconnect 3 0 Workbook for Acute Care Providers Procedure Code ID is the type of procedure code such as HCPCS HIEC National Drug Code in 4 4 2 format 5 3 2 format 5 4 1 format 5 4 2 format or Mutually Defined Patient Provider Status Claim Number New Patient Provider Claim Diagnosis Details Other Insurance Non Coveret 4 Charges Non Covered Charges 0 00 Total Charges 0 00 Dther Insurance Paid 0 00 Net Billed 0 00 Cancel Patient Provider Status Claim Number New Patient Provider Claim Diagnosis Details Other
38. or denied before it can be appealed 2 Amessage appears e An incomplete appeal has been generated and saved e user must go to appeals in TDHconnect to complete the appeal e before submitting verify that the claim is in appealable status 3 Goto Appeals and double click the Incomplete Appeals row then double click the appropriate appeal from the list of Incomplete Appeals 4 Fill out any missing information required on the appeal The fields for appeals are the same as for claims of the same type with one exception the Patient tab has three additional fields not found on claims See Section 21 4 Appeal Fields on page 104 For frequency code select seven for an appeal or eight for a void recoupment enter the original ICN as a 15 or 24 digit claim number and the original Medicaid number is filled in for you Important Remember that bolded fields are required and other fields may be necessary depending on the type of appeal Click OK on the appeal to save it in completed status to be submitted later to TMHP Appeals are only submitted by batch not interactively A batch can contain one or more appeals Clicking OK does not send the request to TMHP Clicking OK stores the request in Completed status on the provider s database only Follow the procedure described in Section 17 4 2 Submit Retrieve Batch Requests on page 53 to send and retrieve batch requests 21 3 1 Create an Appeal from an ER amp S Report To create an appeal
39. page opens 3 Click the Long Term Care Programs link on the left side of the page The Long Term Care Programs web page opens 4 Scroll down to locate and click the LTC Reference Codes link The TMHP File Library web page opens and provides links to reference code files available for download 5 Click each file to download Page 11 TDHconnect 3 0 Workbook for Acute Care Providers 5 2 4 Other TDHconnect 3 0 Resources Online To learn more about how to transmit transactions and current TDHconnect 3 0 issues visit www tmhp com Click the Find Publications File Library link then the TDHconnect link Page 12 PR TDHc3 0AC 02 18 05 v 0 4 Installing TDHconnect 3 0 6 Installing TDHconnect 3 0 This section describes how to install the TDHconnect 3 0 software TDHconnect 3 0 can be installed as a network application on a Local Area Network LAN or as a stand alone application on one or more independent computers 6 1 Before Installing Important Before installing TDHconnect 3 0 carefully read and follow the sequence of installation tasks listed below If the installation sequence is interrupted TDHconnect 3 0 will not install correctly 1 Determine that the computer s meet the hardware and software requirements described in Section 2 TDHconnect 3 0 Hardware and Software Requirements on page 3 2 Ensure that Internet Explorer IE 4 01 Service Pack SP 2 or more recent is installed Internet Explorer 5 0 is included
40. selected Page 97 TDHconnect 3 0 Workbook for Acute Care Providers NOTES Page 98 PR TDHc3 0AC_02 18 05_v 0 4 Medicaid Electronic Remittance amp Status ER amp S 20 Medicaid Electronic Remittance amp Status ER amp S Note Refer to the current Texas Medicaid Provider Procedures Manual Section 4 Appendix C and Appendix D for related information and a copy of the ER amp S Agreement You can also call the TMHP EDI Help Desk at 1 888 863 3638 for this form To view ER amp S information double click ER amp S to display the Medicaid ER amp S Summary List window IDHconnect Medicaid ER amp S File Edit View Tools Navigation Help D e X BA Qo WW TDH connect 9 1 Blue Shield x CSHCN C Family Planning 9 1 Long Term Care C Medicaid Eligibility Claims CSI Medicaid ER amp S Summary List Report No Check No Provider ID R amp S Run Date 123456783 1234567 83 07 07 2003 Report Status Finalized Appeals C Medicare Reference Files L System Display Delete Cancel To display a specific ER amp S report double click the row of the report 20 1 Download an ER amp S Report Before generating a report Program Summary 1 Send Requests Retrieve Responses Retrieve Other Category Type Download a ER amp S LTC Reference Codes LJ Billing Cod
41. 21 Gomnptess TAa e ei aic oe ORI en Leto bed dor Ea cR dcc 36 142 2 tb ono tala Rae eG ead eco eS a eost bane ere d tutela 36 14 23 Mapper Tab eese SECS PESOS SESS 36 14 24 aay nck po ttl dob Cea ah Fewer eae P EER 37 14 3 Password Admirusttaltofti ssa ee ow one A Pan we ad ne wee 38 TAAS 38 14 4 1 Scheduler Dialog Box Options Tab xo hub ae i Ses 39 Seid Reg ests LAB us ue n inte date erase Dade ond Sr hea gts 39 144 3 G t Responses ewe te UR dae eds ER 40 14 4 4 Database ea td adus 41 TAAS Flistory wane Orme hahaa Eee ene ako 42 14 5 Security Admin Add Users ar babens vod ub as ede bb 42 ELSE Sec tity Wizard Step Tod eu etos bw ER Utt tr ROCA 43 14 52 Security WIZatd Step preni Dne PE a d dace Do do mL Peas 44 1S on ecune do eta Gaels PRESA E OE 45 16 Using the TDHconnect System Totals Window ede eh rad C n CR der d 47 10 1 Program S mimary Taba sre Case tr tal ee reseau vetet s doa 47 10 11 Batch Request Statuses ra eee ace e hatin ae ee ee 47 16 1 2 Batch Transmission PrOGPSSQ d eu UU BA odo be Micah ance 48 10 2 Send Requests Tab sce oe E eR tues bee aa ioe CAU ERAS E TE 48 16 5
42. 4 Appeal Fields on page 104 For frequency code select seven for an appeal or eight for a void recoupment enter the original ICN as 15 or 24 digit claim number and the original Medicaid number is filled in for you Important Remember that bolded fields are required and other fields may be necessary depending on the type of appeal Click OK on the appeal to save it in completed status to be submitted later to TMHP Appeals are only submitted by batch not interactively A batch can contain one or more appeals Clicking OK does not send the request to TMHP Clicking OK stores the request in Completed status on the provider s database only You must follow the procedure described in Section 17 4 2 Submit Retrieve Batch Requests on page 53 to send and retrieve batch requests Page 103 TDHconnect 3 0 Workbook for Acute Care Providers 21 3 2 Create an Appeal from a Blank Form To create an appeal from a blank form perform the following steps 1 Open the Appeals window by double clicking Appeals on the left side of the TDHconnect 3 0 System Totals window 2 Click File gt New then one of the following File Edit View Reports Tools Navigaj O F Professional From ER amp S 64 Eyeglass e Professional e Eyeglass WW Dental D Close Inpatient enta Outpatient e Inpatient Outpatient Or click the icon for the appropriate appeal type on the TDHconnect 3 0 menu bar 3 Fill out
43. Claims 18 8 3 Claim Tab Click the Claim tab to enter claim information Patient Provider Status Claim No New Patient Provider Claim Diagnosis Details Other Insurance General Demoaraphics Marital Status Race Ethnicity General Patient Co Pay Date of Occurrence Authorization Number Level of Practitioner Hs Birth Control Primary Before Visit Primary After Visit No Method Reason Reproductive History No Times Pregnant No Live Births No Living Children 87 TDHconnect 3 0 Workbook for Acute Care Providers 18 8 4 Details Tab Click the Details tab to enter details information Note Use the scroll bar at the bottom of the screen to access fields on the right hand side of the window This window is shown in two graphics to display all of the scrolling area Patient Provider Status Claim No Den aim Patient Provider Claim Diagnosis Details Other Insurance Procedure Procedure Mod Diag Oty _ amp 5 tonos ros Fescens e ar onc maA Total Charges 0 00 Other Insurance Paid 0 00 Net Billed 0 00 88 PR TDHc3 0AC_02 18 05_v 0 4 Medicaid and Family Planning Claims Patient Provider Status Claim No New
44. Click Submit Retrieve a Batch Request 1 Twenty four hours after request submission go to the TDHconnect System Totals window and select the Retrieve Responses tab 2 Select the check box for Appeals in the Download column Click Download Requests are now changed to Processed status 4 To view the downloaded response double click Appeals under the Medicaid folder left side of window then double click the response 21 6 Medicaid Appeals Printing Reports Six types of appeals reports may be printed from the Medicaid Appeal Request Response Summary Transmission Summary 1 Click an appeal response 2 Click Reports Transmission Summary to display the report The number of accepted or rejected appeals is listed along with the amount billed 3 Click Print for a paper copy Transmission Detail 1 Click an accepted appeal response 2 Click Reports and Transmission Detail A list of appeal responses in that batch is displayed 3 Click Print for a paper copy Error Summary 1 Click an appeal response with a processed status and number rejected greater than zero 2 Click Reports gt Error Summary A list of rejected appeals and errors in the batch is displayed 3 Click Print for a paper copy Appeal Detail 1 Double click an appeal response Click Reports gt Appeal Detail A detailed list of the appeal is displayed Click Print for a paper copy Completed Appeals 1 Click Reports gt Completed Appeals The followin
45. Database Utilities History Password Admin Scheduling Security Admin TexMedNet TexMedNet Info Page 38 PR TDHc3 0AC_02 18 05_v 0 4 TDHconnect 3 0 System Maintenance 14 4 1 Scheduler Dialog Box Options Tab 96 Scheduler Options Send Requests Get Responses Database History The Options tab is used to allow or Ld to not allow scheduled events 4 Scheduled Events Important The PC must be powered on and the user must be logged into TDHconnect at the time the event is scheduled for the scheduled event to occur Note Schedule events at least 15 minutes apart to allow time for each event to complete Cancel 14 4 2 Requests Tab 6 Scheduler ptions He Get Responses Database History The Send Requests tab is used to Type schedule sending a batch of requests to TMHP 1 Open the Send Requests tab 2 Click Add The Event Scheduler dialog box opens Cancel Page 39 TDHconnect 3 0 Workbook for Acute Care Providers Event Scheduler Type Adjustments When 11 20 2003 hd Interval Daily E E Select event type in the Type menu Select a date in the When menu Enter the time hour minute second AM or PM in the field below the date Use the following format HH MM SS or PM Set the periodicity of the event in the Interval menu If Irregular is selected enter the number
46. Family Planning Long Term Care LTC Medicaid and Children with Special Health Care Needs CSHCN clients see HIPAA table HIPAA Compliant Transaction Types Eligibility Request 270 Eligibility Response 271 Claim Status Inquiry 276 Claim Status Inquiry Response 277 ER amp S Report 835 Dental Claims 837D Institutional Claims 8371 Professional Claims 837P e Support the submission of Blue Cross and Medicare claims Access the same database simultaneously up to ten concurrent users per database Important Basic knowledge of Windows operating systems is required to use TDHconnect 3 0 Providers in rotary dial areas cannot use TDHconnect 3 0 TDHconnect 3 0 works with a standard telephone line or the slower port one that a telephone could connect to of a DSL connection TDHconnect 3 0 does not work with T1 or cable modem transmission lines See Section 9 Opening and Logging on to TDHconnect 3 0 on page 21 for basic information on how to log on after installing TDHconnect 3 0 software Microsoft and Windows are either registered trademarks or trademarks of Microsoft Corporation in the United States and or other countries Page 1 TDHconnect 3 0 Workbook for Acute Care Providers NOTES Page 2 PR TDHc3 0AC_02 18 05_v 0 4 TDHconnect 3 0 Hardware and Software Requirements 2 TDHconnect 3 0 Hardware and Sof
47. HSteps CCP Pharmacies is V7285 Other Specified Examination Independent Laboratory providers Section 25 of the Texas Medicaid Provider Procedures Manual states the following Independent laboratories and pathologists do not have to supply Medicaid with a diagnosis except when billing the following procedures If the procedure being billed by independent laboratory providers is not one of the procedures listed in that section requiring a diagnosis code by policy they may use diagnosis code V726 Laboratory Examination for the claim to be accepted Radiology providers lf no other diagnosis code is available use V725 Radiological Examination Not Elsewhere Classified Patient Provider Status Claim Number New Patient Provider Claim Diagnosis Details Other Insurance Diagnosis Description Cancel Page 60 PR TDHc3 0AC_02 18 05_v 0 4 Medicaid and Family Planning Claims 18 2 5 Details Tab Note Use the scroll bar at the bottom of the screen to access fields on the right hand side of the window This window is shown two graphics to display all of the scrolling area Select the Details tab and enter the date of service in MM DD YYYY format Tab to the POS column and use the drop down menu to select place of service POS Click in the Procedure Code ID field and use the drop down menu to select the type of procedure code HCPCS HIEC National Drug C
