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2004 Acute Care TDHconnect 3.0 Workbook

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1. O a u Eylem Poyam Serd r Adrianit Long Tem Care Apmoale ant Fami Plasma Medicaid SSE Bie Shoal Long T sem Car Medea Pel eacdacae 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 stores the request in Completed status on YOUR 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 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 Progam Sumay Send Fiequests Retrieve Responses Pietnewe Oihe j Spee Download ay tment Appeals LEE SEE Claas fer E bgiiy MESAV 1 Fill out the appeal and click OK Repeat as needed for each appeal 2 Click Cancel to exit The lt Bold Italic gt T DHconnect 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 Click Submit Retrieve a Batch Request 1 24 hours after request submission go to the lt Bold Italic gt TDHconnect System To
2. 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 7TDHconnect 3 0 menu bar The Request Information dialog opens Page 51 TDHconnect 3 0 Workbook for Acute Care Providers 4 5 Save at Template 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 Input any of the listed field combinations Request Informaton Request Sitahus Mew Hags Piowder hiomaan J Provider ID Start Date End Date 234567 89 11721 2003 11 21 2003 Dine of the following field combinations must be entered Medicaid No SSN amp Last Name SSM amp DOB o Last Hame Fust Name DOR Patert Intonmabon pP Medicaid No pP SSN O Account No m re Lasi Hame gt First Name Wi Suffia Ad bonal Search Fields ol Birth Sex Ciy O _ DP meme EE Important Input the minimum amount of information in this section preferably Medicaid number only Note 17 3 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
3. Loe Cancel 18 7 2 2 Operating and Other Providers Patent Provider Status Claim Humber le ee ne rn Patient Provider Claim Diagnosis l Details l Other Insurance Biling and Attending Providers i Operating and Other Providers Operating aa Provider ID p Last Hame pa First Hame Ml Sutfis ID type Other ID Other a Provider ID pE Last Hame pE First Mame Sutfis ID type Other ID DE P k Cancel Page 82 PR TDHc3 0AC_05 02 04 v 0 4 Medicaid and Family Planning Claims 18 7 3 Claim Tab Click the Claim tab to enter claim information Required fields e Admission Date and Hour e Type of Bill Optional fields e Authorization Number e Discharge Hour e Occurrence Codes and dates e Condition Codes Patient Provider Statuz Claim Number ae a s S Patient l Prowider Claim Diagnosis l Details l Other Insurance Admission Information General Date Hour Authorization Humber Type of Bill m E E Discharge Hour ccurence Codes Condition Codes ox Cancel 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 e Date of Service e Diagnosis reference Diag Ref e Quantity Qty e Total Charges Page 83 TDHconnect 3 0 Workbook for Acute
4. sssssssssssssscccssssssssssssssssessseccsssssssssenees 9 5 1 Activating an Account on the TMHP Website ou esesesesesesesesesessssssssesssesesesesseesseeeees 9 5 2 Finding Information on the TMHP Website ue eesesesesesessssssesesesesesssessssseseseseseeeees 11 ep PUDICIHON meena pee nett nee er i PPI NCR So Ee eS ey aE Tne rN eT 11 D WMC IT E sete scctegs ienGuaaiala T aewie ac neaaunas 11 g2 Banner Message pastel set fas i n E E R T 11 02A ROT once C OAO aseissa a E 11 9 2 0 Other TDHconnect 3 0 Resources Online e esssssesssssssesseesssssessresssesesesseesseeseesss 12 Installing TOAHCONRNCCE 3 0 seriinin Graeieedieaeiesss 13 Gl Beror Tastan moann a a OT 13 6 2 installing TDHCOnNECt S O 0na LAN ip antan 14 OEEO EoI 3 e E O E EEE E ES T A E 15 6 4 Setting the Dialing Properties in Windows seessessesssessessesseessessenseeseesersseesersseeseessresreseeses 16 Gi Fmnisimng the TVS Weld AON aeainrirr eine E E E ANEA NN NNA O 16 Data CONVENIO M sonicne E E T 17 7 1 Converting Existing Appeals to TDHconnect 3 0 sessssssssssesssssssesssesssrsssesssesnssrnsseessresss 17 Updating TDHconnect 3 0 esssssssssssssseccsecesesssssooococececcesesssooooccoceceeesssoooo 19 8 1 Downloading TDHconnect 3 0 Service Packs cccssssssssesssessssssssssssesseseeessssssseseseseees 19 8 2 Installing a TDHconnect 3 0 Service Pack seseesseesesssesesseessessenseeseessesseesersseesenssrnseeseeses 20 Opening and Logging on to TDHconnect 3 0
5. TMHP TEXAS MEDICAID HEALTHCARE PARTNERSHIP A STATE MEDICAID CONTRACTOR TDHconnect 3 0 Workbook for Acute Care Providers PR TDHc30 AC_ 4 29 04 v1 0 TDHconnect 3 0 Workbook for Acute Care Providers Cpt codes descriptions and other data only are copyright 1999 American Medical Association or such other date of publication of CPT All rights reserved Applicable FARS DFARS apply PR TDHc3 0AC_05 02 04_v 1 0 N m 10 11 Table of Contents TDAGonneG 3 0 OVEWIEW aciiintnriieminiciinineiniicnnannuininnns 1 TDHconnect 3 0 Hardware and Software Requirements ssssseee 3 O DtAIMING SUP POU soniri a T E 5 SAC Gening PechmiCal ASST Ce aranan E 5 3 2 Accessing Training Resources sessessssessesessessssessessesersessesseesseesevseseeseosesseseeseesesseseoseseesesseesesss D Dro Gewig Clams ASSISTANCE enaena E TO NTO 6 Accessing Documentation sssessscceessssssosoccccccecessssosoooococeceeeessssoooooceceeeee 7 A Using FOR CONNECT 3C OnineH oloriire ti i n EACE a 7 4 1 1 Opening the TDHconnect 3 0 Online Help File wu esesesesseseseseeeseseeeeeens 7 4 1 2 Using the TDHconnect 3 0 Online Help File uu eesssesessesesessesesesesssseseseees 7 4 2 The TDH connect 3 0 Quick Start Guide sessesssesssesssesssesssersssessseesseesseenseeessressroseensens 8 4 3 The TDHeonnect 3 0 User Manual w eccccscssessssssssssesesssssssssessssssssessssessessessssesesssseseseaseseeees 8 Accessing the TMH P Website
6. sssccccceeeennnnssseneeeees 21 TDHconnect 3 0 Log On Eror Messages essesssssssssesesssssssssssssssossooooo 23 10 1 Using TDHconnect Utilities to Log Off a USED oc eesesessesesesesestesesssceesseseseeeeseseseees 23 10 2 Using the Windows Task Manager to Shut Down TDHCONNECE 3 0 n se 24 Keyboard Shortcuts amp Function Keys ccccsssssssssssssccccsssssssssssssseeeeees 25 Setting Up Communications in TDHconnect 3 0 ccssssssssrrrssccesesseees 27 t2 OSONT S LUNGS aa a a a ETE 27 P2 Moder o NA o e ENE ENNA 28 TDHconnect 3 0 Workbook for Acute Care Providers B 14 16 17 Setting Up Reference Files in TDHCONNECE 3 0 cssssssssssssssrscccccseseeees 29 E Aa ON ssa ert re nN An ER Ne ee 29 Roa Ammer C6 08186 Provido nann ee ae ee T 31 13 3 Downloading Reference Codes cccscsssssscssssssssssssscsesessssssssssssssssssssssscsssssssesssssscscaseseee 33 13 4 Downloading Updated Reference Codes Retrieve Other esssssssessesseerserseeserrerresrerrees 34 13 4 1 Downloading Compass21 C21 Reference Codes e sssseeseessesseesessesseeseerrerreere 34 TDHconnect 3 0 System Maintenance sssssssssesssssssecocesessssoooccsssssssooses 39 1 amp 1 System PunChons O Veniew mreana T 35 DEEZ sO GSO UUES o AO T 35 H a npe S K a E A N EAT E 36 DAD Purge TaD cenie E EAT T 36 H N r a aa E ATONE 36 H24 61 018 aD ecarri a A TT AE 37 ES Passworn Adminis aen E A NR 38 WA Sened oian EN ENNEN EN 38 14 4 1 Scheduler
7. 38 TDHconnect Utilities fn Wacom Tablet amp Version Wizard or Programs 2 Documents Et ee winzip i Settings Windows Media Player v r Search Help and Support Page 17 TDHconnect 3 0 Workbook for Acute Care Providers The TDHconnect Appeals Conversion window opens Select the type of appeals to convert such as Convert Medicaid Appeals for Medicaid appeals The totals in the data fields change to reflect the conversion changes w DHconnect Appeals Conversion Hedicaid 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 Appeals Failed Batches 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 TDHc3 0AC_05 02 04 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 via yo
8. Suffix is not contained in the Last Name field it has its own field Creating an Eligibility Template In TDHconnect Explorer double click Medicare to expand the folder and double click Eligibility 1 Page 52 In the TDHconnect 3 0 main menu click File gt New The Request Information tab opens in the 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 PR TDHc3 0AC_05 02 04_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 2 Submit Retrieve Batch Requests Important Clicking OK does not send the request to TMHP Clicking OK stores the request in Completed status on YOUR 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 s
