November 2005 LTC Provider Bulletin No. 24

November 2005 LTC Provider Bulletin No. 24
November 2005
No. 52
P r oCare
v i Needs
d e r Program
B u l
The Children with Special Health
No. 24
l e t i n
IN THIS EDITION
In This Bulletin
In This Bulletin
This bulletin includes a provider survey about the
Long Term Care (LTC) TDHconnect Workshops
currently conducted on a quarterly basis by
TMHP. The Department of Aging and Disability
Services (DADS) is interested in hearing about
the effectiveness of the training workshops and the
training needs of the LTC provider community.
The results of this survey will provide DADS and
TMHP with valuable information to improve
TDHconnect training and to be more effective for
both new and established providers.
What’s New?
This bulletin also includes information about the
release of TDHconnect 3.0 Service Pack 7 on
November 4, 2005.
Reminders
What’s New?
Providers’ Survey TDHconnect Training
With the implementation of the Claims
Management System (CMS) in 1999, TDHconnect
training has been offered through provider
workshops conducted by TMHP on a quarterly
basis. DADS would like to receive comments and
recommendations from the provider community
about the training and is requesting providers
complete the survey found on page 15.
continued on page 2
Providers’ Survey TDHconnect Training .............................. 1
TDHconnect
DHconnect and Broadband ................................................ 2
Release of TDHconnect 3.0 Service Pack 7 .......................... 2
Performing a Claim Status Inquiry (CSI) ............................. 3
Accessing Managed Care Information .................................. 3
Publishing National Code Descriptions ................................ 3
National Provider Identifier (NPI) Update............................ 3
Most Frequently Asked Questions During This Quarter
Answered ................................................................................ 4
Verify Eligibility with a MESAV Inquiry .............................. 4
ER&S Reports Useful for Tracking Billing Activity ............. 5
Tips for Accessing and Downloading Information and
Reports ................................................................................... 6
Providers Encouraged to Bill Electronically........................... 6
Following LTC Claim Form 1290 Guidelines Expedites
Claims Processing ................................................................. 6
Provider Resources
TMHP Provider Workshops .................................................. 6
Helpful Information Available on LTC Websites .................. 7
TMHP Provider Relations Territory Map ............................. 8
TMHP Provider Relations Representatives ........................... 9
continued on page 2
Current Procedural Terminology (CPT) is copyright 2005 American Medical Association (AMA), and the Current Dental Terminology (CDT) is copyright 2005 American
Dental Association (ADA). All Rights Reserved. No fee schedules, basic units, relative values, or related listings are included in CPT or CDT. The AMA and the ADA assume
no liability for the data contained herein. Applicable Federal Acquisition Regulation System/Department of Defense Regulation System (FARS/DFARS) restrictions apply
to government use.
What’s New?
Release of TDHconnect 3.0 Service Pack 7
continued from page 1
TDHconnect 3.0 Service Pack 7 was released on
November 4, 2005. Service Pack 7 includes the
following enhancements:
TMHP LTC Contact Information ...............................10
DADS Contact Information—Claims
Management .................................................................11
• Claim Status Inquiry (CSI) requests can
be made by using the provider number.
Bulletin Article Resources............................................ 13
Provider Survey for the LTC TDHconnect Training
Workshop ......................................................................15
• Managed care information can be viewed
when performing a Medicaid Eligibility Service
Authorization Verification (MESAV) inquiry.
continued from page 1
• The eligibility response files include inactive
eligibility segments (time periods).
This information will assist DADS and TMHP in
making future content and format changes to the
training.
TDHconnect users should download all previously
requested responses, such as CSIs and MESAVs, before
installing Service Pack 7.
This survey may be detached from the bulletin and
either faxed to DADS Claims Management by
November 30, 2005, at 1-512-438-4380 or mailed to:
Follow these steps to access the service pack:
Department of Aging and Disability Services
Claims Management MC-W-465
PO Box 149030
Austin, TX 78714-9030
1. Connect to the TMHP website
at www.tmhp.com.