48. O Provider ID Start Date End Date Medicaid 1234567 01 01 13 200 01 13 200 Eligibility of the following field combinations must be entered Medicaid No SSN amp Last SSN amp DOB or CsI ast Name First Name amp DOB awe Patient Inf Appeals atient Information Medicare 2 Medicaid No SSN Account No 7 Reference Files 7 System 2 Last Name DJ First Name MJ Suffix Additional Search Fields Date of Birth Sex z 20 City ZIP Code gn 4 Enter the Provider ID TPI or click the magnifying glass icon to select the Provider ID Input the Start Date and End Date The Start and End dates can span up to three months The End Date can be the current date The date span must be within the past three years 5 Input any of the listed field combinations Important Input the minimum amount of information in this section preferably Medicaid number only because any incorrect information will cause the request to fail e Medicaid No or e SSN and Last Name or e SSN and Date of Birth or e Last Name First Name and Date of Birth Note Suffix is not contained in the Last field it has its own field 17 3 Creating an Eligibility Template In TDHconnect Explorer double click Medicaid to expand the folder and double click Eligibility 1 Inthe TDHconnect 3 0 main menu click File gt New The Request Information tab opens in the
49. R amp S Print Report Click Print to print the ER amp S report Use the forward or backward arrows to see other pages The down arrow on the size 10096 box reduces or enlarges the image Page 100 PR TDHCc3 0AC 02 18 05 v 0 4 Medicaid Appeals 21 Medicaid Appeals Note Refer to Section 5 in the current Texas Medicaid Provider Procedures Manual for related policy information Important If a claim denies with zero allowed zero paid amounts see R amp S below follow up with a new claim not an appeal within 120 days of the R amp S date See Section 13 Medicaid Claims on page 41 for details An appeal cannot be filed on a pending claim The ER amp S Report has a section for pending claims identified by The following claims are being processed The pending claim must finalize and be paid or denied before an appeal may be filed 21 1 Changes to Appeals Resulting From HIPAA The following items reflect changes to appeals resulting from HIPAA All required data on the appeal must be completed not just the data being changed from the original claim Appeals look similar to claims with the exception of three fields on the Patient tab of the appeal See Section 21 4 Appeal Fields on page 104 Changes to surgical procedure codes on inpatient claims must be appealed on paper with supporting documentation for review Appeals must include all detail lines on the original claim in the same order as on the original claim
50. ab 2 Click Add The Event Scheduler dialog box opens 5 Event Scheduler Select an event type in the Type menu Type 4 Select a date in the When menu Enter the time hour minute second or in the field below the When date Use the following format 11 20 2003 x HH MM SS AM or PM Set how often the event repeats in the Interval menu If Irregular is selected enter the number of days in the field to the right of the Interval A H interval selector Set the age of affected records in the Age menu Only records older ok than the number of days defined in step are affected Click Apply and click OK to schedule Page 41 TDHconnect 3 0 Workbook for Acute Care Providers 14 4 5 History Tab Scheduler ptions 1 Send Requests Get Responses Database The History tab lists any scheduled events En that occurred as successful unsuccessful Use the History tab to verify scheduled events Note If the event was unsuccessful submit the request or response retrieval in the Program Summary window or use the Database Utilities for database maintenance Cancel 14 5 Security Admin Add Users Use Security Admin to set up new TDHconnect 3 0 users Note TDHconnect 3 0 is set up with a default user called Admin 1 Expand the System folder in TDHconnect Explorer Loading Users
51. ails Other Insurance Replacement Indicator Ean Prescription Date Accident State i New Eye Rx Sphere Right Eye Left Eve Old Eve Rx Sphere Right Eye Left Eye Auto Accident Related 7 Employment Related THSteps Indicator Cylinder I l BT Cylinder 1 Near Authorization Number Cataract Surgery Date oe Intermediate lI Intermediate ok 67 TDHconnect 3 0 Workbook for Acute Care Providers 18 4 2 Details Tab Note Use the scroll bar at the bottom of the screen to access fields on the right hand side of the window This window is shown in two graphics to display all of the scrolling area 1 Select the Details tab and enter the date of service in MM DD YYYY format 2 Tab to the POS column and use the drop down box to select place of service POS Click inside the code ID field and use the drop down box to select the type of procedure code HCPCS HIEC National Drug Code in 4 4 2 format 5 3 2 format 5 4 1 format 5 4 2 format or Mutually Defined 4 Input the Procedure Code If needed press lt F2 gt to bring up procedure codes in the reference files for assistance Type of Service TOS is automatically inserted by C21 based on procedure code entered 5 Input any needed modifier codes Mod 1 through Mod 4 6 Input the diagnosis reference Diag Ref to refer to the most important diagnosis code en
52. aim does not guarantee payment Accepted status indicates only that the claim is accepted for further processing Whether the claim is paid or denied is not determined until after it finishes processing Page 47 TDHconnect 3 0 Workbook for Acute Care Providers Important To see the status of accepted claims check your Remittance amp Status R amp S reports or runa claim status inquiry You must have a signed Claim Status Inquiry Authorization form on file with TMHP to perform claim status inquiries Call TMHP 1 888 863 3638 and also see Section 19 Medicaid Claim Status Inquiry on page 93 for a blank agreement form Rejected Electronically submitted requests that received a response indicating the request has been rejected due to errors You can correct and resubmit these requests Note Rejected claims do not receive an ICN and do not appear on the R amp S report nor do they appear on a claim status inquiry 16 1 2 Batch Transmission Process A common error is to click OK in claims or appeals and assume that the transaction has been sent to TMHP Another common error is to submit the claim or appeal to TMHP but not retrieve the response the next day to see if the claim or appeal was accepted or rejected Important Unless all four steps of a batch transmission see diagram below are performed you may overlook rejected claims or appeals resulting in possible loss of reimbursement 16 2 Send Requests Tab The Send Request
53. allation CD TDHconnect 3 0 installation CD ROM ROM Microsoft Internet Explorer version 4 01 with Microsoft Internet Explorer version 5 0 Service Pack 2 or later Microsoft Internet Explorer included the TDHconnect 3 0 installation CD 5 0 is included on the TDHconnect 3 0 installation ROM CD ROM Note Hardware requirements will change with Service Pack 5 Adobe and Acrobat Reader are either registered trademarks or trademarks of Adobe Systems Incorporated in the United States and or other countries Page 3 TDHconnect 3 0 Workbook for Acute Care Providers NOTES Page 4 PR TDHc3 0AC_02 18 05_v 0 4 Obtaining Support 3 Obtaining Support This section explains how to get assistance from Texas Medicaid amp Healthcare Partnership TMHP with technical issues training and claims questions This section also shows how to access additional resources on the TMHP website referenced below 3 1 Getting Technical Assistance The TMHP Electronic Data Interchange EDI Help Desk provides technical assistance only with troubleshooting TDHconnect 3 0 and TMHP EDI Gateway system problems Contact your system administrator for assistance with modem hardware or phone line issues Note Providers in rotary dial areas cannot use TDHconnect 3 0 To reach the TMHP EDI Help Desk available Monday through Friday 7 00 a
54. as referred to the Primary Care Physician or to a specialist Patient Provider Status Claim Number New Patient Provider Claim Diagnosis Details Other Insurance Date of Current Condition Condition Codes E Authorization No Auto Accident Employment Related Acceder THSteps Indicator zl Ambul Informati mbulance Information N None Y e 59 TDHconnect 3 0 Workbook for Acute Care Providers 18 2 4 Diagnosis Tab Note A diagnosis code is required for professional claims 1 Select the Diagnosis tab 2 Input the HCPCS or CPT code to the highest level of specificity If uncertain of the code press F2 while the cursor is in the Code column to bring up diagnosis codes in the reference files More than one diagnosis code may be entered 3 Input the Description in the appropriate column Note THSteps CCP Pharmacies The following note is found in Section 40 of the Texas Medicaid Provider Procedures Manual Pharmacies using their VP TPI should obtain prior authorization for prescription medications not paid through the Vendor Drug Program If a claim is submitted without a diagnosis then a provider must attach documentation establishing medical necessity and a signed prescription from a physician MD or DO Electronic claims must have diagnosis code V7999 for the claim to be accepted Instead use the HIPAA compliant diagnosis code for T
55. as you prepare to install Administrator rights are required when installing to a network The system administrator must install TDHconnect 3 0 on each PC and install the databases in a common LAN location Since there is only one database located on the server only Compass21 User ID and password is needed The most current TDHconnect 3 0 Service Pack must be installed on each PC that has an installed copy of TDHconnect 3 0 The system administrator must map the individual PCs to the database location on the LAN Download the required authorizations and agreements forms as needed from www tmhp com or contact the TMHP EDI Help Desk to obtain these forms See Section 3 Obtaining Support on page 5 for applicable help desk phone numbers Open the TDHconnect 3 0 System Totals window and select Communications gt System Settings on the TDHconnect 3 0 menu bar Verify you have a Production User ID in the Compass21 and or Long Term Care User ID fields Note TDHconnect 3 0 does not support modem pools Page 14 PR TDHc3 0AC 02 18 05 v 0 4 Installing TDHconnect 3 0 6 3 Installation Steps Important Administrator rights are required when installing TDHconnect 3 0 in a Windows network environment 1 Close all open applications and remove all media such as backup tapes CD ROMs or removable disks 2 Select Settings gt Control Panel on the Windows Start menu Double click Add Remove Programs In t
56. backup of TDHconnect onto tape CD ROM or a separate machine if available Important When using TDHconnect 2 0 with Service Pack 7 you must save your data prior to installing TDHconnect 3 0 and performing data conversion Page 13 TDHconnect 3 0 Workbook for Acute Care Providers 6 Purge old records from TDHconnect if this has not been done Perform the following steps to purge records e In TDHconnect Explorer double click System to expand the System menu and double click Database Utilities e Select the Purge tab and select the program to purge e Inthe Age in days field enter or select the number of days Only records older than the number of days defined in this step are purged e Click Purge to purge the records for the selected programs Note See Section 14 2 2 Purge Tab on page 36 for more information 7 Compress the database by double clicking System to expand the System menu and double clicking Database Utilities The Database Utilities dialog box opens Select the Compress tab and select the program to purge Note Only one database can be compressed at a time 8 Click Compress See Section 14 2 1 Compress Tab on page 36 Important Close all open applications and remove all media such as backup tapes CD ROMs or removable disks before installing TDHconnect 3 0 6 2 Installing TDHconnect 3 0 on a LAN This section describes the steps necessary to install TDHconnect 3 0 on a LAN Keep in mind the following