9. 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 10 1 During login the following message may open username is currently logged on to TDHconnect Use 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 section 10 2 on page 24 Using TDHconnect Utilities to Log Off a User 1 Click OK in the error message dialog The error message dialog closes Click Start gt Programs TDHconnect TDHconnect Utilities Programs Favorites z 2 Documents fey TOHconnect 3 Converk ppeals rd TOHconnect 3 0 TBHconnect Utilities 4 Internet Explorer Microsoft Access Microsoft Excel amp version Wizard ic 5 E Microsoft Outlook E i gi Settings Microsoft PowerPoint i p pE Microsoft Project cpe Search o pi Microsoft visio o Help and Support Microsoft Word g
10. The File Download dialog opens 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 iP TIP 2 Double click the TDHconnect 3 0 Updates Service Pack number zip icon This icon was added to the desktop during the file download The file can be moved to a location on a LAN to share with other TDHconnect 3 0 users A dialog 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 The TDHconnect Service Update Installation Utility window opens and the TDHconnect 3 0 Service Pack wizard opens Several informational messages open Read each message and click Next to advance to the next screen A dialog opens with the following message Do you wish to backup your databases This will overwrite databases that are in the Backup folder e Recommended Click Yes to backup your databases before installing any database updates e Click No to continue with the installation without making backups Several additional informational messages open This process may take several minutes as database updates are made 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 Read the document close
11. cccccscssesescsssesssssssescscsssssescsseesseseseeseens D3 1742 Submit Retrieve Batch Requests cccccssessssssscssssssssssssssessssessssessescssesssesesesssens 53 17 5 Medicaid Eligibility Response s sessesesessessesseessenseeseesseeseeseessenseesueesenseeseessresenssessreseessessreses 53 6 STUN EUD REDOT O irine AENEON ENTON 54 18 Medicaid and Family Planning Claims sssssscscsscccscssssesssssssseeeees 99 18 1 18 2 18 3 18 4 18 5 18 6 18 7 18 8 Changes to Claims Resulting from HIPAA sssssssessseseeseesensenseessensenseeseeneenseeseensenseensenseesees 55 Pig Proressional CIMS ircen N E T T sha ta ats 56 Tok EUO E Da AE T 56 Lra PINA ag 6 e TAN EAO 57 18 2 2 1 Provider Facility Sub Tab essesseessesseeseeseessesseeseenseeseeseensenseessesseesseseeseesss 57 18 2 2 2 Referring and Other Provider Sub Tab eeeseseeseeseeseessrerserressersserrersees 98 1020 GVM T AD arrin i aE ek esata esas ETET ayes eos 59 18 2 3 1 Creating a Claims Template s sesesessesseeseessessesssesseeseeseessenseeseesseesseserssesss 59 1024 Diagnos T aeina T OTA 60 1925 Doras T ane A 61 18 2 60 Other Insurance Tab e esessesssessessessesseessessesssessenseeseeseesseeseessessensteeessesseeseeseenseeseesees 63 18 201 Company SUD TaD riina E ENA 63 18 2 6 2 Other Insurance Tab with Subscriber Sub Tab sesser 65 Submitting and Retrieving Requests esesseesseessessesseeseessesseeseessessensenseessensresersseeseesee
12. on uA a Bi fk ik ap B al a I wy TOHeonnect fe CDC Family Planning Fy E Long Tem Care ST O Medicaid alk al al EEN Medicare OOO Reference Files p IM alee Client W a Provider y i u i Reference Codes oo NA si gt System p ET Filter Program Name Display Providers For This a Autofind Colurnir Filter Type Program Type i Sse Blue Shield LastOrganization Name T fe Starts With Aubotind Text Mode m ami Planning UseFindTes C Instantly C Contains Medc d a C Exact Match Medicare h m fat d Cancel 2 Click Add The Provider Common Setup window opens in the workspace Note Fields with bold headings must be completed to successfully add a provider Page 31 TDHconnect 3 0 Workbook for Acute Care Providers lt TDHConnect Provider Common Setup File Edit Reports Security View Tools Communications Navigation Help eet hd XS Sa foo amp i TOHeannect Oo Blue Shield Client y Reference Codes J System r Provider Last Organization Name First Mame ML ________ Brode E meson e p Blue Shield oO jene _ Family Planning See aa Medicaid _ Medicare gt Sutfis r Provider Information Address 1 Address 2 City Shake ZIP Code ae Phone Mo Lz Launch Program For Long Term Care Medicaid r Provider ID Tax ID 3 Select the check box in the Provider
13. 0 00 Other Insurance Company Company Hame Address City state ZIP Code W xl Contact if l Phone Ho Verbal Date Contact Marne Verbal Dental Comment Save as 7 emplate Interactive Cancel 2 Ifthe 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 Ifan 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 phone number Phone No 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_05 02 04 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 social security number Last Name First Name Group Policy Number and Group Employer Name Patient Prowider Status Claim Humber SST a E ee cece as Patient l Provider l Claim Diagnosis l Details Other Insur
14. 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 pages the Provider Manual s and TDHconnect 3 0 updates and provides e mail and chat features that allow you to contact TMHP representatives for assistance All enrolled providers are given 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 e Forums e Polls and Questionnaires e Claim Status Inquiry Acute Care providers only e 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 Q digit Texas Provider Identifier TPI e Q digit Provider Number e TMHP EDI Submitter ID e TMHP EDI Submitter ID e Tax ID EIN e Zip Code e Social Security Number e Medical License Number 2 Access the TMHP web site at www tmhp com The TMHP Home page opens I would like to 3 Click the Activate my Account link in the I would like to oy my Account section The TMHP Activate Account web page opens a Find WittwareService Packs 4 Scroll down to Verify Eligibility Click here to ee p 4ccount Now I nguire about a Claim Status Find Publications File Librar 5 Click the Activate My Account Now link The Activate My Email the Con
15. A TACO INS aeriana EA 107 22 1 Claim Status Inquiry Authorization Form se sesseesseeseeseesseseressensenseeseessenseesernseeseessresensees 107 22 2 MD EL COMMECE Oner rO M 5c sess toe a E tas drasanioooreatavirm auniotel oneaGenetes 109 907170 GO 1 ane a Pee T 111 22 WOKO Ei vatal osa O aliiaaeiede 112 TDHconnect 3 0 Overview 1 TDHconnect 3 0 Overview With TDHconnect 3 0 you can e Administer billing for Family Planning Long Term Care Medicaid and CSHCN CIDC 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 e Access the same database simultaneously up to ten concurrent users per database IMPORTANT e Basic knowledge of Windows operating systems is required to use TDHconnect 3 0 e Providers in rotary dial areas cannot use TDHconnect 3 0 e 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 e See section 9 Opening and Logging on to TDHconnect 3 0 on page 25 for basic information on how to log on after installing TDHconnect 3 0 software M
16. Djo I 4 EE Fan Shake P all COMANN PAL TOF Hw ber i C Long Term Care ikke Cn THERAPED TIC ULTRASOUND OF VESS hae A 7 i 1 r E 7 i e Eu a oon THERAPEUTIC ULTRASOUND OF HEART 00 lake hoe i an THERAPEUTIC ULTRASOUND OF FERIF pit j F Boieseca Loh rents OTHER THERAPEUTIC ULTRASOUND Pita Bee iid ETR TE EER EEEO aes F der Codai Fiber T a Autor C 5 dal Perea Procedure ade 0 Sair with j Aucir Test Lee i Tane nigne oye Left Eye ia aa aa az 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_05 02 04 v 0 4 Medicaid and Family Planning Claims Patent Provider aie Claim Humber Patient Provider Claim Diagnosis Details Other Insurance Total Charges 0 00 Other Insurance Paid 0 00 Met Billed 0 00 Interactive Cancel Patent Provider Status Claim Humber SSS E SS Patient Provider Claim Diagnosis Details Other Insurance Total Perform Provider Perf Last Hame Perf First Marne Perf hal Perf Suffix E ee al 4 Total Charges 0 00 Other Insurance Paid 0 00 Net Billed 0 00 Interactive Cancel Page 71 TDHconnect 3 0 Workbook for Acute Care Pro
17. 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 Contact For claims assistance call TMHP Customer Service at 800 925 9126 For LTC claims assistance call the LTC Help Desk at 800 626 4117 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 DHoonnect Medicaid Claim Slatin tnguiry fie Edt W Reports fook Nevgston feb TD E e ERER 10H connec Medicaid Claim Status Inquiry hequesYAesponse Summary od Bide Shed 23 GDC Gta ust Ne of lham j Fani Planning Li Long Term as Aeected 0 L Medcad E ligiaiiy Cirmi mm y T i Trana e 7 Trramson ID Local Tan I0 Tie Trassem Dahe Tima Shau No of No Sugi ID tor Aequerts Repctec npag DJ Heicae 1 Aetmence Tie I Syatem i CEI 2 There are two types of CSI requests Provider Patient Request and Claim