2. Click the Find Publications/File
Library link in the “I would like to…” list
on the right side of the homepage. The
TMHP File Library webpage opens.
3. Click the TDHconnect link. The TMHP
File Library/TDHconnect webpage opens.
4. Click the TDHconnect Updates link.
The TMHP File Library/TDHconnect/
TDHconnect Updates webpage opens.
TDHconnect and Broadband
5. Click tdhsp7 to begin installation.
TDHconnect service Pack 5 was released on
May 5, 2005. Service Pack 5 added a secure Internet
based solution for TDHconnect that allows providers
or submitters to use broadband, cable, or DSL
connectivity when submitting transactions through
TDHconnect. DADS and TMHP encourages providers
to use the new connectivity methods.
Service Pack Installation
To install the service pack, follow these steps:
1. Double-click the TDHconnect 3.0 Updates
Service Pack 7.msi icon. This icon was added
to the desktop during the file download.
The advantages of using broadband are:
2. A dialog opens with the following message:
“This will install TDHconnect 3.0 Service
Pack 7. Do you want to continue?” Click Yes
to install the TDHconnect 3.0 Service Pack.
• Sending and receiving information is easier and
faster.
• Business telephone lines are not in use for long
periods of time.
• Additional telephone lines are not necessary.
LTC Bulletin, No. 24
2
November 2005
What’s New?
3. After the TDHconnect Service Update
Installation Utility window opens and
the TDHconnect 3.0 Service Pack wizard
opens, several informational messages
will open. Read each message and click
Next to advance to the next screen.
Accessing Managed Care Information
Effective November 2005, providers will be able to
access managed care information when performing
a Medicaid Eligibility System for Application, Verification, Eligibility, Reports, and Referrals (SAVERR)
or a MESAV inquiry. Providers requesting a MESAV
inquiry will receive managed care information if
it exists and if the provider is eligible to receive
valid eligibility information. The provider is not
required to be associated with the individual’s service
authorization to receive managed care information.
A provider who is associated with the individual’s
service authorization will receive all eligibility
information for the individual, including managed
care and service authorization information.
4. A dialog opens with the following message:
“Do you wish to backup your databases?” This
will overwrite databases that are in the Backup
folder. Choose one of the following options:
A. Click Yes to backup your databases
before installing any database updates
(this is the recommended choice).
B. Click No to continue with the installation without making backups.
5. 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.
Publishing National Code Descriptions
Effective September 2005, the LTC Bill Code
Crosswalk no longer includes Current Procedural
Terminology (CPT) and Healthcare Common
Procedure Coding System (HCPCS) code descriptors.
Because of copyright limitations, HHSC directed all
state agencies to remove these descriptors. Providers
may view and/or purchase a list of all current HCPCS
and CPT codes and their descriptors on the Centers for
Medicare & Medicaid Services (CMS) website at www.
cms.hhs.gov/medicare/hcpcs.
6. Read the document, close it, uncheck the View
readme check box, and click Finish.
7. When prompted to restart the computer, select
“Yes, I want to restart my computer now,” and
then click Finish. The next time TDHconnect
is opened, the version of the service pack is listed
along with the name TDHconnect 3.7.0.
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.
National Provider Identifier (NPI) Update
HHSC is currently reviewing a transition strategy to
allow submission of both the legacy provider number
and the National Provider Identifier on standard
electronic transactions. This process will allow the state
to collect data from providers prior to the compliance
date, May 23, 2007, and will facilitate a smoother
transition to the NPI. Submission of a Texas Provider
Identifier (TPI) will not be permitted after the
compliance date.
continued on page 4
Performing a Claim Status Inquiry (CSI)
Effective November 2005, CSI functionality will
include new searching capabilities, allowing providers to
create group templates and access information by using
the provider and individual’s number.
