August 2005 LTC Provider Bulletin No. 23
Contents
1. Long Department of Aging and Disability Services lx TEXAS ba K A In This Bulletin This bulletin features an article titled In This Corner which includes current topics and issues that require in depth details to address In this edition of the bulletin In This Corner addresses the reorganization of the Community Living Assistance and Support Services CLASS Medicaid Waiver Program This article is located on page 3 of this bulletin This bulletin also features an article titled Most Frequently Asked Questions of this quarter which addresses questions providers have asked to Department of Aging and Disability Services DADS and the Texas Medicaid amp Healthcare Partnership TMHP staff members This article is located on page 5 of this bulletin M What s Coming Up Accessing a Claim Status Inquiry CSI Coming in November 2005 providers will have the capability of requesting a CSI by provider number This capability was removed during the Health Insurance Portability and Accountability Act HIPAA implementation in October 2003 Currently providers can only request a CSI by using the individual s number or internal control number Additional information will be provided in the November 2005 Long Term Care Provider Bulletin No 24 M Term Car re Prov Id e r i IN THIS EDITION In This Bulletin Whats Coming Up exercitu pere Chat or2. When the MESAV inquiry indicates that there are not enough authorized units When services have not been added to the authorization When there is a gap in the service authorization When changes need to be made to the service authorization H August 2005 Most Frequently Asked Questions During This Quarter Answered Question How will the rollout of the Texas Integrated Eligibility Redesign System TIERS application impact provider reimbursement in Travis and Hays Counties Answer There should be no impact to the way providers are reimbursed or to the services received by individuals Providers experiencing problems should report them through the normal reporting processes Question lf a primary home care PHC provider is paid at the priority level for a service they billed under a non priority level what should they do to correct it The individual s level is non priority Answer Report this error to the individual s caseworker The caseworker will need to change the level to non priority Once the level has been updated the claims will need to be resubmitted Question What methods are available for providers to check claim status and verify if reimbursement has been received for a previously filed claim Answer Providers should request a CSI by using the individual s case or Medicaid number or contact the TMHP Call Center Help Desk at 1 800 626 4117 Option 1 to determine if payment has b
3. 4666 Fax 1 512 490 4668 Website http ausmis31 dhs state tx us cmsmail Wi Bulletin Article Resources Article Name LTC Bulletin Page Numbers Coordination of Services and HIPAA Privacy Rules November 2004 No 5 Units of Service November 2004 No 6 Tip of the Quarter Diagnosis Codes November 2004 No 6 Common Billing Errors and How to Avoid Them November 2004 No 6 Physician s License Number November 2004 No 7 PASARR Medical Necessity Determination November 2004 No 8 Release of Information Code and Signature Source Code November 2004 No 9 Processing of Claims November 2004 No 20 9 Twelve Month Claims Submittal November 2004 No 20 9 Error and Suspense Reports Available for Medicaid February 2005 No 21 2 Certified Nursing Facility Providers TMHP s Intent to Discontinue Support of Windows 95 February 2005 No 21 3 TDHconnect 3 0 Service Pack 5 Release February 2005 No 21 Medicaid Eligibility Service Authorization February 2005 No 21 4 Verification MESAV Inquiries Use of Modifiers for Transition Assistance Services TAS February 2005 No 21 4 Medically Dependent Children s Program MDCP February 2005 No 21 Availability of Units Community Living Assistance and Support February 2005 No 21 5 Services CLASS Form Completion Most Frequently Asked Questions for This Quarter February 2005 No 21 5 e T claims showing up on R a