18. Interactive Requests ccccsccssesscsssessssssssscscssscssscssscsseseseeseens 95 19 2 2 Submit Retrieve Batch Requests cccssessesssessscsssssssssssssescscssscssscssscsseseseeseens 95 19 3 Medicaid CSI Printing FR CDOTS oiron r eE EEE EEE NNO 97 Medicaid Electronic Remittance amp Status ERGS ccccsssscccessceeee 99 20 1 Download an ER amp S Report sic scsecesuricericasa uncencacabasecadtesetenciaue Oise vaiedteisrotavinnaesasonunaaine 99 202 Genere d ERYS ROPO arina Ta O A EN 100 20 5 Medicala ERGS Prnt REDOT preisi aa a aE 100 Medicaid Appeals sccis nason EE 101 21 1 Changes to Appeals Resulting From HIPAA essesssssessessesseeseeseeeseeseeseesseeseeseessrsseesersseesees 101 21 2 Three Ways to Complete TD Hconnect Appeals uc ccsscscsesecssssssessssssssessseseseseseeeeeeen 101 21 3 Create an Appeal from an Accepted TD Hconnect Claim sssessessessesseessesresresseseeserseesees 102 21 3 1 Create an Appeal from an ER amp S Report wc cceccsesesescscsssesesssssesesssesesees 102 21 3 2 Create and Appeal from a Blank Form sesessessessssseseessesseseeseesenseeseesenseeseeserseeses 104 Dee Appeal Fields sszsach ccc obaceterssnctace E E AAE OA TTR 104 21 5 Medicaid Appeals Submitting and Retrieving Requests ccccseecesssseseseseseseseeeeeeen 105 215 1 Submit Retrieve Batch Requests acn A 105 21 6 Medicaid Appeals Printing Reports esessesseeseessesssessensenseessessenseessensensensenserssrsseesereseeseess 106
19. 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 9 digit TPI 6 digit Medicare number or a 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 Humber le ee ee ne Patient Provider Claim Diagnosis l Details Other Insurance l Billing Provider E Provider ID J2 Last Organization Name pa First Marne Suffis Address City State IP Code ee ID type Other ID Phone Ho Pay ff fo Provider Facility ReterningOther Provider pe Provider ID pa Last Name p First Name hil Suffix C ID type Other ID mer aaa eee Page 58 PR TDHc3 0AC_05 02 04_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 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 Un
20. Request To open a new request do one of the following e Click File gt New Request on the TDHconnect 3 0 menu bar e Click the Provider Patient Request icon e Click the Claim Request icon 19 1 1 Provider Patient Request Page 93 TDHconnect 3 0 Workbook for Acute Care Providers 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 Movedes Patient Regueri Device legin Date Termice End Date _ ths z Picede riforma Provides ID T LaeOrganization Mams D Fast Hame Wi Gutia a r ME Cieri D Medicaid Ho D Last Name D Fint Name Mi Suto a L Required fields e Service Begin Date e Service End Date e Provider ID and Last Organization Name e 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 YOUR database only
21. TDHconnect to complete the appeal and to verify that the claim is in appealable status before submitting it 3 Go to 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 7 for an appeal or 8 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 e Remember that bolded fields are required and other fields may be necessary depending on the type of appeal e Click OK on the appeal to save it in completed status to be submitted later to TMHP e Appeals are only submitted by batch not interactively A batch can contain one or more appeals e Clicking OK does not send the request to TMHP Clicking stores the request in Completed status on YOUR 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 21 3 1 Create an Appeal from an ER amp S Report To create an appeal from an ER amp S report perform the following steps 1 Open the Appeals window by double clicking Appeals on the left s
22. 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_05 02 04 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 Clams Plequesi l Clam Maumee e Pma o 2 Provider D JA Last Otganization Hame g iNe Mi Sufie Cier e Medica No pa Last Hamn H Firat Name bii Sufik ineaca Cancel Required fields e Claim Number 24 digits e Provider ID 9 digit TPI and Last Organization Name e Clients 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 Clicking OK does not send the request to TMHP Clicking OK stores the request in Completed status on YOUR database only You must follow the procedure described in section 18 3 2 Submit Retrieve Batch Requests on page 65 to send and retri
23. 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 Page 36 PR TDHc3 0AC_05 02 04_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 1 Create a folder on the server where the TDHconnect database is stored and shared jac 2 After installing TDHconnect 3 0 on the Program Files EI TDHconnect computers that access the server accepting the default database location the Mapper function is used to locate the TDHconnect database on the server 3 Itis 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 1 Use the check boxes in the Select column to select the type of data to back up and Compress i Purge Mapper click Backup Database Utilities 2 A backup copy of the selected data is Program placed in the TDHconnect backup folder IDC The previous backup is overwritten Family Planning org am Lar Note To back up the data to a different disk Medicare drive to ensure protection in case of alaisissa disk drive failure contact your system administrator or computer support personnel for assistance Important Avoid acci
24. 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 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 Mumber P ee Patient Provider Claim Diagnosis Details Other Insurance Etl Date of Procedure Procedure Remarks Mod Mod Mod Mod Ane Diag Tot Noj Service Code ID Code Lode 1 4 3 4 Min Ref 4 nia a ee a IE oo d S S s S S e S OA S o ee S S S eee eee E d d o T S e T S S T S E O OS S T S S S e E O e e e S T T T T e o e e e S T T T ee ee ee ee ee eee 0 e S e e S se S e e S e BEI x Total Charges 0 00 Other Insurance Paid 0 00 Met Billed 0 00 Cancel Patient Provider Status Claim Mumber P ee ee Patient Provider Claim Diagnosis Detail
25. location such as new location in the From location selection menu Click OK PR TDHc3 0AC_05 02 04_v 0 4 Setting Up Reference Files in TDHconnect 3 0 13 Setting Up Reference Files in TDHconnect 3 0 The client and provider reference files are not required to file claims and appeals However they are recommended and can save time when filling out forms and can reduce input errors TBDHeonnect File Edit Reports Security Vie The tree view containing yellow folders on the left side of the TDHconnect 3 0 System Totals window is referred to as TDHconnect Explorer TOH connect Blue Shield e Double click the file names to expand folders CIDE e Double click the file names again to collapse folders Family Planning Long Term Care Medicaid Medicare Reference Files System E E E ee eal eel 13 1 Adding Clients This section describes the steps necessary to add client data Note New clients also can be added through Eligibility or 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 Reports Security View Tools Communications Navigation Help a bi wegga AP TDHconnect cioc a Family Planning Long Term Care Medicaid Medicare Reference Files Client y Provider Reference Codes System Display Clients For This irae Column Frogram Hame Filter Type Program Type P Bl
26. 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 1 Log into TDHconnect 3 0 if you are not already logged in The TDHconnect 3 0 System Totals window opens in the workspace TDHeconnect File Edit Reports Security View Tools Communications Navigation Help 2 Select Ayame Seen OP Wa lt 2G Communications gt System Fa m oi TOHconnect P TO OHconnect k stem Totals Settings on the TDHconnect 1 Blue Shield 49 Texmedniet CDC 3 0 menu bar i Family Planning Program Summary send Requests Retieve Responses A E Long Tem Care The System Settings dialog aes Program Subsystem Completed Submitted Accepted opens Reference Files a blue acid Clai 0 0 o System i CIDE az System Settings Ea 3 Select the System Settings tab F Note If you do not have a Compass21 User ID oMmpass User ID Password Ora Long Term Care User ID leave those fields blank OrganizationLast Name First Marne Middle Intial es E 4 Inthe Compass21 section enter the Soe eae following information User ID Password eC eEO The User ID not the logon ID that the OrganizationLast Name First Name Middle Initial TMHP EDI Help Desk issued in lower Case cae e The Password that the TMHP EDI Help _ S