November 2005
3
LTC Bulletin, No. 24
What’s New?/Reminders
Most Frequently Asked Questions During
This Quarter Answered
Background
As reported in the May/June 2005 T
Texas Medicaid
Bulletin, No. 186 and the May 2005 Long Term Care
Bulletin, No. 22, the United States Department of
Health and Human Services (HHS) published the
final National Provider Identifier (NPI) rule in January
2004.
Question: What process should a provider follow when
requesting an onsite visit or TDHconnect training from
a TMHP provider relations representative?
Answer: Providers should contact the field-based
representative assigned to their area to request a
visit. The territory map and the corresponding
provider relations representatives, along with
their telephone numbers is also listed on pages 8
through 9 of this bulletin and listed on the TMHP
website at www.tmhp.com.
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 May 23, 2007. An
individual health care provider should not have more
than one NPI.
Question: How many days does a TMHP provider
relations representative have to return calls?
Answer: TMHP provider relations representatives
return telephone calls within 24 to 48 business hours
from receipt.
Providers 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, visit the CMS website at
www.cms.hhs.gov/hipaa/hipaa2. However, covered
entities receiving their NPI cannot use the NPI to bill
Texas Medicaid until directed to do so by the Health and
Human Services Commission (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
denied.
Question: What process should a provider follow when
they do not receive a return call from a TMHP provider
relations representative within the 48-business hour
timeframe?
Answer: Providers should contact the TMHP Call
Center/Help Desk at 1-800-626-4117 and request the
agent make a referral to TMHP Provider Relations.
Question: When would it be more appropriate to call
the TMHP Call Center/ Help Desk at 1-800-626-4117
rather than calling the provider relations representative?
Until given further direction from the Texas Medicaid
Program, health care providers and clearinghouses
should do the following:
Answer: Providers who need technical assistance, claim
status, or other services (listed on page 10 under TMHP
LTC Contact Information) should contact the TMHP
Call Center/Help Desk. Providers should contact their
provider relations representative for onsite educational
and training needs.
• Verify contact information with
TMHP and DADS
• Become informed about the NPI
and its implementation
Reminders
• Identify processes and systems that are
affected by provider identifiers
Verify Eligibility with a MESAV Inquiry
• Develop implementation plans
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 always available.
• Educate staff
For more information, visit the TMHP website at
www.tmhp.com.
LTC Bulletin, No. 24
4
November 2005
Reminders
Providers are encouraged to download and generate
their ER&S reports weekly because each report is
only available for 30 days. When generating a report,
use dates beginning on Friday through the following
Monday.
MESAV inquiries provide valuable information
about each individual enrolled in the LTC
Program. The inquiries enable 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.
ER&S reports are divided into the following three
sections:
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 extend beyond the threemonth range. Information that providers receive
is based on the individual’s eligibility information
available through TMHP. The Claims Management
System maintains confidentiality by returning
information only to the provider authorized to
perform requested services for that individual.
• The Non-Pending section contains HIPAAcompliant information based on 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&S report per warrant issued for the reporting
period.
• 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.
Providers should verify an individual’s eligibility
before submitting a claim by generating a MESAV
inquiry and ensure the dates of service being billed
fall within the effective dates of the service authorization. One of the most common reasons claims
deny is the dates of service are not within the
service authorization period. If the explanation of
benefits (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.
• The Financial Summary section provides warrant
information and warrant amounts for the
reporting period.
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.
To accurately assess claim activity for the reporting
period, all three sections must be used.
The Non-Pending and 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.
ER&S Reports Useful for Tracking Billing
Activity
Electronic Remittance and Status (ER&S) reports are
valuable tools to use when tracking billing activities.
A successful business typically has good accounting
practices, such as reconciliation of ER&S reports.
Agencies that do not reconcile their ER&S reports
may be billing incorrectly, which can result in audit
and/or penalties. It is the provider’s responsibility to
ensure all billing is done correctly.
November 2005
The number of warrants issued, and indirectly, the
number of Non-pending sections to look for are
provided in the Financial Summary section.