4. preferred workshop date online at the TMHP website at www tmhp com or by completing the form below and faxing it to 1 512 302 5068 or mail it to TMHP ATTN Provider Relations PO Box 204270 Austin TX 78720 4270 Select a workshop Community Based Alternatives 3652 CARE Form C Nursing Facility 3618 3619 and 3652 CARE Form LI TDHconnect 3 0 Please print Workshop City Workshop Date Provider Name Vendor Site ID Number Contact Name Daytime Telephone Number Number of Attendees Email Address Please provide an email address in case TMHP needs to contact you Individuals with disabilities who require auxiliary aids or services should call TMHP at 1 512 506 7810 for assistance with these arrangements August 2005 15 LIC Bulletin No 23 LTC Bulletin TEXAS MEDICAID amp HEALTHCARE PARTNERSHIP 12357 B RIATA TRACE PARKWAY PLACE POSTAGE AUSTIN TX 78727 HERE TMHP A STATE MEDICAID CONTRACTOR ATTENTION BUSINESS OFFICE
5. 512 506 3423 Abilene Midland Odessa and San Angelo Diane Molina EI Paso Isaac Romero Oo N AS 1 512 506 3530 Del Rio Kerrville and N San Antonio Sue Lamb 1 512 506 3422 1 512 506 7991 QN Va Brownsville Falfurrias and Laredo Cynthia Gonzales Corpus Christi and S San Antonio Will McGowan 1 512 506 3554 1 512 506 3447 Galveston Harris County and Wharton Rachelle Moore Harris County Linda Dickson Linda Wood CO N NO Conroe and Harris County 1 512 506 3446 1 512 506 7682 Gene Allred Beaumont and Lufkin 1 512 506 3425 Dallas Tyler and Waxahachie Sandra Peterson 1 512 506 3552 Dallas and Texarkana Olga Fletcher 1 512 506 3578 Eastland Fort Worth and Wichita Falls Rita Martinez 1 512 506 7990 Austin Bryan College Station Marble Falls and Andrea Daniell Waco August 2005 9 1 512 506 7600 m LIC Bulletin No 23 Provider Resources TMHP LIC Contact Information The TMHP Call Center Help Desk operates Monday through Friday 7 a m to 7 p m Central Time excluding holidays When calling the TMHP Call Center Help Desk providers are prompted to enter their nine digit LTC provider contract number using the telephone keypad If calling from a rotary telephone remain on the line for assistance Providers calling about Forms 3618 and 3619 and the 3652 CARE form need to enter their nine digit LTC provider contract numb
6. AD 1 512 438 3875 Institutional Services 1 512 438 2546 Hospice Services 1 512 438 2546 MR Services 1 512 438 3544 Cost report information days paid and services paid Use TDHconnect to submit a batch CSI How to prepare a cost report forms and instructions HHSC 1 512 491 1175 Website www hhsc state tx us medicaid programs rad index html How to sign up for or obtain direct deposit electronic funds transfer Accounting 1 512 438 3189 or 1 512 438 4684 Medicaid eligibility and name changes Medicaid Eligibility ME Worker or Claims Management 1 512 490 4666 Fax 1 512 490 4668 Website http ausmis31 dhs state tx us cmsmail Obtaining a copy of LTC Claim Form 1290 Contract Manager or Website ww w dads state tx us business communitycare infoletters index cfm under Community Care Information Letters Provider on hold questions Provider Services CCAD Contract Manager Institutional Services NFs Claims Management 1 512 490 4636 MR Services 1 512 438 3544 Status of warrant claim after it has been transmitted to Accounting fiscal by TMHP Accounting 1 512 438 3989 When calling Accounting provide the document locator number DLN number assigned by TMHP Comptroller s website https ecpa cpa state tx us Choose the State to Vendor Payment Info Online Search link Texas State University Texas Index Level of Effort TILE training The Office of Continu
7. as Ue EE CE o e tete 1 Xerxes vtero Cavite eo OTT E 2 Publishing National Code Descriptions meee eee eea 2 release Gir ID sleommnas 0 Sense aid 7 oman us p National Provider Idenninet NPI Updaten eee eee 2 TOEkonnect Iraning Maternal Available me ee nee 3 Changes to Electronic Data Interchange Agreements 3 In This Corner Changes in the Community Living and Support Services ETEA TEO TA A A A ESTO ATH 3 CLASS Braviders Remiimdets a c Most Frequently Asked Questions During This Quarter AS WELCO eem T d xc E ae Reminders Ni Gries 18 nen yu f SS a ro ND ESSA II UU ueteres eon ER amp S Reports Useful for Tracking Billing Activity 5 Tips Given for Accessing and Downloading Information E a jas M e IM 6 Providers Encouraged to Bill Electronically e E 6 Following LTC Claim Form 1290 Guidelines Expedites lai LEO EES SEA E eme eet A TL EE 6 Most kregu nya ed Repor a a cedeororesa epee 7 Error and Suspense Reports Available for Medicaid Certified Narine kaelhita Providers e eec ere eee ese continued on page 2 Current Procedural Terminology CPT is copyright 2005 American Medical Association AMA and American Dental Association ADA All Rights Reserved No fee schedules basic units relative values or related listings are included in CPT The AMA and the ADA assume no liability for the data contained herein Applicable Federal Acquisition Regulation System Department of Defense Regulati