27. select File gt Print on your browser s menu bar 5 2 4 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 Page 11 TDHconnect 3 0 Workbook for Acute Care Providers 1 Access the TMHP web site at www itmhp com The TMHP Home page opens 2 Click the Providers link at the top of the page The Providers web 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 5 2 5 Other 7DHconnect 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_05 02 04_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 7DHconnect 3 0 carefully read and follow the sequence of installation tasks listed below If the insta
28. to backup your databases This will overwrite databases that are in the Backup folder Click Yes to back up the existing databases Click No to skip backing up the databases The Setup Complete window opens Select Yes want to restart my computer now to complete the installation now Select No will restart my computer later to complete the installation later Click Finish to close the window Note The installation of 7DHconnect 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 1 Open the Windows Start menu and select Settings gt Control Panel 2 Double click the Modems icon If you have more than one modem installed or listed in the Modem Properties dialog select the modem that was set up during TDHconnect 3 0 installation 3 On the Modem Properties dialog click Dial Properties 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 Note Enter a number other than 9 if a different number is required by your service 6 Enter 9 in the To access outside lines for long distance calls d
29. 02 04 v 0 4 Medicaid and Family Planning Claims Patient Provider Status Claim Mo ee ee e a Patient Provider Claim Diagnosis Details Other Insurance l Htp Total Charges Performing Pert Last Name Pert First Name Pert Ml Pert Suffix Units Provider ID a ee es eee Total Charges 0 00 Other Insurance Paid 0 00 Net Billed 0 00 Fst es e oe 18 8 6 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 6 1 Submit Retrieve Interactive Requests To submit and retrieve an interactive claim click Interactive and within a few minutes the claim response accepted or rejected is displayed 18 8 6 2 Submit Retrieve Batch Requests Note Clicking OK does not send the request to TMHP Clicking OK stores the request in Completed status on YOUR 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 Fill out the claim and click OK Repeat for each clai
30. 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 TDHc3 0AC_05 02 04 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 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 vendor or clearinghouse A L Add Claim Status Inquiry Privileges Select Action B L Revoke Claim Status Inquiry Privileg
31. C requirements before ordering TDHconnect e You should receive your software installation instructions and User IDs within 15 business days of our receipt of the form TDHconnect includes an online Help File containing all necessary information for the operation of TDHconnect If you find you need further assistance using TDHconnect workshop style classes are available Information on TDHconnect workshops can be found on the TMHP website at http www tmhp com You need to order only ONE TDHconnect CD ROM for your location Organization Name Billing TPI Number Contact Name Contact Phone Mailing Address Street Address or PO Box Suite City State ZIP NOTE The 7TDHconnect software CD ROM can be used to install the program on multiple computers Each of those computers must have their own User ID and password unless they are sharing a database ona network You will automatically receive ONE User ID and password to use with your software If you plan to install TDHconnect on more than one computer indicate the number of additional User IDs you will need TDHconnect Software and Hardware Requirements System Type Minimum PC compatible with Pentium class processor CPU Microprocessor RECOMMENDED PC compatible with Pentium Il class 400 MHz or faster processor Operating System Microsoft Windows 95 or later OR Microsoft Windows NT version 4 0 with Service Pack 5 or later System Memory RAM Minimum RECOMMENDED 128MB 16MB f
32. Care Providers e Procedure Code ID is the type of procedure code such as HCPCS HIEC National Drug Code in 4 4 2 format or 5 3 2 format or 5 4 1 format or 5 4 2 format or Mutually Defined Patient Provider Status Claim Mumber Her mE Provider cal Diagnosis Details Other Insurance Date of Rey Procedure Procedure Mod Mes Ne E Diag IARE Non Coveret ie Service a a ei Charges Ot E O iii ee E _ a oe E a S al S e e ee T S T S e y y __ M a E O S o e es Qs T i d M E S y eC O i S e O d e y a a a a a e R E a E 4 Non Covered Charges 0 00 Total Charges 0 00 Other Insurance Faid 0 00 Met Billed 0 00 Interactive Cancel Patient Provider Status Claim Mumber Dd ee Patient ae Diagnosis l Details Other Insurance Rev Procedure Procedure a Mod Mod Modi Diag Non Covered Total tis in an aan m am ee el Non Covered Charges 0 00 Total Charges 0 00 Other Insurance Paid 0 00 Met Billed 0 00 Interactive OK Cancel Page 84 PR TDHc3 0AC_05 02 04 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 identi
33. City State IP Code Tax ID Phone Ho Ih Facility Provider Referring and Other Provider Facility D Provider ID D Mame Address City State IP Code ee ee C es e ea Patient Provider S hats Claim No New Patient Provider Claim Diagnosis Details Other Insurance l Billing Provider T2 Provider ID p2 Last Organization Name i First Name Ml Siuttte Address City State IP Code Tax ID Phone No EE oe Heterring and Other Provider eee Reterning Uther Provider J Provider ID H pe Last Hame pe First Name S uffi Ee a E ener es Page 86 PR TDHc3 0AC_05 02 04 v 0 4 Medicaid and Family Planning Claims 18 8 3 Claim Tab Click the Claim tab to enter claim information Patient Provider Status Claim No Patient Provider Claim Diagnosis Details Other Insurance l General Cemoaoraohics Marital Status Race Ethnicity General Patient Co Pay Date of Occurence Authorization Number Level of Practitioner Pp pie pO Birth Control Primary Before Visit Primary After Wist No Method Reason Reproductive History No Times Pregnant No Live Births No Living Children E E E ae es cn 18 8 4 Creating a Claims Template In TDHconnect Explorer double click Family Planning to expand the folder and double click Claims TIP If you have updated your client database you will need to update your claim template
34. DI 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 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 I 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 File Libraries The file libraries contain useful reference materials Some of the libraries are O3manual Contains manuals such as the Texas Medicaid Provider Procedures Manual BNPG Contains banner pages Bulletin Contains bulletins Feesched Contains fee schedules TDHUPDT Contains Service Packs software updates To access the file libraries at TMHP enter www tmhp com file 20library default aspx into your web browser and select from the available library folders 5 2 3 Banner Messages To view Banner Messages from TMHP 1 Access the TMHP website at www tmhp com The TMHP Home page opens 2 Click the Find Publications File library link in the I 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 in date order 4 Use these links to select the banner messages to view 5 To print a banner message file
35. Desk issued also in lower case e The Organization Last Name Cancel Apply 5 Enter your User ID Password and Organization Last Name in the Long Term Care section if applicable 6 Enter 866 627 0015 in the ECMS field in the Phone Number section Important 7DHconnect 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 Ee C21 Site Contact Information Last Name First Mame ee Contact Phone Number O Long Term Care Site Contact Information Last Hame First Name C Contact Phone Nunber 12 2 Modem Settings 8 For each ID on the System Settings tab enter the following information in the correct section C21 Site Contact Information or Long Term Care Site Contact Information e Last Name e First Name e Contact Phone Number 9 Click Apply 10 Click OK 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 NWavigation ar System Settings ca Modems 43 TexMed et F Installed Modems Connect using E ONE From location NONE Co Page 28 2 Select Communications gt Modems on the TDHconnect 3 0 menu bar The Installed Modems dialog opens Select the modem name in the Connect using selection menu Select the