5
LTC Bulletin, No. 24
Reminders/Provider Resources
• Sign each form:
Tips for Accessing and Downloading
Information and Reports
— An original signature is required on each
form.
The following are suggestions for accessing and
downloading information and reports:
— Copied or stamped signatures are not
accepted.
• For help while using TDHconnect to complete,
download, or retrieve files, press the F1 key to
access the electronic help option.
Mail Form 1290 to the following address:
TMHP
ATTN: Long Term Care, MC-B02
PO Box 200105
Austin, TX 78720-0105
• View the latest weekly NEWS 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.
Delivery to TMHP could take five business days. Allow
ten business days for the claim to appear in the system.
Providers Encouraged to Bill Electronically
Send overnight mail to the following address:
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:
Texas Medicaid & Healthcare Partnership
ATTN: Long Term Care, MC-B02
12357-B Riata Trace Parkway
Austin, TX 78727
• TDHconnect is free of charge.
Allow three to five business days for the
overnighted claim to appear in the system.
Providers contacting TMHP to check
the status on a claim must provide the
overnight mail tracking.
• Claims are dispositional within five to seven days.
• The billing cycle is more closely related to
business needs.
• Time delays due to mailing are avoided.
Provider Resources
Contact the TMHP Call Center/Help Desk at
1-800-626-4117, Option 3, to obtain TDHconnect
software.
TMHP Provider Workshops
The following workshops are occurring this quarter:
Following LTC Claim Form 1290
Guidelines Expedites Claims Processing
Long Term Care TDHconnect Workshops
• Do not write in cursive.
TMHP conducts LTC workshops in select cities every
quarter. These workshops are designed to educate
LTC providers about TDHconnect claims submission,
MESAV inquiries, CSI, ER&S reports, and much
more.
• If data is typed, use a font large enough to
distinguish between characters.
Community-Based Alternative 3652 CARE Form—
Nursing Facility Forms Workshops
• Complete all required fields.
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.
Providers should use the following guidelines when
billing LTC Claim Form 1290:
• Print legibly.
• Use the most current LTC Bill Code Crosswalk.
• Review the form for accuracy before submitting.
LTC Bulletin, No. 24
6
November 2005
Provider Resources
Registration and Schedule Information
Workshop information is posted on the TMHP website at www.tmhp.com when schedules are finalized. Additional
information about upcoming 2006 dates and locations for the LTC workshops will be published in the February
2006 Long Term Care Provider Bulletin, No. 25. Providers should register at least ten days before the preferred
workshop date. Providers may register 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. The Workshop Registration Form is available on the TMHP
website at www.tmhp.com/C18/Workshops/Workshop Forms/Workshop Registration Form.pdf.
Helpful Information Available on LTC Websites
The following websites contain information that is helpful to providers:
A. LTC Program information is available on the TMHP-LTC webpage at www.tmhp.com/LTC
Programs.
B. On the DADS website (www.dads.state.tx.us), providers can:
C. Access mental retardation services information.
D. Access Community Care Information Letters at www.dads.state.tx.us/business/communitycare/
infoletters/index.cfm under Community Care Information Letters.
E. Access information for nursing facilities and therapy providers at www.dads.state.tx.us/business/
ltc-policy/index.cfm under Communications.
F. Access the LTC Bill Code Crosswalk at www.dads.state.tx.us/business/communitycare/index.cfm
under Community Care Programs.
G. Access LTC messages and alerts.
November 2005
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LTC Bulletin, No. 24
Provider Resources
TMHP Provider Relations Territory Map
LTC Bulletin, No. 24
8
November 2005
Provider Resources
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. Provider relations representatives assist providers
through telephone contact, on site visits, and scheduled workshops.
The map on page 8 and the following table indicate TMHP provider relations representatives and the areas they
serve. Additional information, including a regional listing by county and workshop information, is available on
TMHP website at www.tmhp.com/Providers/default.aspx. (Click on the Regional Support link, then choose the
applicable region.)