8. ay 23 2007 An individual health care provider should not have more than one NPI Providers and health care plans may now begin transition to the NPI by applying for their identifier For additional NPI information including directions on how to apply for an NPI please visit the CMS website at www cms hhs gov hipaa hipaa2 However covered entities receiving their NPI cannot use the LIC Bulletin No 23 August 2005 NPI to bill Texas Medicaid until directed to do so by HHSC If these entities use the NPI before the state s claim payment systems are modified to accept it their claims will be rejected or denied Until given further direction from Texas Medicaid health care providers and clearinghouses should do the following Verify that TMHP and DADS has your correct contact information e Become informed about the NPI and its implementation e Identify processes and systems that are affected by provider identifiers Develop implementation plans e Educate staff HHSC has begun analysis regarding NPI requirements related to Texas Medicaid Additional provider information will be provided as it becomes available Ni TDHconnect Training Material Available TMHP conducts TDHconnect workshops and training on a quarterly basis in select cities Providers unable to attend a workshop or training session are encouraged to download the TDHconnect training material from the TMHP website at www tmhp com For more info
9. ds state tx us CLASS Interest Cindy Hale Manager List Program Enrollment Access Tellis and Intake Unit 1 e Interest List Updates Indi vidual Contact Information e Release Notices e Selection Notices Telphone 1 512 438 3768 Peggy Maderer Telephone 1 512 438 5235 E mail peggy maderer dads state tx us e Judy Lundgren Telephone 1 512 438 4459 E mail judy lundgren dads state tx us LTC Bulletin No 23 In This Corner Activity CLASS Other Data Entry e Service Authorization System SAS Contact Chris Adkins Data Entry Specialist Telephone 1 512 438 3156 Marta Lancon Data Entry Specialist Telephone 1 512 438 5490 CLASS Policy Development and Support e Adaptive Aid Minor Home Modifications Consumer Directed Services Levels of Care LOC Other activities i e remands of LOCs Policy Procedures Rider 7 28 Rules e Waiver Consumer Directed Services All Community Care Programs Susan Syler Unit Manager Policy Development and Support Unit Gwen Barrs Program Consultant Telephone 1 512 438 4278 E mail gwen barrs dads state tx us Bob Scott Program Consultant Telephone 1 512 438 4481 E mail bob scott dads state tx us Tommy Ford Program Specialist Telephone 1 512 438 3689 E mail tommy ford dads state tx us Ii CLASS Providers Reminders 1 Keep a copy of all documents mai
10. e Medical necessity Option 2 To speak with a nurse TDHconnect Technical issues obtaining access user IDs and passwords Modem and telecommunication issues ANSI ASC X12 specifications testing and transmission Processing provider agreements Verifying that system screens are functioning Getting EDI assistance from software developers EDI and connectivity Option 3 Technical support Electronic transmission of 3652 CARE forms Electronic transmission of Forms 3618 and 3619 Weekly Status Reports MDS submission problems Technical issues CARE form software CFS installation Transmitting forms Interpreting Quality Indicator QI Reports Option 3 Technical support LTC Bulletin No 23 10 August 2005 For questions about New messages banner in audio format for paper submitters Provider Resources Choose Option 4 Headlines topics for paper submitters Individual appeals Individual fair hearing requests Appeal guidelines Option 5 Request fair hearing Replay for menu options Option 6 Replay options NI DADS Contact Information Claims Management If you have questions about 12 month claims payment rule Contact Provider Services CCAD Contract Manager Institutional Services NFs Claims Management 1 512 490 4666 MR Services Claims Management 1 512 490 4666 Contract enrollment Provider Services CC