36. Dialog Options Tab ssseessesseesesssessessesseessensenseeseensensenseeseesseeseessesses 38 TEA Send REESS TaD sri aa E E NT E 39 TAAS Get RESPONSES Fall anan a adel eee 40 Had Daab T aD A E OE AA E 41 ALS FONA aD ina a E NN E EN oe 42 TAD Secun Admin AdU SES aione T A AEE 42 Aal Secun W Zid OLED enire EE ENNEN 43 lo Sccurnty Ward SUED Ae seiirenieiiirii aiT ana E A AAT 44 Connecting to TMH P sesstisiecocssasnsiestedevecsenciitaivavanieces S 45 Using the TDHconnect System Totals Window esssssssssssssosoocccecesessssoo 47 lo Proorom summay Tah ouieneuraan naaa N OAA 47 16 1 1 Batch Request Statuses sinesine a E OTE 47 16 12 Batch Transmission Process senetron A A 48 16 2 Send Requests TaD T eee 48 I6 Retrieve Responses TaD siaran AE OA 49 TOA Reve Oter TaD aneo EA TNE 49 164 1 Retieve ER amp S REPOTIS orisiirisii OION 50 16 4 2 Retrieve Reference Codes cccscsscssssssssssseccssssssessssssssssscscscscscssesessssssssssssssecesesee 50 Medicaid E HgiDility scese 51 E CoD D OPA ENA OAT A TANO 5l 17 2 Beginning the Eligibility Request e eseeseeseessesseesesseessenseessensenseeseeseeeseeseessreseessrssrnsressessreses 5l 17 3 Creating an Eligibility Template se eeeeseeseeseessesseeseeseessesseeseeesenseeseensenseessensrnsenseessrsseeseeseeeses 52 17 4 Submitting and Retrieving Eligibility Requests ee eseesessessesssesessenseessessenseeseeesenseesseereesees 53 17 4 1 Submit Retrieve Interactive Requests
37. Ect ew epote fook Navigston Help AEGEE Lara a S E F ToHcornect Faten Provida Statut Adusted Cham No Bie Sheli Mew J Ode S z i o E S Fanb Planing Patent Praveen Cian iagi Lied the brit anice E SA Long Tem Lae Frequency Code Original ICH Original Merbt md Number Medcad E np Ll E bgitaltp i Clam Faber ldenibcabon Muniben cl Arroun No SSM Neva Mecho Mo are ERES l f Appeals w amp Mecicare Mama DU Asleenoe Flee S lant Name Et Nome ME iin eg sl cil Fater General reonmaton TER Daa of Birth Cate of Masik 1 ir F FF Fits ts a Sime S Se 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 Select the value of 7 to indicate an appeal or 8 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 Frequency Code Original ICN Original Medicaid Number Page 104 Input the 15 or 24 digit claim number of the claim being appealed Input the 9 digit client Medicaid number used on the claim being appealed PR TDHc3 0AC_05 02 04 v 0 4 Medicaid Appeals 21 5 Medicaid Appeals Submitting and Retrieving Requests 21 5 1 Submit Retrieve Batch Requests Program Summary Tepl Hequesis 1 Aetneve Herponmi s Retmewe Oihe
38. Insert the CD ROM containing the program to install and click Next 4 If 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 backup of DHconnect onto tape CD ROM or a separate machine if available Important You must save your data using TDHconnect 2 0 with Service Pack 7 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 7DHconnect if this has not been done Perform the following steps to purge records Note See section 14 2 2 Purge Tab on page 36 for more information 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 7 Compress the database by double clicking System to expand the System menu and double clicking Database Utilities The Database Utilities dialog opens Select the Compress tab and select the program to purge Note Only one database can be compressed at a ti
39. Status column next to the appropriate Program Name 4 Select the program in the Launch Program for Provider menu this example selected Medicaid The tabs for a Medicaid client are Client Detail Associated Provider Authorization Diagnosis Other Insurance and Miscellaneous TDHeonnect Provider Medicaid File Edit Reports Security View Tools Communications Navigation Help fat hd amp By Le ve l TDHconnect Blue Shield HY CIDE Family Planning Long Term Care Medicaid Medicare H Reference Files Client Provider vv Reference Codes System Page 32 S 5 Sov First Name lJ ohn Last Organization Mame hal gt Medicaid Provider Provider IDs Provider ID Group ID No aa CLIA Ho State License Mo ae o o o o Motes _ Carce _ PR TDHc3 0AC_05 02 04 v 0 4 Setting Up Reference Files in TDHconnect 3 0 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 13 3 Downloading Reference Codes Double click Reference Codes to view the various codes such as procedure codes diagnostic codes billing codes and EOB codes included in the TDHconnect software DHconnect Relerence Codes Filo Edit Reperts Securky View Tools Communications Navigation Help Donk i oe fe st We 924 SoD gpu E gt Ble Shed J z TOKcommect a oor Fary P
40. Step 1 dialog opens Follow the step by step instructions in the Security Wizard to add a user Page 42 PR TDHc3 0AC_05 02 04_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 m E left side of the dialog indicates the current UserID ooo step in the process se Full Name Po Description S Fields with bold titles are required fields BB step 3 Password P 4 TexMedi et ie step 4 User ID fC O Passwork SS 5 Enter password in the Password field New Finish users are asked to change their password the first time they login 6 Click Next to advance to the next step Enter the User ID Full Name and a Description for the user Security Wizard Step 2 of 5 7 Select the programs that the user can access I a E by double clicking a program name in the E Frogram Options Selections Program Options menu The program name IS step 2 Jaana ical moved to the Selections menu We Flanni Double click a program name in the Selections BB ster 3 menu to deselect it The program name is moved too the Program Options menu Step 4 i E 8 Click Next to continue Finish Security Wizard Step 3 of 5 9 Select the options that the new user is authorized to use 2 e Double click the user ID to expand a list of Medicaid available programs How Eligibility l Hy Claims e Double click a program name such as Ho ESI Med
41. To edit your provider or claim template open the template and use the magnifying glass to select the provider s or client s to update 1 In TDHconnect 3 0 main menu click File and select the type of claim for which you are creating a template Complete the required fields for the claim type 3 Add line item information Note This is required for the initial template set up 4 Click OK after each client and line item information is completed 5 Once all clients have been added click Save As Template You are prompted to select a name for the template Enter a name and click OK 18 8 5 Details Tab Page 87 TDHconnect 3 0 Workbook for Acute Care Providers 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 Claim Ho Patient Provider Claim TR Details Other Insurance Lit Procedure Procedure Modi Modi Modi Modi Dia ty ae es os esi Paces FPS wg wom ee eee eo SE Oal ee ae ee es ees es es es S hh ii i ee ee ee ee ee eee eee Ee pt ht f e e Bae Rs es es es Gs Gs IE ee ee eee eee eee e M wt SE a ee ee a O i aE Be es es es es er er eee eee m O e e e a i Total Charges 0 00 Other Insurance Paid 0 00 Met Billed 0 00 Interactive ok Page 88 PR TDHc3 0AC_05
42. 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 E E E E Frogram Summary Send Requests Hetneve Responses Retieve Other Download 1 Use the check boxes in the Download column to select the responses to download 2 When finished click Download 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 Select All _Dowriced O l L E L Note If you are unable to retrieve a response 48 hours after submitting a request call the TMHP Electronic Data Interchange EDI Help Desk at 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 180 days following the date of the rejection In this case you must print the rejection report to prove timely filing and send it along with a paper claim to TMHP 16 4 Retrieve Other Tab Program Summary Send Requests Aetieve Responses Category Download A LTC Reference Cod
43. a separate new day claim Reminders e Ifthe appeal requires additional paperwork such as on ambulance claims the appeal must be sent on paper e Crossover claims must be submitted on paper along with a Remittance Advice from Medicare e Appeals with dates of service prior to 10 16 2003 should contain Medicaid local procedure codes if applicable e TDHconnect appeals are only by batch there are no interactive TDHconnect appeals Note Providers who file eyeglass appeals If you convert 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 e Create an appeal from an accepted TDHconnect claim e 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 or denied before it can be appealed 2 Amessage appears stating that an incomplete appeal has been generated and saved to go to Appeals in