Territory
Regional Area
Provider Representative Telephone Number
1
Amarillo, Childress, and Lubbock
Elizabeth Ramirez
1-512-506-6217
2
Midland, Odessa, and San Angelo
Diane Molina
1-512-506-3423
3
Alpine, El Paso, and Van Horn
Isaac Romero
1-512-506-3530
4
Del Rio, Eagle Pass, and Laredo
Francisca Sanchez
1-512-506-7271
5
Brownsville, Harlingen, and McAllen
Cynthia Gonzales
1-512-506-7991
6
Abilene and Wichita Falls
Matthew Cogburn
1-512-506-7095
7
Brady, Brownwood, Hospitals in Travis County, Andrea Daniell
Round Rock, and Waco
1-512-506-7600
8
Austin, Bryan, College Station, and Wharton
Heather Tarman
1-512-506-3526
9
San Antonio and Kerrville
Sue Lamb
1-512-506-3422
10
San Antonio, Corpus Christi, and Victoria
Will McGowan
1-512-506-3554
11
Cleburne, Denton, and Fort Worth
Rita Martinez
1-512-506-7990
12
Dallas, Corsicana, and Groesbeck
Sandra Peterson
1-512-506-3552
13
Dallas and Whitesboro
Olga Fletcher
1-512-506-3578
14
Tyler, Texarkana, and Paris
Trilby Foster
1-512-506-7053
15
Beaumont and Lufkin
Gene Allred
1-512-506-3425
16
Houston and Conroe
Linda Wood
1-512-506-7682
17
Houston and Katy
Rachelle Moore
1-512-506-3447
18
Galveston and Matagorda
John Miller
1-512-506-3586
19
Houston
Stephen Hirschfelder
1-512-506-3446
November 2005
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LTC Bulletin, No. 24
Provider Resources
TMHP LTC Contact Information
The TMHP Call Center/Help Desk operates Monday through Friday, 7 a.m. to 7 p.m., Central Time (excluding
TMHP-recognized 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 the about Forms 3618, 3619, and the 3652 CARE form need to enter their nine-digit LTC
provider/contract number 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 medical chart 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. This enables the representative to research and respond to inquiries more
effectively.
For questions, providers should call the TMHP Call Center/Help Desk at the following telephone numbers:
• Austin local telephone number at 1-512-335-4729
• Toll-free telephone number (outside Austin) at 1-800-626-4117 or 1-800-727-5436
For questions about…
Choose…
•
•
•
•
•
•
General inquiries
Using TDHconnect
Completing Claim Form 1290
Claim adjustments
Claim status inquiries
Claim history
•
Medical necessity
•
TDHconnect—Technical issues,
obtaining access, user IDs, and
passwords
Modem and telecommunication
issues
American National Standards
Institute (ANSI) ASC X12
specifications, testing, and
transmission
•
Electronic transmission of
3652 CARE forms
Electronic transmission of Forms
3618 and 3619
Weekly Status Reports
MDS submission problems
Technical issues
•
•
•
•
•
•
•
•
LTC Bulletin, No. 24
•
•
•
•
•
Claim rejection and denials
Understanding R&S reports
3652 CARE form
Forms 3618 or 3619
TILE levels
Option 1: Customer service/general
inquiry
Option 2: To speak with a nurse
•
•
•
•
•
Processing provider
agreements
Verifying that system screens
are functioning
Getting EDI assistance from
software developers
EDI and connectivity
Option 3: Technical support
CARE form software (CFS)
installation
Transmitting forms
Interpreting Quality
Indicator (QI) Reports
Option 3: Technical support
10
November 2005
Provider Resources
For questions about…
Choose…
•
New messages (banner) in audio format for paper submitters
Option 4: Headlines/topics for
paper submitters
•
•
Individual appeals
Individual fair hearing requests
Option 5: Request fair hearing
•
Replay for menu options
•
Appeal guidelines
Option 6: Replay options
DADS Contact Information—Claims Management
If you have questions about.