57. cell Place the cursor beneath the cell to copy and press lt F3 gt lt F4 gt Copies the entire row Place the cursor beneath the line to copy and press lt F4 gt lt F5 gt Causes a window to refresh and display all data created simultaneously by multiple users of TDHconnect 3 0 F6 Inserts a new row Place the cursor on a row the new line is added below this row and press F6 Press Action CTRL Copy selected text lt CTRL gt E Focus on Error window lt CTRL gt D Delete record from the database lt CTRL gt Open a record from a list lt CTRL gt R Focus onTDHconnect Explorer lt CTRL gt S Save a request lt CTRL gt T Clear all fields on this window lt CTRL gt V Paste selected text lt CTRL gt W Focus on Workspace lt CTRL gt X Cut selected text ALT E Open Edit menu ALT H Open Help menu lt ALT gt N Open Navigation menu lt ALT gt R Open Reports menu lt ALT gt V Open View menu lt F7 gt Deletes a row Place the cursor on the row to delete and press lt F7 gt lt Shift gt lt F1 gt Open What s This Page 25 TDHconnect 3 0 Workbook for Acute Care Providers NOTES Page 26 PR TDHc3 0AC_02 18 05_v 0 4 Setting Up Communications in TDHconnect 3 0 12 Setting Up Co
58. connect 3 0 Important Each user must have a unique TDHconnect 3 0 user ID and password Additional user IDs can be created in TDHconnect 3 0 using the security function 542 1 Double click the TDHconnect 3 0 icon on your desktop The TDHconnect Version 3 0 Login dialog box opens TDHconnect Version 3 3 0 admin password In the User ID field enter admin in lowercase letters In the Password field enter password in lowercase letters The Password field is always case sensitive Click OK TDHconnect 3 0 starts Note When logging on the following error messages may be encountered e Admin is currently logged on to TDHconnect TDHconnect is already running Please open Task Manager and End Task for the Shell and Hints tasks that are running To resolve these errors see the instructions in Section 10 TDHconnect 3 0 Log On Error Messages on page 23 Page 21 TDHconnect 3 0 Workbook for Acute Care Providers NOTES Page 22 PR TDHc3 0AC_02 18 05_v 0 4 TDHconnect 3 0 Log On Error Messages 10 TDHconnect 3 0 Log On Error Messages This section explains what to do when you receive the two most common error messages encountered while using TDHconnect 3 0 Error Message SOLUTION Error Message SOLUTION During login the following message may open username is currently logged on to TDHconnect Use
59. connect 3 0 Quick Start Guide o o xpo d vo RATER E Seems 8 4 3 The TDHcontect 3 0 User ities oak pati eho oe ae aed wae here 8 PRC ta vas ee ASL hae a ah aden grout 9 5 1 Activating an Account on the TMHP Website eek et dha to doe hee c es 9 5 2 Finding Information on the TMHP Websites tke e RR e he ees 11 52 Publicatons Sap eed aped SS dort ts 11 Dv Bannet Bere DA win Ke BERNER OO RON TREO 11 529 Reference GOdes cota eee bon edna ab veter 11 5 24 Other TDHconnect 3 0 Resources 12 3007 eve soe veh CEPR o edel erbe eda enti 13 6 1 Before Installing sk ctp EV 13 6 2 Installing TDHconnect 3 0 ona LAN oL este ta nen PR Rete Vx ES EP 14 6 3 Installation Steps os sebo ERAN SOUCIS MER QUO EAS RR A 15 6 4 Setting the Dialing Properties in WV OWS ENUMERARE NOE 16 Goo Finishing sas oU a Hee ng ae EA 16 Data a omis boron STI X SES PENES fessa viride bi 17 7 1 Converune Existing Appeals to TDHconnect 3 0 17 Updates cometa he meos db Be oo prot Cte 19 8 1 Downloading TDHconnect 3 0 Service Packs oer e tme 19 8 2 Installing a TDHconnect 3 0 Service Pack us iud S ea
60. cute Care completed claims are converted with the status of Incomplete As a result you have to open all converted claims and save them If the claim passes TDHconnect 3 0 edits the claim saves as Complete however the word Complete should not be confused with a claim being processed and finalized by TMHP Complete in this context means that a completed claim is stored on your hard drive and is ready to submit to TMHP Note Providers who file eyeglass appeals If data is converted from TDHconnect 2 0 to TDHconnect 3 0 any rejected eyeglass appeals that were stored in TDHconnect 2 0 must be manually re entered in TDHconnect 3 0 before resubmitting the eyeglass appeal 7 1 Converting Existing Appeals to TDHconnect 3 0 1 Back up and save your TDHconnect 2 0 data prior to conversion Important You must save your data using TDHconnect 2 0 with Service Pack 7 prior to installing TDHconnect 3 0 and performing data conversion 2 Exitall versions of TDHconnect including TDHconnect 3 0 3 Open the Windows Start menu and select Programs TDHconnect ConvertAppeals Programs TDHconnect ConvertAppeals M Unicenter Asset Management gt H TDHconnect 3 0 Y Favorites gt Unicenter Software Delivery gt 3 TDHconnect Utilities Wacom Tablet Version Wizard A Documents e gt fT Winzip 2 Settings windows Media Player 9 Search and Support J Run Page 17 TDHco
61. do not receive your user name and password within 24 hours please contact the TMHP EDI Help Desk at 1 888 863 3638 for assistance 5 2 Finding Information on the TMHP Website 5 2 1 Publications Publications available online include the Texas Medicaid Provider Procedures Manual and bulletins To download publications follow these steps 1 Access the TMHP web site at www tmhp com The TMHP Home page opens 2 Click the Find Publications File library link in the would like to section The TMHP File Library web page opens 3 Use the links on the TMHP File Library web page to locate specific publications 5 2 2 Banner Messages To view banner messages from TMHP 1 Access the TMHP website at www tmhp com The TMHP Home page opens 2 Clickthe Find Publications File library link in the would like to section The TMHP File Library web page opens 3 Click the Banner Messages link The TMHP File Library web page provides links to banner message files organized by publication date 4 Use these links to select banner messages to view 1 To print a banner message file select File then Print on your browser s menu bar 5 2 3 Reference Codes Download reference codes using TDHconnect 3 0 or perform the following steps to download reference codes from the TMHP website Long Term Care 1 Access the TMHP web site at www tmhp com The TMHP Home page opens 2 Click the Providers link at the top of the page The Providers web
62. e ER hare den 20 Opening and Logging on to TDHconnect 90 4444 Lorem ebbe p Joe aD teen p 21 TDEHeconnect o Log MesSages coevesnone pas openana a Ta ous m dotes te b tl oc 23 10 1 Using TDHconnect Utilities to Log Off aU sepa os Dec ca ees RC yeaa pedea 23 10 2 Using the Windows Task Manager to Shut Down 3 0 24 Keyboard Shortcuts amp Function 25 Setting Up Communications in TDHconnect 9 0 ees me RNC 27 L2 Systeme lu ag s coa Eo eu e icta aue emp ES AG P dre e Ede 27 12 2 Modem DELIS se ate d drame re freres eani metre e o eaten tes en ordre d 28 Setting Up Reference Files in TDHconnect bte bt rer eb cea Ens 29 PR TDHc3 0AC_02 18 05_v 1 0 TDHconnect 3 0 Workbook for Acute Care Providers 15 l Adding Clients aeo beo das Rea ee etc eei dec detur Paetus etd s 29 13 2 Adding Providers Sey dog Meath t gy alate 31 13 3 Downloading Reference Codes oo os EET CUPIDE ca Doa exer 33 13 4 Downloading Updated Reference Codes Retrieve 34 13 4 1 Downloading Compass21 C21 Reference Codes 34 14 FD connect 3 0 System MaIBtenatige s s uo pick aw oi oco tror LE REDEEM 35 DEI System Functions Overview a e uera ox Wes CR s P UN Mica OCA oM CR ate 25 14 2 Database bread aderit esti at bcr AME De ee obe aliti 35 14
63. e of Eligibility Patient Status County of Residence v i v ra v v v Address Income Street Family Size City State ZIP Code Family Income ooo o rx ene mea ae ERE 18 8 2 Provider Tab The Provider tab has two sub tabs Facility Provider and Referring and Other Provider Required fields Billing Provider ID and Last Organization Name Address City State and Zip Code e Tax ID Page 85 TDHconnect 3 0 Workbook for Acute Care Providers Patient Provider Status Claim No New Patient Provider Claim Diagnosis Details Other Insurance Billing Provider Provider ID Last Organization First Name MI Suffix qmm B _ Address City State ZIP Code xl Tax ID Phone No ft Je Facility Provider Referring and Other Provider Facility 2 Provider ID Name Address City State ZIP Code Esmee Lox IL cos Patient Provider Status Claim No New Patient Provider Claim Diagnosis Details Other Insurance Billing Provider 2 Provider ID 2 Last Organization First Name MI Suffix Address City State ZIP Code xl Tax ID Phone No f Juss RE Hz ad Ute 4 Referring Other Provider p Provider ID 2 Last Name First Name MI Suffix Im Teen ER 86 PR TDHc3 0AC_02 18 05_v 0 4 Medicaid and Family Planning
64. ed Page 77 TDHconnect 3 0 Workbook for Acute Care Providers 18 6 5 2 Ancillary Details Click the Ancillary Details sub tab of the Details tab to enter ancillary charges Note This window is shown in two graphics to display all of the scrolling area Required fields Revenue codes Rev Code Units Total Charges Unit price is required for revenue codes 100 219 The Non Covered Charges column may be used to report line specific non covered amounts Patient Provider Status Claim Number accent 10 pucr seg Patient Provider Claim Diagnosis Details Other Insurance Rev T Non Covered 4 TEE pen t _ 1 2 3 4 5 6 Y 8 E 10 11 12 Total Charges 0 00 13 Non Covered Charges 0 00 Other Insurance Paid 0 00 Net Billed 0 00 Accommodation Details Ancillary Details Surgery Details Page 78 PR TDHC3 0AC 02 18 05 v 0 4 Medicaid and Family Planning Claims Patient Provider Status New Patient Provider Claim Diagnosis Details Other Insurance Rev T Non Covered Jone atone S Accommodation Details Ancillary Details Claim Number Total Charges Non Covered Charges Other Insurance Paid Net Billed 0 00 0 00 0 00 0 00 Cancel Page 79 TDHconnect 3 0 Workbook for Acute Care Providers 18 6 5 3
65. ed to successfully add a provider Page 31 TDHconnect 3 0 Workbook for Acute Care Providers TDHConnect Provider Common Setup File Edit Reports Security View Tools Communications Navigation Help a 7 lt e ggu E 5 TDHconnect Provider Blue Shield Last Organization Name First Name 1 Suffix L CIDC Family Planning Long Term Care 1 Medicaid Provider Information Provider Launch Program For 3 Program Name o9 C1 Medea pes __ Reference Files Blue Shield O Blue Shield Client Es CIDE L CIDC Provider e __ Family Planning Family Plannin Reference Codes Long Term Care LI Long Term Care E System Medicaid Medicaid Medicare L1 Medicare City State ZIP Code Phone No Jie Provider IDs Tax ID SSN gt 3 3 Select the check box in the Provider Status column next to the appropriate Program Name 4 Select the program in the Launch Program for Provider menu this example selected Medicaid 5 Input the nine digit Texas Provider Number TPI in the Provider ID field This field is required to successfully add a provider 6 Click OK TDHconnect Provider Medicaid File Edit Reports Security View Tools Communications Navigation Help a 7 z i TDHconnect Last Organization Name Sf 00 First Name
66. endor or clearinghouse L Add Claim Status Inquiry Privileges 3 Select Action B Revoke Claim Status Inquiry Privileges 4 Enter organization information List the billing Texas Provider Identifier TPI number s you choose to access using the Production User ID given above Submit additional copies of this form if you need to add more TPI numbers Provider Name 7 Digit BILLING TPI Base Number Must be the name associated with the TPI Base number listed at right The first 7 digits of the 9 digit TPI number Note Performing TPI numbers do not have Claim Status Inquiry access Enter only BILLING TPI numbers 5 Enter Requestor Information Name Title Signature Telephone Number ext Fax Number ext 6 Return this form to Texas Medicaid amp Healthcare Partnership Attention EDI Help Desk MC B14 Or Fax to PO Box 204270 512 514 4228 or 512 514 4230 Austin TX 78720 4270 DO NOT WRITE IN THIS AREA For Office Use Input By Input Date Mailbox ID Page 108 PR TDHc3 0AC_02 18 05_v 0 4 Attachments 22 2 TDHconnect Order Form This section provides the TMHP TDHconnect order form TIP Photocopy this form and retain the original for future use TDHconnect Order Form TDHconnect is the software owned by the State of Texas for interfacing into the TexMedNet system You will be able to use Eligibility Claims Subm
67. enerate an EROS REPO eve ute HORUM Set CP EA testet 100 PR TDHc8 0AC 02 18 05 v 1 0 TDHconnect 3 0 Workbook for Acute Care Providers 20 3 Medicaid PRES Report EE Goh wl Cree ras 100 21 Medicaid 1 it rv ward s Re TAE NON 101 21 1 Changes to Appeals Resulting From 101 21 2 Three Ways to Complete TDHconnect 101 21 3 Create an Appeal from an Accepted TDHconnect 1 102 21 3 1 Create an Appeal from an ER amp S ree 102 21 3 2 Create and Appeal from a Blank Form ale dae ec reete 104 21A Appeal Fields Vende a rp E a 104 21 5 Medicaid Appeals Submitting and Retrieving 105 21 5 1 Submit Retrieve Batch Requests 47 soda ets ta RE een Aen 105 21 6 Medicaid Appeals Printing Reports SS ee 106 22 JAvtachtieibs dms teo uo Au te eese Ee doctas ttr m pf au 107 22 1 Claim Status Inquiry Authorization Form v ois ses OU Ea eor ape 107 22 2 TDHconnect Order Form 0 ce en 109 22 0 etes utrius se et fee ge Sastre sea 112 224 Workshop Evaluation RA ERR RR HERRERA WE da 114 PR TDHCc3 0AC 02 18 05 v 1 0 TDHconnect 3 0 Overview 1 TDHconnect 3 0 Overview With TDHconnect 3 0 you can Administer billing for