44. ab 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 addition 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 Online Manuals Quick Start Guide on the 7DHconnect 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 7TDHconnect 3 0 after installation Click Help gt Online Manuals gt User Manual on the 7DHconnect 3 0 menu bar Acrobat Reader opens and displays the 7DHconnect 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_05 02 04 v
45. age 35 TDHconnect 3 0 Workbook for Acute Care Providers 14 2 1 Compress Tab Database Utilities Back up Important To improve the performance of CIDE Family Planning Long Term Care Medicaid Medicare Reference Files 1 Use the check boxes in the Select column to select the databases to compress TDHconnect use the Compress feature at least once per month and after each time you purge data 2 Click Compress to compress the database s Cancel 14 2 2 Purge Tab Important To ensure database integrity back up your Database Utilities Compress Back up database before purging data and compress after purging Age in days E System all Program E Adjustments The Purge tab is used to purge old data from TDHconnect Long Term Care H Appeals CIDEC Family Planning TERE 1 Scroll through the selections on the Purge tab and use the check boxes in the Purge Blue Shield column to select data types to delete CIBC Family Planning Long Term Care Medicaid 2 Inthe Age in days field enter the age of the data to select for deletion Only data that old or older is deleted 3 Click Purge to delete the data E O O L L E O L L E E L 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 10
46. ance Other Insurance 1 Other Insurance 2 Other Insurance 3 Insurance Policy Holder D ID S5SH Last Name First Hame E Ti E a 3 Insurance Policy Information Group Policy Number Group Employer Name an F Interactive Cancel Save as 7 emplate 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 and 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 YOUR 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 Submit a Batch Request 1 A ne Fill 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
47. and any applicable Condition Codes Page 74 PR TDHc3 0AC_05 02 04_v 0 4 Medicaid and Family Planning Claims Patient Provider Status Claim Mumber e ee Patient Provider Claim Diagnosis Details Other Insurance l Statement Covers General From Date To Date Authorization Number Patient Status Type of Bill eE SEEE R apan Code Admission Information 5 Date Hour Type Source E x f f From Date To Date ad i Occurence Codes Condition Codes Daye Covered Covered Hon Covered pT Discharge Information Date Hour Ez 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 Patent Provider Status Claim Humber gg Oa a waa Patient l Provider l Eea Diagnosis Details l Other Insurance Admitting Diagnosis Code Description E Diagnosis BACS 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 e Days e Daily Rate No
48. ard 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 follow up with a new claim instead of an appeal within 180 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 7TDHconnect 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 180 days of the rejection See claim reports at the end of this section Begin claims by double clicking Claims to display the Medicaid Claim Request Response Summary window WDHeonnect Medicaid Claims File Edit view Reports Tools Navigation Help Douee ER lt 5o0 Medicaid Claim Request Response Summary TOH connect HC Blue Shield ei cbc i No of ltem H Family Planning ape inie Long Term Care 2 Medicaid MP Eligibility Claims PP CSI E ER KS EP Ap
49. 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 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 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 Medicaid folder in TDHconnect Explorer then double click the response Page 66 PR TDHc3 0AC_05 02 04_v 0 4 Medicaid and Family Planning Claims 18 4 Eyeglass Claims After double clicking Claims under Medicaid click the Eyeglass icon or click File gt New gt Eyeglass Note The Patient tab 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 Patent Provider Status Claim Humber a o Nawe pP Patient Provider Claim Diagnosis l Detaile Other Insurance l Replacement Indicator Auto Accident Related p Authorization Number o ind E mploymernt Felated Prescription Date Accident State Cataract Surgery Date THSte
50. bmit 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 Requests tab allows the user to send batches or groups of appeals claims claim status inquiries or eligibility requests Program Summary Send Requests Aetieve Responses Aetieve Uther Family Planning Long Term Care Medicaid Medicare Program Summary tab and verify that the sent requests have changed from Completed status to Submitted status Select All CIBC Family Planning Program end 1 Use the check boxes in the Send E Adjustments L column to select batches to send g Term Care O Appeals o to TMHP CIBC O cee f Family Planning 7 2 When finished selecting click Medicaid o Submit O Blue Shield o 3 Once the transmission to TMHP is CIDE C Test Mode completed without errors open the E E E O oO O Page 48 PR TDHc3 0AC_05 02 04 v 0 4
51. cal 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 S hats Claim No New Patient Provider Claim Diagnosis Details Other Insurance l Family Planning Prograrn Tithe amp Information Bie TS Level of Payment Title Titles D Tite Title Cr Patient Identification Mumbers Account Ho je SSM je Medicaid No i Family Planning Moa Name rz Last Name First Hame hal SLAF Personal En Date of Birth Date of Eligibility Patient Status County of Residence F i f a Fi fa F Address Income Street Family Size J 0 City State lIF Code Family Income Tx Y aon rs 18 8 2 Provider Tab Click the Provider tab has two sub tabs Facility Provider and Referring and Other Provider Required fields e Billing Provider ID and Last Organization Name e Address City State and Zip Code e Tax ID Page 85 TDHconnect 3 0 Workbook for Acute Care Providers Patient Provider S hats Claim No Patient Provider Claim Diagnosis Details Other Insurance l Billing Provider l2 Provider ID pE Last Organization Hame pa First Name Ml Sulfite r E Address
52. cent 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 installation CD ROM TDHconnect 3 0 installation CD ROM Microsoft Internet Explorer E version 4 01 with Service Pack 2 or later Microsoft Internet Explorer 5 0 is included on the 7DHconnect 3 0 installation CD ROM Microsoft Internet Explorer I E version 5 0 included on the TDHconnect 3 0 installation CD ROM 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_05 02 04_v 0 4 Obtaining Support 3 Obtaining Support This section explains how to get assistance from TMHP with technical issues training and claims questions This section also shows how to access additional resources on the TMHP website 3 1 Getting Technical Assistance The TMHP Electronic Data Interchange EDI Help Desk provides technical assistance only with troubleshooting 7DHconnect 3 0 and TMHP EDI Gateway system problems Contact your system administrator for assistance with modem hardware or phone line issues Note Providers in ro
53. coupment enter the Original ICN as a 15 or 24 digit claim number and the Original Medicaid Number is filled in for you IMPORTANT e Remember that bolded fields are required and other fields may be necessary depending on the type of appeal e Click OK on the appeal to save it in completed status to be submitted later to TMHP e Appeals are only submitted by batch not interactively A batch can contain one or more appeals e Clicking does not send the request to TMHP Clicking OK stores the request in Completed status on YOUR 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 and 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 fle Ect Yew Reports Tools Hawg 2 Click File gt New then one of the following PNM 7 eoan BW From Eras A Eyeglass Professional i Dental e Eyeglass jz 5 eigen e Dental 3 Quinstiers e Inpatient e Outpatient Or click the icon for the appropriate appeal type on the 7DHconnect 3 0 menu bar 3 Fill out all required fields in the corresponding dialog displayed 21 4 Appeal Fields IDHeonnert Medicaid Appeals Professional Fie