11. ebsite http ausmis31 dhs state tx us cmsmail Mental Health and Mental Retardation MHMR 1 512 438 4720 Client Assessment Registration System CARE Help Desk Program enrollment for utilization review UR usual 1 512 438 3597 customary utilization control UC Purpose codes and MR RC Assessment Form level of service level of need level of care and ICAP Provider contracts eligibility and vendor holds 1 512 438 3544 Provider systems access for CARE forms 1 512 438 5037 TPR issues 1 512 490 4635 Hospice Nursing Facilities Swing Beds or Rehabilitation Specialized Services 3652 CARE form and Forms 3618 and 3619 Claims Management 1 512 490 4666 missing incorrect information Fax 1 512 490 4668 Website http ausmis31 dhs state tx us cmsmail Deductions Claims Management 1 512 490 4666 Provider on hold questions Fax 1 512 490 4636 Audits Website http ausmis31 dhs state tx us cmsmail HCS TxHml billing policy payment reviews 1 512 438 3612 LTC Bulletin No 23 12 August 2005 Provider Resources If you have questions about Contact Hospice Nursing Facilities Swing Beds or Rehabilitation Specialized Services Hospice Authorization Forms 3071 3074 issues Claims Management 1 512 490 4666 Fax 1 512 490 4668 Website http ausmis31 dhs state tx us cmsmail Rehabilitation specialized services 1 800 792 1109 Service authorizations Claims Management 1 512 490
12. een made W Reminders Verify Eligibility with a MESAV Inquiry A MESAV inquiry enables providers to electronically obtain eligibility and service authorization information through TDHconnect software DADS updates TMHP files each weekday so the most current MESAV information is available to providers daily MESAV inquiries provide valuable information about each individual participating in the LTC Program It enables providers to check services units eligibility medical necessity applied income co payment and level of service in the Service Authorization System SAS as well as the effective dates for those authorizations August 2005 In This Corner Reminders Authorized providers can access information about a specific individual for a specific date range by requesting a MESAV inquiry Information may be requested for dates spanning up to three months The information returned may expand beyond the three month range Information that providers receive is based on the individual s eligibility information available at TMHP The Claims Management System maintains confiden tiality by returning information only to the provider authorized to perform requested services for that individual Providers should verify an individual s eligibility before submitting a claim by generating a MESAV inquiry and also ensure the dates of service being billed fall within the effective dates of the service authorization One of the most c
13. er using a telephone keypad Additionally providers should have their four digit Vendor Facility Site ID number available When inquiring about a specific individual providers must have the Medicaid and or Social Security number available along with the individual s file or documentation When the nine digit LTC provider contract number is entered on the telephone keypad the TMHP Call Center Help Desk system automatically populates the TMHP representative s screen with that provider s specific information such as name and telephone number TMHP call center representatives can instantly view a provider s contact history complete with prior communication dates discussion topics and any notes made by representatives the provider has spoken to previously These enhancements enable the representative to research and respond to inquiries more effectively For questions to TMHP providers should call the TMHP Call Center Help Desk at the following telephone numbers For questions about General inquiries Using TDH connect e Austin local telephone number at 1 512 335 4729 Claim rejection and denials Understanding R amp S reports e Toll free telephone number outside Austin at 1 800 626 4117 or 1 800 727 5436 Choose Option 1 Customer service general inquiry e Completing Claim Form 1290 3652 CARE form e Claim adjustments Forms 3618 or 3619 e Claim status inquiries TILE levels e Claim history