68. es Li Service Codes Service Group LTC Procedure Codes Item Codes Li EOB LTC Crosswalk All LTC Reference Codes LTC System C21 Reference Codes Diagnosis Codes DRG Code Mi Process 99 TDHconnect 3 0 Workbook for Acute Care Providers Open the TDHconnect System Totals window Open the Retrieve Other tab Select the check box in the Download column for ER amp S Click Download qu Oc Note ER amp S reports are available to download at 6 00 a m each Monday A good practice is to download them weekly 20 2 Generate an ER amp S Report File Edit View Tools D Open Close Delete Ctrl D Ext In the Medicaid ER amp S Summary List window click File gt Generate R amp S Eile Edit View Tools Navigation Help hav 3 Required fields are Blue Shield Provider ID 7 CSHCN Provider ID ta inre e Start Date ong Term Care E 5 0 Medicaid End Date i X End Date Eligibility Claim Soit Claims R4 Claim Status check one CSI Detail Sort None x The Start Date is usually a Friday im us A Appeals the End Date is usually the following Medicare Paid C Reference Files Monday System Denied Click Display Report to see the report s es 20 3 Medicaid E
69. f Birth v i Address Street City State ZIP Code L HEN UE DOAN Page 72 PR TDHc3 0AC_02 18 05_v 0 4 Medicaid and Family Planning Claims 18 6 2 Provider Tab The Provider tab has two sub tabs within it Billing and Attending Providers Operating and Other Providers 18 6 2 1 Billing and Attending Providers Sub Tab Required fields Billing Provider s Provider ID Facility Name Address City State Zip Code and Tax ID No Attending Provider s Provider ID Last Name First Name ID Type Employer ID or Social Security No and Other ID corresponding to ID type Patient Provider Status Claim Number pe DM T D SERT Patient Provider Claim Diagnosis Details Other Insurance Billing and Attending Providers Operating and other Providers Billing Provider 2 Provider ID 2 Facility Phone No es 1 Address City State ZIP Code Tax ID Attending Provider ID Last Name First Name Suffix EE BH ID type Other ID E Page 73 TDHconnect 3 0 Workbook for Acute Care Providers 18 6 2 2 Operating and Other Provider Sub Tab Required fields if applicable Operating Provider ID Last Name and First Name The Other Provider ID Last Name and First Name Patient Provider Status Claim Number Dresses PN e n Patient Provider Claim Diagnosis Details Other Insurance Billing a
70. g statement appears There are appeals to print Do you want to continue 2 Click Yes to print a detailed list of all completed but not yet submitted appeals Rejected Appeals 1 Click Reports gt Print Rejected Appeals The following message appears There are appeals to print Do you want to continue 2 Click Yes to print a detailed list of all rejected appeals Page 106 PR TDHCc3 0AC 02 18 05 v 0 4 Attachments 22 Attachments 22 1 Claim Status Inquiry Authorization Form This section contains the TMHP Claims Status Inquiry Authorization form Note This form is for Acute Care providers only Long Term Care providers should contact the TMHP EDI Help Desk at 1 888 863 3638 for assistance TIP Photocopy this form and retain the original for future use Page 107 TDHconnect 3 0 Workbook for Acute Care Providers Claim Status Inquiry Authorization This form is for ACUTE CARE providers only If you are a Long Term Care provider contact TMHP s EDI Help Desk at 888 863 3638 to request the correct form The following information MUST be completed before you can be granted Claim Status Inquiry CSI access 1 Enter your Production User ID 2 Enter your Production User ID Password The TMHP Production User ID Submitter ID is the electronic mailbox ID used for downloading your Claim Status Inquiry reports For assistance with identifying and using your Production User ID and password contact your software v
71. ge 36 PR TDHc3 0AC_02 18 05_v 0 4 TDHconnect 3 0 System Maintenance Important Administrator rights are required when installing TDHconnect 3 0 in a Windows NT or Windows 2000 environment Database Utilities To set up concurrent users Compress Purge Back up 1 Create a folder on the server where the TDHconnect database is stored and ec shared 2 After installing TDHconnect 3 0 the Witenes computers that access the server accepting the default database location Ca Backups the Mapper function is used to locate the TDHconnect database on the server 3 It is also possible to point to the TDHconnect database on the server during installation of TDHconnect 3 0 on each computer 14 2 4 Back up Tab Database Utilities 1 Use the check boxes in the Select column to select the type of data to back up and click Compress Purge 2 A backup copy of the selected data is ENS placed in the TDHconnect backup folder Blue Shield i k CIDC The previous backup is overwritten Family Planning To Note To back up the data to a different disk Medicare drive to ensure protection in case of Reference Files disk drive failure contact your system administrator or computer support personnel for assistance Important Avoid accidentally clicking Restore Clicking Restore overwrites the existing database image with the previously backed up database
72. ght side contains TDHconnect 3 0 Help Overview Health care providers use 7DHconnect the selected help information and Getting Started 3 0 to System Administration and Security instructional steps Reference Files M TDHconnect Version Wizard ag appeals adjustments and 2 The Contents tab contains a TDHconnect 3 0 Quick Reference multi tiered list of help topics in Conduct claim status inquiries TDHconnect 3 0 help Claim Status Inquiry Make client eligibility and Medicaid Electronic Remittance and Status Rep Eligibility Service Authorization 3 Index tab contains an Verification MESAV requests alphabetized index for MESAV M gt lt Reports Generate billing reports TDHconnect 3 0 help Adjustments Access the Texas Medicaid Network lt TexMedNet Web site Contents Index Search Favorites 4 The Search tab works like most Internet search engines Enter the word or words to find in the Type in the keyword to find field and click List Topics The help system lists the help topics that contain the keyword s you entered 5 The Favorites tab allows you to bookmark the address of a help topic you use frequently Open the help topic and select the Aad in the Favorites tab to add a link to the current topic on the tab Page 7 TDHconnect 3 0 Workbook for Acute Care Providers 4 2 The TDHconnect 3 0 Quick Start Guide In add
73. he nstall Uninstall tab click Install 3 Insert the installation CD ROM into your CD ROM drive Click Next Click Browse 4 Selectthe location of your CD ROM drive in the Look in field Select Setup exe in the list of files and click Open 5 Click Finish The TDHconnect 3 0 installation window opens 6 Read the welcome screen click Next and Next again to confirm that you are about to install TDHconnect 3 0 The Choose Destination Location window opens Click Next to install the default installation location or click Browse to select a new location Click Next in the Start Copying Files window After installation completes the Acrobat Reader 4 05 Setup window opens Note f Acrobat Reader 4 05 or higher is already installed on your system click Cancel click Yes and skip to step 12 9 Click Next to install Acrobat Reader 4 05 The Choose Destination Location window opens 10 Click Next to install to the default location or click Browse to select a new location A message opens Copying program files 11 After installation is complete the Information dialog box displays the following message Thank you for choosing Acrobat Reader 12 Click OK to close this dialog box A message opens Do you wish to backup your databases This will overwrite databases that are in the Backup folder e Click Yes to back up the existing databases e Click No to skip backing up the databases 13 The Setup Complete window opens
74. he suffix appended to the last name On the eligibility response authorization information is no longer available Call the TMHP Contact Center at 1 800 925 9126 TPR Third Party Resources relationship to the insured is no longer available on the eligibility response 17 2 Beginning the Eligibility Request Medicaid Eligibility File Edit View Reports Tools Navigation Help O S a amp amp EA TDHconnect Medicaid Eligibility Request Response Summary Blue Shield 8 21 CSHCN No of Items C Family Planning Completed 0 1 Long Care Rejected 0 57 Medicaid Template 0 mum Claims yp equests Rejected ERES 1 10 20 2000 03 46 06 PM Processed 1 0 Appeals C Medicare 9 Reference Files 9 System T List Delete Cancel 1 Double click Medicaid to expand the Medicaid folder 2 Double click Eligibility to display the Medicaid Eligibility Request Response Summary window 3 Click File gt New on the TDHconnect 3 0 menu bar The Request Information dialog box opens Page 51 TDHconnect 3 0 Workbook for Acute Care Providers ile Edit View Reports Tools Navigation Help lt 7 700 TDHconnect 2 Blue Shield Request Information CSHCN Request Status New Request Family Planning Provider Information Long Care
75. her Insurance 2 Other Insurance 3 Payment Delay o Source Of Payment ee Indicator Bill Date Disposition Adjustment Reason Code Disposition Date PPO Discount Paid Amt 0 00 0 00 Dther Insurance Company Address City State ZIP Code wo EB 8 Contact 8 Phone No Verbal Date Contact Name Verbal Denial Comment Save as Template Interactive Cancel 2 If the other insurance delays and does not reply see the Texas Medicaid Provider Procedures Manual click the Delay Indicator check box and enter the bill date 3 If an Adjustment Reason Code is applicable select it and enter the Disposition Date and paid amount Paid Amt 4 Input the Other Insurance Company information Company Name Address City State Zip Code and telephone number 5 Ifa verbal denial was received from the other insurer click the Verbal Denial check box and enter the date they were contacted Verbal Date the Contact Name and a Comment regarding the conversation The Disposition indicator on the Other Insurance tab can be used to indicate if the other insurer denied did not file paid or issued no response Page 64 PR TDHC3 0AC 02 18 05 v 0 4 Medicaid and Family Planning Claims 18 2 6 2 Other Insurance Tab with Subscriber Sub Tab To enter information about the insured open the Subscriber tab on the lower right side of the Other Insurance sub tab Enter the ID SSN Last Name
76. ick the magnifying glass icon to autopopulate the fields in the provider reference files database or enter the fields manually Required fields appear in bold type If services were provided in a place other than the patient s home or the provider s facility such as a hospital birthing center or nursing facility open the Provider Facility sub tab and enter information Required fields are Facility Provider ID Name ID type employer ID or social security number Other ID corresponding to ID type Service Location Address City State and Zip Code Patient Provider Status Claim Number e x Mense ne gem Patient Provider Claim Diagnosis Details Other Insurance Billing Provider Provider ID Last Organization Name First Name Ml mB i Address City State 21 Code E ID type Other ID Phone No zl 2 Provider Facility Referring and Other Provider Facility Provider ID Name ID type Other ID Service Location Address City State ZIP Code xij Cancel Page 57 TDHconnect 3 0 Workbook for Acute Care Providers 18 22 2 Referring and Other Provider Sub Tab If required by the type of claim to enter a referring or primary care physician open the Referring and Other Provider sub tab and enter the 6 13 character referring Provider ID as a nine digit TPI six digit Medicare number or a Universal
77. in the TDHconnect 3 0 installation CD ROM Help To determine the version of Internet Explorer installed on your Contents and Index System start Internet Explorer click Help on the Internet Explorer Tip of the Day toolbar and select About Internet Explorer The About Internet For Netscape Users Explorer dialog box opens Online Support f Internet Explorer is not installed use the TDHconnect 3 0 Send Feedback CD ROM to install Internet Explorer 5 0 About Internet Explorer 3 If an earlier version of Internet Explorer is installed uninstall the earlier version and use the TDHconnect 3 0 CD ROM to install Internet Explorer 5 0 e To uninstall a program open the Windows Start menu in the lower left corner of the screen and click Settings Control Panel Double click Add Remove Programs In the nstall Uninstall tab select the program to remove and click Add Remove e To install a program open the Windows Start menu in the lower left corner of the screen and click Settings Control Panel Double click Add Remove Programs In the nstall Uninstall tab click Install Insert the CD ROM containing the program to install and click Next 4 f Acrobat Reader 3 0 is installed it must be uninstalled See the instructions above to uninstall a program or contact your system administrator for assistance If you do not have a system administrator please contact the appropriate technical assistance group 5 Create and save an external