54. dentally clicking Restore Clicking Restore overwrites the existing database Cancel image with the previously backed up database 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 password is changed and 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 Lil Password Administration Eg Ene i To change the password of the user currently logged in 1 Expand the System folder Enter Current Password D Double click Password Admin The Password Administration dialog opens Enter Mew Password 3 Enter the current password enter the new password and enter the CC new password again to confirm in the appropriate fields Confirm Password 4 Click OK to accept the password change _ ox Cancel 14 4 Scheduling _ TDHconnect OE 1 Expand the System folder file Edit Reports Security Wev 2 Double click Scheduling The Scheduler dialog opens The Scheduler dialog is used to schedule future events such as sending TOH connect requests to TMHP getting responses from TMHP and completing Blue Shield database maintenance i CIDE The Scheduler dialog has the following five tabs Family Planning Long Term Care O
55. der Treatment Indicates that the client s screen was abnormal but the condition is under treatment ST New Services Requested __ ndicates new services requested such as when the client was referred to the Primary Care Physician or to a specialist Patent Provider Status Claim Humber SD EA D e Ne p Patient Provider Claim Diagnosis l Details Other Insurance l Date of Current Condition Condition Codes ete Authorization Ho 7s x Auto Accident Employment Related Foe tre ate THSteps Indicator Ambul Inf ti mbulance Information Type of Transport N None ero a a ooo o O Due as 18 2 3 1 Creating a Claims Template In TDHconnect Explorer double click Medicare to expand the folder and double click Claims TIP If you have updated your client database you will need to update your claim template To edit your provider or claim template open the template and use the magnifying glass to select the provider s or client s to update Page 59 TDHconnect 3 0 Workbook for Acute Care Providers 1 In TDHconnect 3 0 main menu click File and select the type of claim for which you are creating a template Complete the required fields for the claim type Add line item information Note This is required for the initial template set up 4 Click OK after each client and line item information is completed 5 Once all clients have been added click Save As Template You are prompted
56. e First Name iam 7 CIDE Doe John H Family Planning Lord Term Care Client Detail Associated Provider Authorization Diagnosis Other Insurance Miscellaneous 1 Medicaid ca Medicare r Client IDs H Reference Files Account Ho Medicaid Mo Medical Record Mo Soo OOOO CO C O Reference Codes System r Personal Parent Guardian Mame Date of Death Last First poa SS Sw Page 30 PR TDHc3 0AC_05 02 04 v 0 4 Setting Up Reference Files in TDHconnect 3 0 TIP 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 section 17 Medicaid Eligibility on page 51 for more information about determining Medicaid eligibility e Account No is a 1 20 character alphanumeric field assigned by the provider not TMHP to track the client e Medicaid No is the 9 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 TDHeonnect Provider Selection File Edit Reports Security view Tools Communications Navigation Help C gt ey Li w FA a 7 Ey Wf ries JD E A
57. e Help File E TDHconnect 3 0 Online Help Sele ire z E ad Pink inten Contents Index Search and Favorites tabs on the left side of the a ee Next window provide access to help topics A TOHcormect 3 0 Introduction TOHconnect 3 0 Overview P i i p P i TOHeonnect 3 0 Overview and the right side contains the z S a geen wenuiel Health care providers use TOHconnect selected help information and g Getting Started 20 tp Z i g gt System Administration and Security l instructional steps Reference Files TDHconnect version wizard o appeals adjustments and The Contents tab contains a multi TOHconnect 3 0 Quick Reference tiered list of helo topics in Appeals Conduct claim status inquiries TDHconnect 3 help Clai 7 amp T Make client eligibility and Medicaid i Electronic Remittance and Status Repi ee The Index tab contains an aha ea er alphabetized index for a Reports Generate biling reports TDHconnect 3 0 help Adjustments Access the Texas Medicaid Network t ii TexMedNet Web site 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 Add in the Favorites t
58. e 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 FRetieve Responses Retrieve Other The Program Summary tab contains the following columns of information Program Subsystem Completed Submitted Accepted Rejected A ATF P oe Program Blue Shield CIDC Claims 0 0 0 Family Planning Long Term Care sar Medicaid and Medicare Igioiity Claims e Request types Subsystem Col ne ae ae i E Eligibility Claims CSI Appeals Family Planning Adjustments and MESAV Ae e Request status the number of CSI Completed Submitted Accepted Appeals s J Long Term Care or Rejected requests MESA Claims CSI 16 1 1 Batch Request Statuses Important Itis critically important to download all submitted claims and appeals to see if any were rejected and work them immediately e 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 e Incomplete displayed in claims section only The request was entered into TDHconnect but did not pass all the local edi
59. e down arrow on the size 100 box reduces or enlarges the image Page 100 PR TDHc3 0AC_05 02 04 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 180 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 before an appeal may be filed 21 1 Changes to Appeals Resulting From HIPAA The following items reflect changes to appeals resulting from HIPAA e ALL required data on the appeal must be completed not just the data being changed from the original claim e 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 e Changes to surgical procedure codes on inpatient claims must be appealed on paper with supporting documentation for review e Appeals must include all detail lines on the original claim in the same order as on the original claim An appeal will reject if it contains fewer detail lines than the original claim being appealed e An added detail line must be submitted as
60. e in the When menu Enter the time hour minute second AM or PM in the field below the When date Use the format 11 20 2003 HH MM SS AM or PM Me 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 Set the age of affected records in the Age menu Only records older Interval Age Diw BE no ok Cace than the number of days defined in step are affected 7 Click Apply and click OK to schedule Page 41 TDHconnect 3 0 Workbook for Acute Care Providers 14 4 5 History Tab Scheduler Options Send Requests Get Responses i The History tab lists any scheduled events that occurred as successful or unsuccessful Use the History tab to verify scheduled events Note Ifthe 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 7DHconnect 3 0 is set up with a default user called Admin 1 Expand the System folder in TDHconnect Explorer Loading Users 2 Double click Security Admin The Loading Users OT AROE A EEA progress dialog opens Once all users are loaded this dialog closes and the Security Administration dialog opens 3 Click Add User The Security Wizard
61. e 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 Acute 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 you convert data 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 Exit all versions of TDHconnect including DHconnect 3 0 3 Open the Windows Start menu and select Programs TDHconnect gt ConvertAppeals ry TDHeonnect Converbappeals Tn Unicenter Asset Management La TOHconnect 3 0 se Favorites PR Unicenter Software Delivery
62. ect 3 0 in a Windows network environment Close all open applications and remove all media such as backup tapes CD ROMs or removable disks Select Settings gt Control Panel on the Windows Start menu Double click Add Remove Programs In the Install Uninstall tab click Install Insert the installation CD ROM into your CD ROM drive Click Next Click Browse Select the location of your CD ROM drive in the Look in field Select Setup exe in the list of files and click Open Click Finish The TDHconnect 3 0 installation window opens Read the welcome screen click Next and Next again to confirm that you are about to install 7DHconnect 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 If Acrobat Reader 4 05 or higher is already installed on your system click Cancel click Yes and skip to step 11 Click Next to install Acrobat Reader 4 05 The Choose Destination Location window opens Click Next to install to the default location or click Browse to select a new location A message opens Copying program files After installation is complete the Information dialog displays the following message Thank you for choosing Acrobat Reader Click OK to close this dialog A message opens Do you wish