14. ing Education Online course 1 512 245 7118 or 1 512 245 2507 correspondence course and general information Website www txstate edu continuinged Third Party Resources TPR TORT August 2005 Claims Management 1 512 490 4635 11 LIC Bulletin No 23 Provider Resources If you have questions about Contact Community Care for the Aged and Disabled Programs CCAD Community Based Alternatives CBA Community Living Assistance and Support Services CLASS Deaf and Blind with Multiple Disabilities DB MD Medically Dependent Children Program MDCP Consolidated Waiver and Hospice Programs CLASS Program Program Consultant DB MD Program 1 512 438 2622 Financial or functional eligibility criteria Caseworker or Case Manager Hospice policy questions 1 512 438 3169 MDCP 1 512 438 5391 Program policies procedures Contract Manager Intermediate Care Facility for Persons with Mental Retardation ICF MR Cost report payments quality assurance fee QAF 1 512 438 3597 Health and Human Services Commission 1 512 438 4720 Network HHSCN connection problems ICF MR durable medical equipment DME 1 512 490 4642 Home Community Based Services HCS Texas Home Living Waiver TxHml and home modifications adaptive aids and dental services ICF MR Residential Care RC billing questions and Claims Management 1 512 490 4666 individual movements service authorization Fax 1 512 490 4668 W
15. led faxed to the state office for data entry 2 To ensure there is no delay in entering data and receiving timely payment perform a quality review on each form submitted LTC Bulletin No 23 3 Review each form for accuracy and for the following requirements not all inclusive The form is legible and can be accurately read and deciphered The form includes the individual s correct Medicaid number The form includes the correct provider contract number Changes to the Individual Service Plan ISP are identified correctly C Change and N New Note Forms submitted that do not meet the above requirements will be returned for correction If a document has been faxed and the faxed copy is difficult to read include a copy of the original to ensure that information for data entry is legible 4 Allow 24 hours from the time the form is faxed to the agency by the state office for authori zations forms to appear on a MESAV inquiry Notify Claims Management immediately of any discrepancies When a claim is denied request a MESAV inquiry to determine the reason the claim denied Contact TMHP for the following issues When the reason for the claim denial is unknown To get an explanation of benefits EOB To find out how to correct an error To get assistance with using the Bill Code Crosswalk Contact the CLASS Program for the following issues
16. mp S report e Vendor Facility Site ID number Downloading the CARE Weekly Status Report Approved MN forms not showing up on SAS Accessing the Remittance and Status R amp S report February 2005 No 21 6 Through the TMHP Website Medical Necessity Weekly Status Report February 2005 No 21 Purpose Code E Reminders February 2005 No 21 2005 LTC User Manual to Be Mailed to Paper Submitters May 2005 No 22 August 2005 13 LTC Bulletin No 23 Provider Resources Article Name LTC Bulletin Page Numbers Tentative Release of TDH connect 3 0 Service Pack 6 May 2005 No Scheduled In This Bulletin Glossary has been removed May 2005 No New Security Features Enhance TMHP Website May 2005 No In This Corner May 2005 No e 3652 CARE Forms Tips for Completing the 3652 CARE Form Top Three Reasons Why Claims Deny May 2005 No Providers Verify Eligibility with a MESAV Inquiry May 2005 No Most Frequently Asked Questions During This Quarter May 2005 No e EOB 250 Late Billing Must be filed within 12 months from the end of the service month e T Miscellaneous Claims Recoupment e Vendor Facility Site ID number LTC Bulletin No 23 14 August 2005 Workshop Registration Form v 4 2005 Training TEXAS MEDICAID amp HEALTHCARE PARTNERSHIP a E TMHP ASTATE MEDICAID CONTRACTOR Registration Form Seating and materials are limited Please RSVP at least 10 days prior to your
17. n the national procedure or revenue code submitted on the claim It also lists any adjustments made to the total provider payment Providers will receive one ER amp S report per warrant issued for the reporting period e The Claim Activity section provides information about all finalized claims and claims still pending processing and or payment Finalized claims that make it through the claims payment process are either approved to pay or denied This section contains information such as the derived local billing code units paid billed amount paid amount and so forth Providers will receive only one Claim Activity section per reporting period The Claim Activity section may correspond to multiple Non pending sections if more than one warrant was received that week The Financial Summary section provides warrant information and warrant amounts for the reporting period To accurately assess claim activity for the reporting period all three sections must be used The Non pending and the Claim Activity sections outline which claims were processed the national code billed the local bill code derived and the payment amount for the services based on the derived bill code This is the only way to determine if the system derived the correct bill code for payment The number of warrants issued and indirectly the number of Non pending sections to look for are provided in the Financial Summary section NI Tips Given for Accessi