78. in this case admin to log off 4 Click Log Off 5 Click OK 10 2 Using the Windows Task Manager to Shut Down TDHconnect 3 0 1 Click OK in the error message dialog box The error message dialog box closes 2 Press lt CTRL gt lt ALT gt lt Delete gt keys simultaneously to start the Task Manager Note Different computers may offer different Task Manager options such as Task List or an Application tab Ei Windows Task Manager File Options View Windows Help Applications Processes Performance Networking Task Status fI TDHconnect 3 v0 0a doc Microsoft Word Running 3 Select TDHconnect in the Task Manager SnagIt Running 5 amp Hints Running d ialog box Sud one 4 Select Hints Workbooks Running 5 Click End Task TDHconnect 3 0 shuts down gt End Task Switch To New Task Processes 46 CPU Usage 1 Commit Charge 286248K 865756K Page 24 PR TDHc3 0AC_02 18 05_v 0 4 Keyboard Shortcuts amp Function Keys 11 Keyboard Shortcuts amp Function Keys The following tables describe the keyboard shortcuts and function key actions available in TDHconnect 3 0 Keyboard Shortcuts Press lt F1 gt Function Keys Action Access the Help files for information about the current window lt F2 gt Access the Local Reference Database for the selected field Place the cursor in the field and press lt F2 gt lt F3 gt Copies a single
79. ission Claim Status Inquiry Remittance and Status Report Appeals TexMedNet Email and access the TexMedNet BBS using this software The system requirements for TDHconnect are listed on the bottom of this page You should acquire at the least the minimum PC requirements before ordering TDHconnect This form should be faxed to 1 512 514 4228 or 1 512 514 4230 You should receive your software and User IDs within two weeks of our receipt of the form Installation instructions will be enclosed with your software TDHconnect includes an online help file containing all necessary information for the operation of TDHconnect However if you find you need further assistance using TDHconnect workshop style classes are available Contact the TDHconnect workshop registration line at 1 512 514 3250 for information regarding TDHconnect workshops Only one TDHconnect order form for your location is necessary If you have multiple billing Texas Provider Identifiers TPIs list all TPIs in the Billing TPI s field Send a separate attachment listing all billing TPIs if there are more than seven Organization Name Billing Texas Provider Identifier s Contact Name Contact Phone Address City State ZIP TDHconnect Software and Hardware Requirements Minimum PC Requirements Recommended PC Requirements PC with a Pentium class processor PC with a Pentium 200 MHz or higher processor 16MB of RAM for Window
80. ith other TDHconnect 3 0 users 2 A dialog box opens with the following message This will install TDHconnect 3 0 Service Pack Do you want to continue Click Yes to install the TDHconnect 3 0 Service Pack 3 The TDHconnect Service Update Installation Utility window opens and the TDHconnect 3 0 Service Pack wizard opens 4 Several informational messages open Read each message and click Next to advance to the next screen 5 Adialog box opens with the following message Do you wish to backup your databases This will overwrite databases that are in the Backup folder e Click Yes to backup your databases before installing any database updates Recommended or e Click No to continue with the installation without making backups 6 Several additional informational messages open This process may take several minutes as database updates are made 7 Installation of the TDHconnect 3 0 Service Pack is complete To view the readme file check the View readme check box and click Finish The readme document opens 8 Read the document close it uncheck the View readme check box and click Finish 9 When prompted to restart the computer select Yes want to restart my computer now and click Finish Important The next time TDHconnect is opened the version of the Service Pack is listed along with the name TDHconnect 3 0 Page 20 PR TDHC3 0AC 02 18 05 v 0 4 Opening and Logging to TDHconnect 3 0 9 Opening and Logging on to TDH
81. ition to the instructions contained in this manual the installation and setup instructions are also contained in the TDHconnect 3 0 Quick Start Guide A printed copy of the TDHconnect 3 0 Quick Start Guide is sent with the software An electronic version of the TDHconnect 3 0 Quick Start Guide is also available inside TDHconnect 3 0 after installation Select Help gt Online Manuals gt Quick Start Guide on the TDHconnect 3 0 menu bar Acrobat Reader opens and displays the TDHconnect 3 0 Quick Start Guide Important Adobe Acrobat Reader 4 01 with Service Pack 2 or higher is required to open view and print the electronic version of the TDHconnect 3 0 Quick Start Guide 4 3 The TDHconnect 3 0 User Manual An electronic version of the TDHconnect 3 0 User Manual is available inside TDHconnect 3 0 after installation Click Help gt Online Manuals gt User Manual on the TDHconnect 3 0 menu bar Acrobat Reader opens and displays the TDHconnect 3 0 User Manual To print the TDHconnect 3 0 User Manual select File gt Print on the Acrobat Reader menu bar select the printer and printer settings and click OK Important Adobe Acrobat Reader 4 01 with Service Pack 2 or higher is required to open view and print the electronic version of the TDHconnect 3 0 User Manual Page 8 PR TDHc3 0AC_02 18 05_v 0 4 Accessing the TMHP Website 5 Accessing the TMHP Website The TMHP website is a valuable resource for obtaining information such as bulletins banner
82. ld r1 after each time you purge data CIDC aL i anang 1 Use the check boxes in the Select column to Long Term Care Medicaid select the databases to compress Medicare Reference Files Mapper Back up 2 Click Compress to compress the database s Compress Cancel 14 2 2 Purge Tab Important To ensure database integrity back up your database before purging Database Utilities data and compress after purging Deren 3 TRN The Purge tab is used to purge old data from System Program Purge S TDHconnect 1 8 1 Scroll through the selections on the Purge Long Term Care Appeals tab and use the check boxes in the Purge column to select data types to delete Family Planning Medicaid 2 Inthe Age in Days field enter the age of ee the data to select for deletion Only data that CIDC old or older is deleted 3 Click Purge to delete the data Medicaid Cancel 14 2 3 Mapper Tab Mapper is most frequently used when multiple users are sharing one TDHconnect 3 0 database although any TDHconnect 3 0 user can change the location of the database The system can support up to ten concurrent users A shared database is located on a server and TDHconnect 3 0 is installed on the computers connected to the server The database is shared but TDHconnect 3 0 itself is not Pa
83. ll out the claim and click OK Repeat for each claim Claims are stored in Completed status on your database Click Cancel to exit Claims and go back to the TDHconnect System Totals window In the TDHconnect System Totals window open the Send Requests tab Select the check box for Family Planning Claims in the Send column Click Submit Requests are changed to Submitted status and are sent to TMHP Retrieve Responses to a Batch Request 1 24 hours after request submission go to the TDHconnect 3 0 System Totals window and open the Retrieve Responses tab Select the check box for Claims in the Download column Click Download Requests are now changed to Processed status To view the downloaded response double click Claims under the Family Planning folder in TDHconnect Explorer then double click the response 18 9 Printing Reports Seven types of claim reports may be printed from the Medicaid Claim Request Response Summary Transmission Summary Click a batch claim response has Transmit Type B and a Transmission ID Click Reports gt Transmission Summary to display the report The number of accepted or rejected claim responses is listed Click Print for a paper copy Transmission Detail Click an accepted batch claim response has Transmit Type B and a Transmission ID and the No of Requests is greater than the No Rejected Click Reports gt Transmission Detail A list of claim responses in that batch is displayed Click Print for
84. lly submitted requests that have passed the acceptance edits been assigned an ICN and are processing in the system Accepted claims appear on your R amp S report One or more transactions grouped together and submitted for processing You may download a response 24 hours after submission Request has been entered into TDHconnect 3 0 passed all the local edits but has not been submitted Completed requests convert to Submitted status after being sent in a batch A claim that has been denied for payment because it did not pass all program edits A denied claim appears on your R amp S report in the non pending section The process of retrieving electronic files from another system Submission of a single electronic transaction that receives a response during one session Reduce a window or dialog box to an item on the Windows taskbar The minimize button is on the upper right corner of a window dialog box or message The version of Windows you are currently using such as Windows 95 98 ME NT and 2000 A claim that has been approved to pay because it passed the program edits This claim appears on the R amp S report A claim that has failed a program edit and is pending edit resolution before continued processing You cannot submit a claim or an adjustment for a claim in the pending section of your R amp S report Request has been submitted through TDHconnect 3 0 and a response has been downloaded Processed requests cannot be
85. mily Planning o Select All s z Y Fill out the CSI request and click OK Repeat as needed for each CSI request Click Cancel to exit The TDHconnect 3 0 System Totals window is displayed Select the Send Requests tab Select the check box for Medicaid CSI in the Send column Click Submit Retrieve a Batch Request Qu Be oom c Program Summary 1 Send Requests 1 Retrieve Responses Retrieve Other System Download Adjustments LJ Appeals Claims Eligibility MESAV Select All 1 24hours after request submission go to the System Totals window and select the Retrieve Responses tab 2 Select the check box for CSI in the Download column Click Download Requests are now changed to Processed status 4 view the downloaded response double click CSI under the Medicaid folder left side of window then double click the response Page 96 PR TDHC3 0AC 02 18 05 v 0 4 Medicaid Claim Status Inquiry 19 3 Medicaid CSI Printing Reports Two types of CSI reports may be printed from the Medicaid Claim Status Inquiry Request Response Summary Response Report Click an accepted CSI response number of requests is greater than the number rejected Click Reports Response Report and Claim Report Click Print for a paper copy e Batch Report Select interactive or batch response click Reports Batch Report The report immediately starts printing a detailed list of all CSI responses from the row you
86. mit Batch Finish Cale Page 44 PR TDHc3 0AC_02 18 05_v 0 4 Connecting to 15 Connecting to TMHP The only way to connect to the TMHP website is through an Internet Service Provider ISP This incurs the cost of having an ISP 1 Connect to your ISP if not already connected 2 Open Internet Explorer 3 Inthe address line enter www tmhp com The TMHP website opens and displays the TMHP home page Page 45 TDHconnect 3 0 Workbook for Acute Care Providers NOTES Page 46 PR TDHc3 0AC_02 18 05_v 0 4 Using the TDHconnect System Totals Window 16 Using the TDHconnect System Totals Window The TDHconnect 3 0 System Totals window is the default window in TDHconnect 3 0 It features the following four tabs Program Summary Send Requests Retrieve Responses and Retrieve Other 16 1 Program Summary Tab TDHconnect System Totals Program Summary Send Requests Retrieve Responses Retrieve Other 1 The Program Summary tab contains the following columns of information Subsystem Completed Submitted Accepted Rejected A Program Blue Shield CIDC Claims D 0 D 0 Family Planning Long Term Care gt Medicaid and Medicare Eligibility 0 0 0 0 Claims 0 0 0 0 Request types Subsystem 0 Eligibility Claims CSI Appeals Family Planning Adjustments and MESAV Eligibility 0 0 0 0