Contact…
12-month claims payment rule
Provider Services (Community Care for Aged and
Disabled Programs [CCAD])—Contract Manager
Institutional Services (NFs)—Claims Management:
1-512-490-4666
MR Services—Claims Management: 1-512-490-4666
Contract enrollment
Provider Services (CCAD): 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: 1-512-438-4310, 1-512-438-5595, 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: www.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-OnlineSearch link.)
Texas State University Texas Index Level of
Effort (TILE) training
The Office of Continuing 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
Claims Management: 1-512-490-4635
November 2005
11
LTC Bulletin, No. 24
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
CLASS Interest Line
Program Consultant
1-877-438-5658
DB/MD Program
1-512-438-2622
Financial or functional eligibility criteria
Caseworker or Case Manager
Hospice policy questions
1-512-438-3169
Medically Dependent Children Program (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
Network (HHSCN) connection problems
1-512-438-4720
ICF/MR/durable medical equip.m.ent (DME),
Home Community-Based Services (HCS),
Texas Home Living Waiver (TxHml), and home
modifications, adaptive aids, and dental services
1-512-490-4642
ICF/MR/Residential Care (RC) billing questions and
individual movements/service authorization
Claims Management: 1-512-490-4666
Fax: 1-512-490-4668
Website: http://ausmis31.dhs.state.tx.us/cmsmail
Mental Health and Mental Retardation (MHMR)
Client Assessment Registration System (CARE) Help
Desk
1-512-438-4720
Program enrollment for utilization review (UR)/usual,
customary utilization control (UC),
Purpose codes, and MR/RC Assessment Form, level of
service, level of need, level of care, and ICAP
1-512-438-3597
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
missing/incorrect information
Claims Management: 1-512-490-4666
Fax: 1-512-490-4668
Website: http://ausmis31.dhs.state.tx.us/cmsmail
Deductions
Provider-on-hold questions
Audits
Claims Management: 1-512-490-4666
Fax: 1-512-490-4636
Website: http://ausmis31.dhs.state.tx.us/cmsmail
HCS, TxHml billing, policy, payment reviews
1-512-438-3612
LTC Bulletin, No. 24
12
November 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: 1-512-490-4666
Fax: 1-512-490-4668
Website: http://ausmis31.dhs.state.tx.us/cmsmail
Bulletin Article Resources
The Bulletin Article Resource table includes a list of previously published articles, sequenced in order of the bulletin
edition in which the articles appear, starting with November 2004. Providers may use this table as a resource for
referencing previously published articles.
Article Name
LTC Bulletin
Page Numbers
Coordination of Services and HIPAA Privacy Rules
November 2004, No. 20
5
Units of Service
November 2004, No. 20
6
Tip of the Quarter—Diagnosis Codes
November 2004, No. 20
6
Common Billing Errors and How to Avoid Them
November 2004, No. 20
6
Physician’s License Number
November 2004, No. 20
7
Preadmissions Screening and Resident Review (PASARR) November 2004, No. 20
Medical Necessity Determination
8
Release of Information Code and Signature Source Code
November 2004, No. 20
9
Processing of Claims
November 2004, No. 20
9
Twelve-Month Claims Submittal
November 2004, No. 20
9
Error and Suspense Reports Available for MedicaidCertified Nursing Facility Providers
February 2005, No. 21
2
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
3
Medicaid Eligibility Service Authorization
Verification (MESAV) Inquiries
February 2005, No. 21
4
Use of Modifiers for Transition Assistance Services (TAS)
February 2005, No. 21
4
Medically Dependent Children’s Program (MDCP)—
Availability of Units
February 2005, No. 21
5
Community Living Assistance and Support
Services (CLASS)—Form Completion
February 2005, No. 21
5
Most Frequently Asked Questions for This Quarter
February 2005, No. 21