18. nal signature is required on each form Copied or stamped signatures are not accepted August 2005 Mail Form 1290 to the following address Texas Medicaid amp Healthcare Partnership ATTN Long Term Care MC B02 PO Box 200105 Austin TX 78720 0105 Delivery to TMHP could take five business days Allow ten business days for the claim to appear in the system Send overnight mail to the following address Texas Medicaid amp Healthcare Partnership ATTN Long Term Care MC B02 12357 B Riata Trace Parkway Austin TX 78727 Allow three days for the overnighted claim to appear in the system When contacting TMHP to check the status on a claim the overnight mail tracking number must be provided H Most Frequently Used Reports Processed 3652 CARE Forms Shown in Medical Necessity Weekly Status Report The Medical Necessity Weekly Status report contains all the 3652 CARE forms that have been successfully processed by TMHP for the previous week Providers receive the report in the same manner that forms are submitted If forms are transmitted electronically the report is available electronically for download If forms are submitted by mail the report is mailed to the provider If a form was mailed or submitted electronically and it does not appear on the Medical Necessity Weekly Status Report contact the Technical Support Help Desk at 1 800 626 4117 Option 3 When contacting the Technical Support Help Desk providers m
19. ng and Downloading Information and Reports The following are suggestions for accessing and downloading information and reports For help while using TDHconnect to complete download or retrieve files press the F1 key to access the electronic help option LIC Bulletin No 23 View the latest NEWS weekly on the TMHP website at www tmhp com LTC Programs Contact the TMHP Call Center Help Desk at 1 800 626 4117 Option 3 for assistance Ni Providers Encouraged to Bill Electronically TDHconnect is software designed for electronic submission of claims It is recommended that all providers submit claims electronically The following are advantages of using TDHconnect TDHconnect is free of charge e Providers can receive payment within five to seven days e The billing cycle is more closely related to business needs Time delays due to mailing are avoided Contact the TMHP Call Center Help Desk at 1 800 626 4117 Option 3 to obtain TDHconnect software H Following LTC Claim Form 1290 Guidelines Expedites Claims Processing Providers should use the following guidelines when billing using LTC Claim Form 1290 Print legibly Do not write in cursive If data is typed use a font large enough to distinguish between characters Complete all required fields Use the most current LTC Bill Code Crosswalk Review the form for accuracy before submitting e Sign each form An origi
20. ollowing are dates and locations for upcoming LTC workshops August 2005 in San Angelo Abilene and Corpus Christi October 2005 in Tyler Beaumont and Weslaco LIC Bulletin No 23 Provider Resources These workshops are designed to educate LTC providers about medical necessity processes for submitting a 3652 CARE form the importance of downloading and using the Weekly Status Report and much more Workshop information is posted on the TMHP website at www tmhp com when schedules are finalized A postcard will be mailed to providers as a reminder to register for the August and October 2005 workshops Providers should register at least ten days before the preferred workshop date Registration is available online at the TMHP website or by faxing the completed registration form to 1 512 302 5068 or mailing it to TMHP ATTN Provider Relations PO Box 204270 Austin TX 78720 4270 Providers do not receive a confirmation for registration Ihe Workshop Registration Form is available on page 15 of this bulletin and also on the TMHP website at www tmhp com C18 Workshops Workshop Forms Workshop Registration Form pdf M Helpful Information Available on LTC Websites The following websites contain information that is helpful to providers LIC Program information is available on the TMHP LTC webpage at www tmhp com LIC Programs The DADS website address is www dads state tx us On this website providers can A Access mental re