87. mit a Batch Request 1 Fill out the claim and click OK Repeat for each claim Claims are stored in Completed status on the provider s database Click Cancel to exit Claims and go back to the TDHconnect System Totals window In the TDHconnect System Totals window open the Send Requests tab Select the check box for Medicaid Claims in the Send column ao fF oO Click Submit Requests are changed to Submitted status and are sent to TMHP 18 3 2 2 Retrieve Responses to a Batch Request 1 24 hours after request submission go to the TDHconnect 3 0 System Totals window and open the Retrieve Responses tab 2 Select the check box for Claims in the Download column 3 Click Download Requests are now changed to Processed status 4 To view the downloaded response double click Claims under the Medicaid folder in TDHconnect Explorer then double click the response Page 66 PR TDHc3 0AC_02 18 05_v 0 4 18 4 Eyeglass Claims Medicaid and Family Planning Claims After double clicking Claims under Medicaid click the Eyeglass icon or click File gt New gt Eyeglass Note The Patienttab Provider tab Diagnosis tab and Other Insurance tab are identical to the professional 837P claim previously covered The Claim tab and Details tab are described below 18 4 1 Claim Tab Note Eyeglass claims require eyeglass specific information Patient Provider Status Claim Number New Patient Provider Claim Diagnosis Det
88. mmunications in TDHconnect 3 0 This section explains how to configure your computer s System Settings and Modem Settings to allow TDHconnect 3 0 to communicate 12 1 System Settings Important If you do not already have a Production User ID and Password contact the TMHP EDI Help Desk for assistance at 1 888 863 3638 1 Log into TDHconnect 3 0 if you are not already logged in The TDHconnect 3 0 System Totals window opens in the workspace File Edit Reports Security View Tools Communications Navigation Help 2 Select Zoe OR Fas eroon Communications gt System Modems TDHconnect System Totals Settings on the TDHconnect i L Blue Shield 3 0 b x7 U menu Dar Family Planning Program Summary Send Requests Retrieve Responses z B Long Tem Cae The System Settings dialog L1 Medicaid Program Subsystem Completed Submitted Accepted box opens Medicare B Blue Shield iz Reference Files Clans 0 0 0 L System i System Settings E Select the System Settings tab System Settings Contact Information UE Note If you do not have a Compass21 User ID User Roser or a Long Term Care User ID leave those fields blank Organization Last Name First Name Middle Intial 4 Inthe Compass21 section enter the following Long Term Care information User ID Paseo e User ID not the logon ID that the Organization Last Name First Name Middle In
89. nd Attending Providers Operating and other Providers Operating Provider ID 2 Last 2 First Ml Suffix BEES m ID type Dther ID Other Provider ID Last Name First Name Ml Suffix ID type Other ID E Cancel 18 6 3 Claim Tab Click the Claim tab to enter claim data Required fields From Date and To Date Authorization Number if needed Patient Status and Type of Bill Admission Date Hour Type and Source Days Covered and Non Covered Discharge Hour Include any applicable occurrence codes and dates and any applicable condition codes Page 74 PR TDHc3 0AC 02 18 05 v 0 4 Medicaid and Family Planning Claims Patient Provider Status Claim Number New Patient Provider Claim Diagnosis Details Other Insurance Statement Covers General From Date To Date Authorization Number Patient Status Type of Bill Y i Y Y Occurrence Span Code Admission Information Code m Date Hour Type Source fi Y Y T From Date To Date i gt i hd Occurrence Codes Condition Codes Days Covered Covered Non Covered Discharge Information Date Hour Page 75 TDHconnect 3 0 Workbook for Acute Care Providers 18 6 4 Diagnosis Tab Click the Diagnosis tab to enter diagnoses At least one diagnosis code is required Patient Provider Status Claim Number
90. nnect 3 0 Workbook for Acute Care Providers The TDHconnect Appeals Conversion window opens w TDHconnect Appeals Conversion Medicaid Appeals Appeals to Convert Batches to Covert Convert Medicaid Appeals Converted Appeals Batches Converted Appeals Failed Batches Failed CIDC Appeals Appeals to Convert Batches to Covert Convert CIDC Batches Converted Appeals Appeals Converted Appeals Failed Batches Failed Family Planning Appeals Appeals to Convert Batches to Covert Convert Family Planning Appeals Converted Appeals Batches Converted Batches Failed Appeals Failed 4 Select the type of appeals to convert such as Convert Medicaid Appeals The totals in the data fields change to reflect the conversion changes Page 18 PR TDHCc3 0AC 02 18 05 v 0 4 Updating TDHconnect 3 0 8 Updating TDHconnect 3 0 8 1 Downloading TDHconnect 3 0 Service Packs The easiest way to obtain Service Packs is to download them from the TMHP website However this method works only if you have an Internet connection This method may be slower than connecting to TMHP if you are using a dial up connection Perform the following steps to download a Service Pack from the TMHP website I would like to Activate My Account 1 Connect to TMHP via the Internet see section 5 Find Software Service Packs Accessing the TMHP Website on page 9 Verify that you are viewing the TMHP homepage at ww
91. nswers to questions about LTC electronic or paper claims call the TMHP LTC Help Desk at 1 800 626 4117 In Austin call 335 4729 For links to the LTC home page visit the TMHP website at www tmhp com TIP For other useful numbers refer to the Telephone and Addresses Guide in the current Texas Medicaid Provider Procedures Manual Page 6 PR TDHC3 0AC 02 18 05 v 0 4 Accessing Documentation 4 Accessing Documentation 4 1 Using TDHconnect 3 0 Online Help Important Internet Explorer 4 01 Service Pack 2 or higher must be installed on your computer to run TDHconnect 3 0 help TDHconnect 3 0 contains an online help file that is available after the TDHconnect 3 0 software is installed The help topics provide instructions for using TDHconnect 3 0 4 1 1 Opening the TDHconnect 3 0 Online Help File There are three ways to open the TDHconnect 3 0 Online Help file Help What s This Shift Fl_ 4 Click Help gt Contents and Index on the TDHconnect 3 0 menu bar 2 Contents and Index Fi Online Manuals 2 Click the help book icon 2 on the TDHconnect 3 0 tool bar Product Support 3 Press F1 to open related help topics related to the TDHconnect 3 0 About TDHconnect active window 4 1 2 Using the TDHconnect 3 0 Online Help File E TDHconnect 3 0 Online Help z E 1 Contents Index Search and Favorites tabs on the left side of the E daniel window provide access to help TDHconnect 3 0 Overview topics and the ri
92. ode in 4 4 2 format 5 3 2 format 5 4 1 format 5 4 2 format or Mutually Defined Input the Procedure Code If needed press lt F2 gt to bring up procedure codes in the reference files for assistance Type of Service TOS is automatically inserted by C21 based on the procedure code entered Genetic providers must use the Remarks Code field after completing the Procedure Code field to enter the five character local procedure code that identifies the DNA test or laboratory enzyme test performed Dental claims for Orthodontics require a remarks code See Medicaid Bulletin 174 Input any needed modifier codes Mod 1 through Mod 4 If needed enter anesthesia minutes Ane Min Input the diagnosis reference Diag Ref to refer to the most important diagnosis code entered on the Diagnosis tab 10 Input the quantity Qty and Unit Price The Total Charges are calculated 11 Use the scroll bar to gain access to the fields on the right hand side of the window Page 61 TDHconnect 3 0 Workbook for Acute Care Providers 12 If the provider is a member of a group enter the nine digit performing provider number Perform Provider ID and name Perf Last Name Patient Provider Status Claim Number New Patient Provider Claim Diagnosis Details Other Insurance Date of Procedure Procedure Remarks Mod Mod Mod Mod Ane Diag Service Code ID Code Code 1 2 3 4 Min Ref
93. of days in the field to the right of the interval selector The Age menu is not used to send requests Click Apply and click OK to schedule 14 4 3 Get Responses Tab Scheduler Options Send Requests 1 6 Database History Use the Get Responses tab to schedule Type Start Date Event Scheduler Type Adjustments When 11 20 2003 x Interval Daily x 37 40 ETEN the retrieval of batch responses Note If Send Requests have been scheduled consider scheduling Get Responses on the following day 1 Select the Get Responses tab 2 Click Add The Event Scheduler dialog box opens Cancel Select an event type in the Type menu Select a date in the When menu Enter the time hour minute second AM or PM in the field below the date Use the following format HH MM SS AM or PM Set how often the event repeats in the Interval menu If Irregular is selected enter the number of days in the field to the right of the interval selector The Age menu is not used to send requests Click Apply and OK to schedule PR TDHc3 0AC_02 18 05_v 0 4 TDHconnect 3 0 System Maintenance 14 4 4 Database Tab Scheduler Options 1 Send Requests Get Responses 1 3 History Interval Use the Database tab to schedule the automatic execution of database maintenance functions such as backup compress or purge 1 Select the Database t
94. pages provider manuals and TDHconnect 3 0 updates The TMHP website provides documentation email and chat features that allow you to contact TMHP representatives for assistance All enrolled providers are given an account to access the TMHP website but you must activate your account and select a password to gain access to many of the advanced features of the TMHP website such as Forums Polls and questionnaires Claim status inquiry Acute Care providers only Eligibility verification Acute Care providers only 5 1 Activating an Account on the TMHP Website 1 Have the following information ready Acute Care Providers Long Term Care Providers e Nine digit Texas Provider Identifier TPI Nine digit Texas Provider Number TMHP EDI submitter ID TMHP EDI submitter ID Tax ID Employer Identification Number EIN Zip code Social Security Number SSN Medical license number 2 Access the TMHP website at www tmhp com The TMHP homepage opens I would like to 3 Click the Activate my Account link in the would like to section Activate my Account The TMHP Activate Account web page opens B Ls Rte Packs 4 Scroll down to verify Eligibility Click here to Sn is Account Now Inquire about a Claim Status Find Publications File Librar 5 Click the Activate My Account Now link The Activate My Email the Contact Center Account web page opens Register for a Worksho Page 9 TDHconnect 3 0
95. resubmitted Request that has received a response indicating the request has been sent back for errors The request may be corrected and resubmitted Rejected claims do not receive an ICN nor do they appear on the R amp S report Providers are still bound to submitting a claim within the original 95 day timeline but if the rejection is within the 95 day timeline they may print the rejection report and submit a new claim with a paper copy of the rejection report within 120 days of the rejection A submit error is a software level error that resulted in the batch not being transmitted electronically to TMHP A submit error is usually the result of keying errors on one or more claims but could be the result of several different reasons If the error in the claim s cannot be located please contact the TMHP EDI Help Desk at 1 888 863 3638 Request has been transmitted for processing Submitted requests convert to Processed after the response has been downloaded The nine character numeric ID first issued when providers start to bill electronically This should placed in the Compass21 user ID field and or CMS user ID field located in the System settings window You can reach this window by going to Communications System Settings A TDHconnect 3 0 window that shows all the data fields needed to submit a claim or MESAV request Templates allow you to save complete or partial data for future use The nine character numeric Texas Pro
96. rity Vie S m TDHconnect C Blue Shield C C Family Planning C Long Term Care 1 Medicaid C Medicare 1 1 Reference Files Database Utilities Password Admin Scheduling Security Admin TexMedNet TexMedNet Info 14 2 Database Utilities C System Note TDHconnect Explorer 2 The System folder expands The options are Database Utilities Password Admin istration Scheduling Security Admin istration TexMedNet TexMedNet Info rmation While TexMedNet functions are now performed by the TMHP EDI Gateway the way to access these functions in TDHconnect 3 0 remains the same After sending and receiving requests the TDHconnect 3 0 database becomes larger and response time eventually becomes slower Regular maintenance such as backing up files purging files and compressing the database is important to TDHconnect 3 0 database performance The database utilities described in this section help maintain the size and response time of the TDHconnect 3 0 database 1 Expand the System folder in TDHconnect Explorer 2 Double click Database Utilities The Database Utilities dialog box opens with four tabs Compress Purge Mapper and Back up Page 35 TDHconnect 3 0 Workbook for Acute Care Providers 14 2 1 Compress Tab Database Utilities Important To improve the performance of TDHconnect use the Compress feature at least once per month and Select K Blue Shie