5
• “T” claims showing up on R&S report
• Vendor/Facility Site ID number
• Downloading the (CARE ) Weekly Status Report
• Approved MN forms not showing up on SAS
November 2005
13
LTC Bulletin, No. 24
Provider Resources
Article Name
LTC Bulletin
Page Numbers
Accessing the Remittance and Status (R&S) report
Through TMHP Website
February 2005, No. 21
6
Medical Necessity Weekly Status Report
February 2005, No. 21
6
Purpose Code E Reminders
February 2005, No. 21
7
2005 LTC User Manual to Be Mailed to Paper Submitters
May 2005, No. 22
2
Tentative Release of TDHconnect 3.0 Service Pack 6
Scheduled
May 2005, No. 22
2
In This Bulletin “Glossary has been removed”
May 2005, No. 22
2
New Security Features Enhance TMHP Website
May 2005, No. 22
3
In This Corner
May 2005, No. 22
4
Top Three Reasons Why Claims Deny
May 2005, No. 22
5
Providers Verify Eligibility with a MESAV Inquiry
May 2005, No. 22
6
Most Frequently Asked Questions During This Quarter
May 2005, No. 22
7
• TDHconnect Training Materials Available
August 2005, No. 23
3
• Changes to Electronic Data Interchange Agreements
August 2005, No. 23
3
• Changes in the Community Living and Support
Services (CLASS) Program
August 2005, No. 23
3
• Most Frequent Asked Questions During This Quarter
Answered
August 2005, No. 23
5
August 2005, No. 23
7
• 3652 CARE Forms
• Tips for Completing the 3652 CARE Form
• EOB 250—Late Billing—Must be filed within
12 months from the end of the service month
• “T” Miscellaneous Claims—Recoup.m.ent
• Vendor/Facility Site ID number
• TIERS Impact
• Primary Home Changes to Priority Level
• Claims Status Inquiries
• Most Frequently Used Reports
• Processed 3652 CARE Forms Shown in Medical
Necessity Weekly Status Report
• Error and Suspense Reports Available for MedicaidCertified Nursing Facility Providers
LTC Bulletin, No. 24
14
November 2005
Workshop Survey
Provider Survey for the LTC
TDHconnect Training Workshop
Survey (Please print requested information below)
Please take a moment to provide DADS with your feedback to help improve the TDHconnect training
workshops.
1. Have you ever attended a TDHconnect training workshop?
Yes (If Yes, please continue to question number 2.)
No (If No, please indicate below the reason for not attending.)
2. When was the last time you attended a training workshop?
During 2005
During 2004
Prior to 2004
If you attended a training workshop prior to the calendar year 2003, please continue to question number 6. If you
attended the training workshop during the calendar years 2004 and 2005, please continue to question number 3.
3. Did you find the training useful?
Yes (If Yes, please continue to question number 4.)
No (If No, please indicate below why not. Continue to question number 4.)
November 2005
15
LTC Bulletin, No. 24
LTC Bulletin, No. 24
16
November 2005
Workshop Survey
Survey (Please print requested information below)
4. Which parts of the training were the most useful?
Claim Submission
Eligibility
Claim Tracking
All (Please continue to question number 5.)
None (Please indicate below the reason that the training workshops were not useful. Continue to question
number 5.)
5. Was the length of the training appropriate?
Yes (If Yes, continue to question number 6.)
No (If No, please indicate below why not. Continue to question number 6.)
Explain:
November 2005
17
LTC Bulletin, No. 24
LTC Bulletin, No. 24
18
November 2005
Workshop Survey
Survey (Please print requested information below)
6. What changes or recommendations do you have for future training workshops?
Additional comments:
Please detach the survey and mail or fax by November 30, 2005, to:
Department of Aging and Disability Services
Claims Management MC-462-1
PO Box 149030
Austin, TX 78714-9030
Fax: 1-512-438-4380
November 2005
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LTC Bulletin, No. 24
LTC Bulletin
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