21. ommon reasons that claims deny is because the dates of service are not authorized during the service authorization period If the EOB states the individual is not authorized for services received generate a MESAV inquiry to verify that the correct dates and services are on file at TMHP Eligibility can expire or could be on hold Providers submitting paper claims on a Form 1290 can verify an individual s eligibility by contacting the TMHP Call Center Help Desk at 1 800 626 4117 Option 1 M ER amp S Reports Useful for Tracking Billing Activity The Electronic Remittance and Status ER amp S reports are valuable tools to use when tracking billing activities A successful business typically has good accounting practices such as reconciliation of ER amp S reports Agencies who do not reconcile their ER amp S reports may be billing incorrectly which can result in an audit exception and penalties assessed on the agency It is the providers responsibility to reconcile all ER amp S reports to ensure billing is done correctly Providers are encouraged to download and generate their ER amp S reports weekly because each report is only available for a 30 day time period When generating a report use dates beginning on Friday through the following Monday LTC Bulletin No 23 Reminders ER amp S reports are divided into the following three separate sections e The Non pending section contains HIPAA compliant information based o
22. on System FARS DFARS restrictions apply to government use Whats Coming Up continued from page 1 Provider Resources Dates and Locations Given for TMHP Provider Workshops Helpful Information Available on LTC Websites TMHP Provider Relations Representatives TMHP LIC Contact Information DADS Contact Information Claims Management Bulletin Article Resources Forms Accessing Managed Care Information Providers will be able to access Managed Care information when requesting a Medicaid Eligibility System for Application Verification Eligibility Reports and Referrals SAVERR and Medicaid Eligibility Service Authorization Verification MESAV inquiry beginning in November 2005 Look for additional information published in the November 2005 Long Term Care Provider Bulletin No 24 M Publishing National Code Descriptions Because of copyright limitations the Texas Health and Human Services Commission HHSC has directed all state agencies to remove all Current Procedural Terminology CPT and Healthcare Common Procedure Coding System HCPCS code descriptors from any publication related to Medicaid Removal of these descriptors should not result in major inconveniences for providers since most agencies are familiar with which procedure codes to use when billing Providers can access a list of all current HCPCS and CPT codes and their descriptors on the Centers for Medicare amp Medicaid Services CMS website at
23. rmation refer to the Provider Resource article on page 7 of this bulletin 8 Changes to Electronic Data Interchange Agreements The Electronic Data Interchange Agreement TDHconnect Order Form and the Submitter ID Linking Form have been modified to reflect changes to the software platform and to comply with HIPAA updates These modifications should decrease form duplication and the number of errors when completing the form thereby decreasing return mail to the provider community Effective immediately providers should use the new forms located on the TMHP website at www tmhp com Providers can contact the TMHP EDI Help Desk at 1 800 626 4117 Option 3 with questions about completing the forms H August 2005 What s Coming Up In This Corner In This Corner Activity CLASS Contracts Complaints nvestigations e Contract Management Monitoring Changes in the Community Living and Support Services CLASS Program The DADS Community Services Department is in the process of reorganizing the CLASS Medicaid Waiver Program Refer to the following table for a list of activities and the contact information for each Contact e Rosalin Willis Community Services Contracts Unit Manager Linda Bettis Telephone 1 512 438 5652 E mail linda bettis dads state tx us Geraldine Taylor Program Request for Consultant Proposal RFP Telephone 1 512 438 2655 E mail geraldine taylor da