97. rst Name Suffix MI m Patient General Information Sex Date of Birth i Address Street City State ZIP Code D Cancel 18 7 2 Provider Tab The Provider tab has two sub tabs Billing and Attending Providers and Operating and Other Providers Page 81 TDHconnect 3 0 Workbook for Acute Care Providers 18 7 2 1 Billing and Attending Providers Patient Provider Status Claim Number New Patient Provider Claim Diagnosis Details Other Insurance Billing and Attending Providers Operating and Other Providers Billing Provider Provider ID Last Facility Name Phone No Ex Address City State ZIP Code Attending Provider ID O Last Name First Name Suffix ID type Other ID ra f Cancel 18 7 2 2 Operating and Other Providers Patient Provider Status Claim Number New Patient Provider Claim Diagnosis Details Other Insurance Billing and Attending Providers Operating and Other Providers Operating Provider ID Last Name First Name MI Suffix E ID type Other ID xl Other O Provider ID p Last Name 2 First Name Ml Suffix ID type Dther ID m Cancel 82 PR TDHc3 0AC_02 18 05_v 0 4 Medicaid and Family Planning Claims 18 7 3 Claim Tab Click the Claim tab to enter claim information Required fields Admission Date and Hour Type
98. s 95 48MB of RAM for Windows 95 or later 24MB of RAM for Windows 98 64MB of RAM for Windows 98 32MB of RAM for Windows ME 64MB of RAM for Windows ME 24MB of RAM for Windows NT 4 0 w Service Pack 5 64MB of RAM for Windows NT 4 0 64MB of RAM for Windows 2000 Professional 128MB of RAM for Windows 2000 Professional Operating System Operating System Page 109 TDHconnect 3 0 Workbook for Acute Care Providers 100MB hard disk space for installation 50MB hard disk space per user per year for database 100MB hard disk space for installation 50MB hard disk space per user per user per year for database CD ROM drive for installation CD ROM drive for installation 800 x 600 VGA monitor resolution 256 colors 800 x 600 VGA monitor resolution 256 colors Microsoft Windows 95 or later operating system or Microsoft Windows NT operating system version 4 0 with Service Pack 5 or later Microsoft Windows 95 or later operating system or Microsoft Windows NT operating system version 4 0 with Service Pack 5 or later 8600 bps modem 28800 or greater bps modem Adobe Acrobat Reader 4 0 4 05 will be included on the installation CD Adobe Acrobat Reader 4 05 4 05 will be included on the installation CD Microsoft Internet Explorer I E 4 01 with Service Pack 2 Microsoft Internet Explorer 5 0 will be included on the TDHconnect installation CD Microsoft Internet Explorer I E 5 0 Micro
99. s d veut 59 18 24 Diagnosis Tab pe ERA odd a ed uen 60 Details Paus es Pub eben e er v Dee au bee re aah 61 19 2 6 Other Insurance Tab ssis iota Oka Fe eS STAR 63 18 3 Submitting and Retrieving Requests au dex fewest EM nee Ri E Dad 65 18 3 1 Submit Retrieve Interactive Requests reo br e re eg 65 18 3 2 Submit Retrieve Batch Requests oues m De lao ER ORA 65 19 4 Eyeclass Olattas e ee Us edel trea t eee e et AES 67 EST DAD NE Im 67 TB Ae AIDE tan Sash ded pate d 68 18 5 Dental Claims ee oS AOS TE ES E ASS IO ien RADI bte dedi 70 ES el vC POE oet kao SP UOTE D EPIS Rae 70 8 5 2 Details eee sit a eroe eo bre er pss pan erat 70 18 6 inpatient S AR AL aC ecd Ro Maa v e v quy 72 cet Ce EL Yatego eM vati idt 72 196 2 Provider Lab utet ee dca an ACID ad Dat 73 18 63 Gib aad Cv us une notet cadet ee meh eae eer en a 74 19 64 Diagnosis aes ceci v va APES Saa etes bea 76 18 6 5 Details FAD urtica ie bond ode B dept is s 76 13 7 Outpatient C ATIS s eR pa UP ear eR e OPER aig MR NC 80 Patent TA ute doc o RU AC AU AMO ROI Aseo s 81 LAD ewe uei terme d im EI ERE IE P REIR TE
100. s tab allows the user to send batches or groups of appeals claims claim status inquiries or eligibility requests Program Summary 1 Send Requests 1 Retrieve Responses 1 Retrieve Other stem Program Send 1 Use the check boxes in the Send T column to select batches to send ong Term Care L Appeals to CIDE t Family Planning 2 When finished selecting click Medicaid Submit Claims 2 Blue Shield 3 Once the transmission to TMHP is m Test Mode completed without errors open the Family Planning Long Term Care m Program Summary tab and verify Medicaid that the sent requests have Medicare changed from Completed status to CIDC 0 Submitted status Family Planning 48 PR TDHc3 0AC_02 18 05_v 0 4 Using the TDHconnect System Totals Window 16 3 Retrieve Responses Tab Responses become available approximately 24 hours after submitting requests to TMHP To view responses open the Retrieve Responses tab Program Summary Send Requests d le Retrieve Other Download 1 Use the check boxes in the ustments LJ eem Oo Download column to select the Claims responses to download o Eligibility o 2 When finished click Download MESAV 3 To verify that responses were successfully downloaded open the Program Summary tab Verify that the status has updated from Submitted status to Accepted or Rejected status Selec
101. scription for the user Enter password in the Password field New users are asked to change their password the first time they login Click Next to advance to the next step Select the programs that the user can access by double clicking a program name in the Program Options menu The program name is moved to the Selections menu Double click a program name in the Selections menu to deselect it The program name is moved to the Program Options menu Click Next to continue Select the options that the new user is authorized to use e Double click the user ID to expand a list of available programs e Double click a program name such as Medicaid to expand a list of options available for that program e Double click an option to expand a list of functions available for that option A 4 indicates that the user has access and x indicates that a user does NOT have access e Change the settings by double clicking on the J or X symbols 10 Click Next when done Page 43 TDHconnect 3 0 Workbook for Acute Care Providers 14 5 2 Security Wizard Step 4 Security Wizard Step 4 of 5 Summary User ID 123456789 Full Name John Smith Dasciptiort Abed Efgh Kd Mron ret Unine Step four summarizes the functions that the user TexMedNet User ID TexMedNet Password 4 can comp lete To change a selection click Back or Eligibility n ini ES ESNE Click Finish to add the user gt Delete E gt Sub
102. soft Internet Explorer 5 0 will be included on the TDHconnect installation CD Last update 03 30 2001 PR TDHC3 0AC 02 18 05 v 0 4 Page 110 Attachments TDHconnect Order Form Submission amp Shipping Instructions Standard delivery of the TDHconnect software is via USPS regular mail Overnight or Next Day Air shipping is available at Provider s expense via UPS Indicate below the shipping method you prefer Standard mail delivery allow 15 working days UPS Overnight UPS delivery is at Provider s expense Enter your UPS Account UPS 2nd Day Air Number below Requests submitted without a valid account number will be shipped via standard mail delivery UPS cannot deliver to a PO BOX Before faxing or mailing this agreement ensure that all required information is completely filled out and that the agreement is signed Incomplete agreements cannot be processed Mail to Texas Medicaid amp Healthcare Partnership Attention EDI Help Desk 14 PO Box 204270 Austin TX 78720 4270 Fax to 512 514 4228 OR 512 514 4230 Page 111 TDHconnect 3 0 Workbook for Acute Care Providers 22 3 Accepted Batch Submission Completed Denied Download Interactive Submission Minimize Operating System Paid Pended Suspended Claim Processed Rejected Submit Error Submitted Submitter ID Template TPI Number Page 112 Glossary Electronica
103. t All Note f you are unable to retrieve a response 48 hours after submitting a request call the TMHP Electronic Data Interchange EDI Help Desk at 1 888 863 3638 for assistance Important Rejected claims are not kept by TMHP and are not included in R amp S reports or claims status inquiries If the rejected claim is within the appropriate filing deadline period based on the date of service you may correct and resubmit the rejected claim If the rejected claim is beyond the filing deadline the next deadline to meet is 120 days following the date of the rejection In this case you must print the rejection report with valid batch ID to prove timely filing and send it along with a paper claim to TMHP 16 4 Retrieve Other Tab Program Summary 1 Send Requests Category Type Download LTC Reference Codes Billing Codes Service Codes Service Group The Retrieve Other tab is used to LTC Procedure Codes ltem Codes electronically download R amp S reports EOB and reference codes LTC Crosswalk AlI LTC Reference Codes LTC System C21 Reference Codes Diagnosis Codes DRG Codes Edit Audit Codes Codes Process ER amp S 49 TDHconnect 3 0 Workbook for Acute Care Providers 16 4 1 Retrieve ER amp S Reports Important You must have a signed Electronic Remittance and Status ER amp S Agreement on file with TMHP before you are allowed to download ER amp S reports ER
104. tabase see Section 14 2 Database Utilities on page 35 for instructions after downloading codes 13 4 1 Downloading Compass21 C21 Reference Codes Select the Retrieve Other tab on the TDHconnect System Totals window File Edit Reports Security View Tools Communications Navigation Help OR lt P OU 0 DHconnect TDHconnect System Totals 1 Blue Shield 2 C Family Planning Long Term Care Medicaid Medicare Files LTC Reference Codes ystem Billing Codes Program Summary Send Requests Retrieve Responses X Category Type Download Service Codes Service Group LTC Procedure Codes Item Codes LTC Crosswalk AI LTC Reference Codes LTC System C21 Reference Codes Diagnosis Codes DRG Codes E dit Audit Codes Process ER amp S EOB Codes 7 Scroll down to C21 Reference Codes 8 Use the check boxes in the Download column to select the codes to download 9 Click Download 10 After the download is complete compress the database again see Section 14 2 Database Utilities on page 35 for instructions Page 34 PR TDHc3 0AC_02 18 05_v 0 4 TDHconnect 3 0 System Maintenance 14 TDHconnect 3 0 System Maintenance 14 1 System Functions Overview 1 To view system functions double click the System folder in File Edit Reports Secu
105. tal Charges 0 00 Other Insurance Paid 0 00 Net Billed saye as emplate Patient Provider Status Claim Number New Patient Provider Claim Diagnosis Details Other Insurance Total Perform Provider Perf Last Name Perf First Name B Charges ID EM 3 j a di Sa P 4 b Total Charges 0 00 Other Insurance Paid 0 00 Net Billed 0 00 Save as Template Interactive Gk Cancel 71 TDHconnect 3 0 Workbook for Acute Care Providers 18 6 Inpatient Claims To fill out an inpatient claim HIPAA transaction 8371 double click Claims in the Medicaid folder then click the Inpatient icon or click File New Inpatient Note The Other Insurance tab is identical on the professional 837P claim previously covered The Patient tab Provider tab Claim tab Diagnosis tab and Details tab are described below 18 6 1 Patient Tab Required fields Account No Medicaid No and provider defined Medical Record No Last Name and First Name Sex Date of Birth Street Address City State and Zip Code Patient Provider Status Claim Number pee D ton E Patient Provider Claim Diagnosis Details Other Insurance Patient Identification Numbers Account No SSN Medicaid No Medical Record No Name Last Name First Name MI Suffix 8 MU Patient General Information Sex Date o
106. tered on the Diagnosis tab 7 Input the quantity Qty and Unit Price The Total Charges are calculated 8 Use the scroll bar to gain access to the fields on the right hand side of the window If the provider is a member of a group enter the nine digit performing provider number Perform Provider ID and name Perf Last Name Patient Provider Status Claim Number New Patient Provider Claim Diagnosis Details Other Insurance Date of POS Procedure Procedure Mod Mod Mod Mod Diag Total Service Code ID Code 1 2453 ee od e Ref Charges ER a 32 FEE 4 EE _ 68 _ F _ 8 3 10 11 4 b Total Charges 0 00 Dther Insurance Paid 0 00 Net Billed 0 00 Page 68 PR TDHC3 0AC 02 18 05 v 0 4 Medicaid and Family Planning Claims Patient Provider Status Claim Number New Patient Provider Claim Diagnosis Details Other Insurance Total Perform Provider Perf Last Name Perf First Name B Charges ID NS p E LL um 5 4 i Total Charges 0 00 Other Insurance Paid 0 00 Net Billed 0 00 Save as Template Interactive Ok Cancel 69 TDHconnect 3 0 Workbook for Acute Care Providers 18 5 Dental Claims To fill out a dental claim HIPAA transaction 837D double