24. tardation services information B Access Community Care Information Letters at www dads state tx us business communitycare infoletters index cfm under Community Care Information Letters C Access information for nursing facilities and therapy providers at www dads state tx us business Itc policy index cfm under Communications D Access the LTC Bill Code Crosswalk at www dads state tx us business communitycare index cfm under Community Care Programs E Access LTC messages and alerts LTC Bulletin No 23 8 August 2005 TMHP Provider Relations Representatives TMHP provider relations representatives offer a variety of services designed to inform and educate the provider community about TDHconnect and claims filing procedures Technical support and training are also provided for TDHconnect software users Provider relations representatives assist providers through telephone contact on site visits and scheduled workshops The map at right and the table below indicate the TMHP provider relations represen tatives and the areas they serve Additional information including a regional listing by county and workshop information is available on the TMHP website at www tmhp com Providers default aspx Click on the Regional Support link then choose the applicable region Territory Regional Area Provider Resources Provider Representative Telephone Number 1 Amarillo and Lubbock Elizabeth Ramirez 1 512 506 6217 1
25. ust have transmission information available the transmission number date of transmission number of forms sent etc For additional information contact the TMHP Call Center Help Desk at 1 800 626 4117 Option 1 E August 2005 Reminders Provider Resources Error and Suspense Reports Available for Medicaid Certified Nursing Facility Providers Nursing facility NF providers can electronically access the Nursing Home Form Suspense and Error Report This report contains transaction notices Forms 3618 and 3619 and 3652 CARE forms that have suspended or received errors in the system and cannot be processed for payment For more information refer to the DADS secured webpage at http txnfsr dhs state tx us NFSRWeb app home or call Provider Support at 1 512 490 4666 M Provider Resources Dates and Locations Given for TMHP Provider Workshops Long Term Care TDHconnect Workshops TMHP conducts TDHconnect 3 0 workshops in select cities every quarter The following are dates and locations for upcoming LTC workshops August 2005 in San Angelo Abilene and Corpus Christi October 2005 in Tyler Beaumont and Weslaco These workshops are designed to educate LTC providers about claims submission MESAV inquiries CSI ER amp S reports and much more Community Based Alternative 3652 CARE Form Nursing Facility Forms Workshops TMHP conducts forms completion workshops in select cities every quarter The f
26. www cms hhs gov medicare hcpcs Additionally providers can purchase a copy of the HCPCS and CPT codes with the descriptors through the same CMS website 8 Release of TDHconnect 3 0 Service Pack 7 The TDH connect 3 0 Service Pack 7 is scheduled for release on November 4 2005 Service Pack 7 includes an enhancement that will give providers the ability to request a CSI by provider number and the ability to view the managed care information when requesting a MESAV inquiry Additional information will be published in the November 2005 Long Term Care Provider Bulletin No 24 For more information or help with downloading or installing service packs contact the TMHP Electronic Data Interchange EDI Help Desk at 1 800 626 4117 Option 3 M National Provider Identifier NPI Update As reported in the February 2005 Long Term Care Provider Bulletin No 21 and the May 2005 Long Term Care Provider Bulletin No 22 the United States Department of Health and Human Services HHS published the NPI Final Rule in January 2004 This rule adopts the NPI as the standard unique identifier for health care providers All entities meeting the definition of health care provider as described in the 45 Code of Federal Regulations CFR 160 103 can apply for an NPI Covered entities that meet the definition for health care providers will be required to obtain and use the NPI in standard transactions by the compliance date of the rule which is M
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