107. tia TMHP EDI Help Desk issued in lower case Phone Number Password that the TMHP EDI Help ECMS Desk issued also in lower case e Organization Last Name Cancel 5 Enter your User ID Password and Organization Last Name in the Long Term Care section if applicable 6 Enter 1 800 291 3734 in the ECMS field in the Phone Number section Important TDHconnect 3 0 uses a single telephone number for all transmissions batch and interactive Page 27 TDHconnect 3 0 Workbook for Acute Care Providers 7 Select the Contact Information tab System Settings SystemSettings 8 For each ID on the System Settings tab enter the following information in the correct section C21 Site Contact Information or Long Term Last Name First Name Care Site Contact Information Contact Phone Number 07 e First Name C21 Site Contact Information e Last Name e Contact Phone Number 9 Click Apply 10 Click OK Long Term Care Site Contact Information Last Name First Name Contact Phone Number TE 12 2 Modem Settings 1 Log into TDHconnect 3 0 if you are not already logged in The TDHconnect 3 0 System Totals window opens in the workspace Communications Navigation E System Settings 2 Select Communications gt Modems on the TDHconnect 3 0 menu bar Modems The Installed Modems dialog box opens TexMedNet Installed Mod gt
108. to track the client e Medicaid No is the nine digit client Medicaid number 4 After entering client data click OK The Client Common Setup window opens 5 Enter another client or click Cancel to close 13 2 Adding Providers This section describes the steps necessary to add provider data 1 Expand the Reference Files folder and double click Provider The Provider Selection window opens in the workspace 7 TDHconnect Provider Selection File Edit Reports Security View Tools Communications Navigation Help D a a amp weugu TDHconnect C Blue Shield Last Organization Name First Name Tax ID Blue C Family Planning Long Term Care Medicaid Medicare C Reference Files Client Provider v Reference Codes System 17 5 8 8 EH E gt Display Providers For This Filter Program Name z Autofind Column Filter Type Blue Shield Last Organization Name 7 6 Starts With CIDC ivi Autofind Text Mode Family Planning Use Find Test Instantly Contains Long Term Care iv 3 Medicaid VERE Exact Match Medicare v Ma Deere A animam fal Find Text Add 2 Click The Provider Common Setup window opens in the workspace Note Fields with bold headings must be complet
109. to TMHP ao fF oO Retrieve a batch request 1 24 hours after request submission open the TDHconnect 3 0 System Totals window and select the Retrieve Responses tab 2 Select the check box for Eligibility in the Download column Click Download Requests are now changed to Processed status 4 To view the downloaded response double click Eligibility under the Medicaid folder left side of window then double click the response 17 5 Medicaid Eligibility Response The response displays client eligibility Tabs with shaded labels have no information to display Note HIPAA compliant eligibility responses no longer display authorization information or Relationship to the Insured on the Other Insurance tab Click the Patient icon in the upper right corner of the screen to send client information to the Client Reference file which allows the magnifying glass icons to be used later to populate client information in forms Page 53 TDHconnect 3 0 Workbook for Acute Care Providers When the Eligibility Save Patient Wizard opens select the fields to send to the client reference file or click Select All and click Finish A message states that the patient was updated Select the Managed Care tab to see the HMO or PCCM Texas Health Network information Select the Benefit Limits tab for the latest eyeglass hearing aid THSteps dental and THSteps medical claims Select the Other Insurance tab for information on other ins
110. ts Security View Tools Communications Navigation Help D a aw Ba f amp E X TDHconnect Blue Shield CIDC Family Planning Long Term Care L Medicaid Medicare __ Reference Files Client Provider Reference Codes System Filter Program Name ciens PUT his Autofind Column Filter Type Biue Shield Last Name c amp Stats With iv Autofind Text Mode Family Planning Use Find Text Instantly Contains Long Term Care z Medicaid ic SES LI GS Exact Match Medicare fa Find Text Add 2 clients manually click Add The Client Common Setup window opens in the workspace Note You must complete all fields with bold headings to successfully add a client Page 29 TDHconnect 3 0 Workbook for Acute Care Providers Client Last Name First Name Suffix Client Information Address 1 Client Status Launch Program For Program Name Client b Blue Shield L1 Blue Shield Address 2 EEDE LI CIDC Family Planning O Family Planning i LongTemCae Long Term Care City State ZIP Code ea Medicaid Medicaid Y Medicare O Medicare Phone No
111. tware Requirements Important Verify that your system meets the minimum requirements before attempting to install the TDHconnect 3 0 software The table below gives the minimum and recommended hardware configurations for running TDHconnect 3 0 software Torun TDHconnect 3 0 your computer system must meet the minimum requirements TDHconnect 3 0 is not supported on non Windows operating systems or on systems not meeting the minimum requirements For improved performance your system should meet or exceed the recommended requirements HARDWARE Minimum Recommended PC with a Pentium class processor PC with a Pentium class processor 400 MHz or faster 128MB of RAM 128MB of RAM 100MB hard disk space for installation 100MB hard disk space for installation plus three times the size of the database plus three times the size of the database CD ROM drive for installation CD ROM drive for installation 800 x 600 VGA monitor resolution 256 colors 800 x 600 VGA monitor resolution 256 colors 9600 bps modem 28800 28 8K bps or faster modem SOFTWARE Minimum Recommended Microsoft Windows 95 or more recent operating Microsoft Windows 95 or more recent operating system or Microsoft Windows NT 4 0 with Service system or Microsoft Windows NT 4 0 with Service Pack 5 Pack 5 Adobe Acrobat Reader 4 0 Acrobat Reader 4 05 is Adobe Acrobat Reader 4 05 included on the included on the TDHconnect 3 0 inst
112. ubsidiaries employees consultants x H the right side of the text box to betas Ge ae scroll through the text By accepting the terms of use you will be allowed access to programs reports and information protected by federal and state law contained in the secure portion of this 9 After you read and understand website Only authorized persons in lawful possession of a password provided by TMHP to P provide such passwords may enter and access the secure portion of this website The use the general terms and conditions of this website is subject to the terms of use contained herein Once you have accepted the terms of use you will not be asked to accept such terms select the check box next to again when you access the site another time TMHP has the right at any time to change or modify the terms of use which will be posted on this website Any use of the website by agree to these terms you after modified terms have been posted will be deemed to constitute acceptance by you I agree to these terms Activate Account 10 Click Activate Account J Your account is now activated Page 10 PR TDHC3 0AC 02 18 05 v 0 4 Accessing the TMHP Website 11 An Account Activation Confirmation dialog box opens to confirm that your user name and password have been sent to the email address that was specified in your request 12 Write down your user name and password and put it in a safe place Note If you
113. urers for the client To update the client s other insurance contact Third Party Resources at 1 800 846 7307 See also the Third Party Resources section in the Texas Medicaid Provider Procedures Manual nclude an account number before saving client data 17 6 Printing Eligibility Reports Six types of eligibility reports may be printed from the Medicaid Eligibility Request Response Summary Transmission 1 Click a batch eligibility response has Transmit Type B and a Transmission ID Summary 2 Click Reports and Transmission Summary to display the report The number of accepted or rejected responses is listed 3 Click Print for a paper copy Transmission 1 Click an accepted batch eligibility response has Transmit Type B and a Detail Transmission ID 2 Click Reports and Transmission Detail A list of eligibility responses in that batch is displayed 3 Click Print for a paper copy Information 1 Double click the completed row near the top of the window At least one Request completed eligibility request is required 2 Select a request that has been Completed but not Submitted 3 Click Reports gt Information Request on the TDHconnect 3 0 menu bar A detailed display of the request is given but no response information is available since this request has not yet been submitted to TMHP and retrieved 4 Click Print for a paper copy Information 1 Select an accepted response batch or interactive The response is displayed
114. vider Identifier number issued to you through Medicaid PR TDHC3 0AC 02 18 05 v 0 4 Attachments 22 4 Workshop Evaluation Location City Date Presenter s l Objective evaluate from 1 to 5 How well do you feel this workshop has fulfilled its objectives This workshop has helped me understand Effective Ineffective Installation 5 4 3 2 1 Eligibility Inquiries 5 4 3 2 1 Client Database 5 4 3 2 1 Claims Submission 5 4 3 2 1 Claim Status Inquiry 5 4 3 2 1 Electronic Adjustments 5 4 3 2 1 Reference Files 5 4 3 2 1 Electronic Remittance amp Status Reports 5 4 3 2 1 Paper Claim Forms 5 4 3 2 1 Overall program evaluate from 1 to 5 Yes No Content was informative and helpful to your office 5 4 3 2 1 Information was clearly presented and easily understood 5 4 3 2 1 Seminar met or exceeded your expectations 5 4 3 2 1 Would recommend this seminar to others 5 4 3 2 1 Comments Suggestions IV How did you hear about this workshop V Complete the following section only if you would like information or you have a question or problem you need help resolving Name Provider Provider Name Mailing Address Phone would like a visit to discuss the following questions or problems Page 113
115. w tmhp com 2 Click the Find Software Service Packs link in the I would like to list on the right side of the home page rify Eligibility Inquire about a Claim Status Find Publications File Library The TMHP File Library main page opens Email the Contact Center 3 Scroll down to locate the File Library links Register for a Worksho File Library VgFilter 4 Click the TDHconnect link The TMHP File Library TDHconnect web page opens 5 Scroll down to locate the File Library links Long Term Care Programs TDHconnect a vider Manuals File Library 6 Click the TDHconnect Updates link The TMHP File Library TDHconnect TDHconnect Updates web page opens Type Name Scroll down to locate the File Library links dj TDHconnect Install Errors 8 Select the most recent Service Pack IHconnect 3 0 Updates Service Pack 3 Ld TDHconnect Updates The File Download dialog box opens 9 Click Save The Save As dialog box opens 10 Save the file to the desktop 11 After the download is complete click Close and exit the TMHP website Page 19 TDHconnect 3 0 Workbook for Acute Care Providers 8 2 Installing a TDHconnect 3 0 Service Pack 1 Double click the TDHconnect 3 0 Updates Service Pack number zip icon This icon was added to the desktop during the file download TIP The file can be moved to a location on a LAN to share w
116. xn ID Type Transmit Date Time Requests Rejected Submitter ID Type Appeals 01 08 2001 12 51 05 PM Processed 1 L Medicare x C Reference Files C System List Delete 2 There are two types of CSI requests Provider Patient Request and Claim Request open new request do one of the following Click File New Request on the TDHconnect 3 0 menu bar Click the Provider Patient Request icon Click the Claim Request icon Page 93 TDHconnect 3 0 Workbook for Acute Care Providers 19 1 1 Provider Patient Request This batch request retrieves claim information for a specific client and provider over a range of up to three months of service dates and this three month window can go back three years Although the range of service dates can span only up to three months several requests could be submitted in a batch to cover a longer range of service dates TDHconnect Medicaid Claim Status Inquiry Provider Patient Request File Edit View Reports Tools Navigation Help ei amp 56 7 lt E TDHconnect Provider Patient Request C Blue Shield C CSHCN Family Planning Service Begin Date Service End Date Long Term Care vi 74 x 2 Medicaid Eligibility Provider Information Claims Provider ID Last Organization Name First Name Suffix rM ERS Appeals C Medicare Chent C Reference Files Medicaid

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