63. ed after the response has been Downloaded The 9 character numeric ID first issued when starting to electronically bill This should be 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 gt 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 9 character numeric Texas Provider Identifier number issued to you through Medicaid Page 111 TDHconnect 3 0 Workbook for Acute Care Providers 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 ll 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 W
64. ed eligibility request is required Select a request that has been Completed but not Submitted Click Reports gt Information Request on the DHconnect 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 Click Print for a paper copy e Information Response Select an accepted response batch or interactive The response is displayed To print the response click Reports Information Response and Print on the TDHconnect 3 0 menu bar Interactive Summary Click Reports and Interactive Summary on the 7DHconnect 3 0 menu bar Input a range of beginning and ending transmit dates and click OK A report of eligibility responses is displayed Click Print for a paper copy e Batch Report Select an interactive or a batch response 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 TDHc3 0AC_05 02 04 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 stand
65. ed in that section requiring a diagnosis code by policy they may use diagnosis code V726 Laboratory Examination for the claim to be accepted e Radiology providers If no other diagnosis code is available use V725 Radiological Examination Not Elsewhere Classified Page 60 PR TDHc3 0AC_05 02 04 v 0 4 Medicaid and Family Planning Claims Patent Provider Status Claim Humber LLL LL Le DT Nw Pp Patient Provider l E Diagnosis Details Other Insurance ea o heesie Duc Gna Diagnosis T ie gt ode Description 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 O o TS This window is shown in 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 Code in 4 4 2 format or 5 3 2 format or 5 4 1 format or 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
66. eements cannot be processed Mail to Texas Medicaid amp Healthcare Partnership Attention EDI Help Desk MC B14 PO Box 204270 Austin TX 78720 4270 Fax to 512 514 4228 OR 512 514 4230 Page 110 PR TDHc3 0AC_05 02 04 v 0 4 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 Attachments Glossary Electronically 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 to an item on the Windows taskbar The minimize button is on the upper right corner of a window dialog o
67. equest returns very helpful information such as if the client is a member of an HMO has other insurance or is no longer is 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 e 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 the suffix appended to the last name e On the eligibility response authorization information is no longer available Call the TMHP Contact Center at 800 925 9126 e TPR Third Party Resources relationship to the insured is no longer available on the eligibility response 17 2 Beginning the Eligibility Request DHconnect Medicaid Chigibility Fle Edt View Beports Tool Wavigation Help De a 7520 z MP TDHconneci Medicaid Eligibility Request Response Summary l Blue Stead _ D eae Sj coc Status hho of liemi L Fami Planning Long Term Care Aeected iO J Medcaid Template T Eligibility w Liame p DP col he ainda Aias Submitter iC Appas F __ Medza __ Reference Fles Oj System
68. er of a group enter the nine digit performing provider number Perform Provider ID and name Perf Last Name Patent Provider Status Claim Humber New Patient Provider l Claim Diagnosis Details Other Insurance Date of Procedure Procedure a a oe Da Diag Total o S ID ee a ee Total Charges 0 00 Other Insurance Paid 0 00 Met Billed 0 00 Loe Cancel Page 68 PR TDHc3 0AC_05 02 04 v 0 4 Medicaid and Family Planning Claims Patent Provider aie Claim Humber Patient Provider Claim Diagnosis Details Other Insurance o Total Charges 0 00 Other Insurance Paid 0 00 Met Billed 0 00 Interactive Lo Cancel Page 69 TDHconnect 3 0 Workbook for Acute Care Providers 18 5 Dental Claims To fill out a dental claim HIPAA transaction 837D double 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 Dental Note The Patient tab Provider tab 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 Decent Helerence Lodes Fle Edt Repent Securty View Tool Communications Mavigation Help ea ki x Aa Ce wf z eka Ses oO Su P WF Totcoret 1 aD eie 7
69. es 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 TP 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 Fax Number 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_05 02 04 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 Texas Health and Human Services Commission for interfacing with the TMHP EDI System You will be able to use features such as Eligibility Claim Submission Claim Status Inquiry Remittance and Status Report and Appeals e The system requirements for TDHconnect are listed on the bottom of this page You should acquire the minimum P
70. es Biling Codes Service Codes Service Group LTC Procedure Codes ltem Codes EQOB LTC Crosswalk AILLTC Reference Codes LTC System C21 Reference Codes Diagnosis Codes DAG Codes Edit Audit Codes EOE Codes The Retrieve Other tab is used to electronically download R amp S reports and reference codes Process ERAS OHOOOOUOOUOOOOOOOOO Page 49 TDHconnect 3 0 Workbook for Acute Care Providers 16 4 1 Retrieve ER amp S Reports Important You must have a signed ER amp S Agreement on file with TMHP before you are allowed to download ER amp S reports Electronic R amp S ER amp S reports are available weekly at 6 00 a m 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 Other tab 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_05 02 04 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 r
71. essesescsesssesesssseseseseseseeeeeeee 82 18 7 2 2 Operating and Other Providers eesesssessesesescssesesssssssssescecseeseseen 82 Ty SIUM le AUD uct eins cazanadbaea EEEE NT 83 e ay ame 12 co er ere ee nn er ner ee fe bn nn 83 Famy Planning Clais nana Tana nren eee NENE TOTT TT 85 TDHconnect 3 0 Workbook for Acute Care Providers 20 21 22 oe ort mm c s a Eat Gol Ars o Seen A Oem Oe en er eT A Teneo 85 1002 POVA VAD ira et ETTET OEEO OOTAN 85 1663 CUM TAD soinn n nE tat enone Guana eae oe 87 18 8 4 Creating a Claims Template 0 ccsscscscsccscsssssssssssssssscscscesesesessssssesescsseseseseeeen 87 NGO AV CVANS al catecatanc sate cesar anoniae chaksese tip iaset een E O 87 18 8 6 Submitting and Retrieving Requests csccscececscecssseseescsescsssessessssssesssesseeeeees 89 18 8 6 1 Submit Retrieve Interactive Requests ccsccssssssesseessesescsesesssesesees 69 18 8 6 2 Submit Retrieve Batch Requests ccceeseessescesssesessscseseessesesesees 89 1097 PANUNG REDOT arnan ren em ere roi a re E a 90 Medicaid Claim Status Inquiry ssssessseccsssssssssococcccecesessssosococccceesesssssooo 93 19 1 Cr atea New CSL REGUCSE sexcstestacserucavushedivauts sE EEA EO 93 19 4 1 Provider Patient REGUESI erana O E ATEN 93 OD Clams Regie ST aano OA AEE 95 19 2 Submitting and Retrieving Requests ccscccscsssssssssssssscssscssesesessssssssesescscesesesesesesessees 95 19 2 1 Submit Retrieve
72. eve thes a ie oA ERAS LTC Relemnce Codes Biting Coden Senace Codes Sennace Grou LTC Protedise Codes lien Comes ES LTC Cippi ADLTC Relerence Cokes LTC upam C2 Reference Codes Dagoan Codes DAG Codes Edit Aud Codes EDE Codes ba Doniad Page 99 TDHconnect 3 0 Workbook for Acute Care Providers Open the lt Bold Italic gt TDHconnect System Totals window Open the Retrieve Other tab Select the check box in the Download column for ER amp S o u a Click Download 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 fie Edt yew Took H In the Medicaid ER amp S Summary List window click File gt Generate R amp S iehconnec Medmaid HES Fle Edt Yew Took fengstion Help o gt ites B FC oQ E gomme Required fields are omin D Provide 1D ave lt Provider ID fia ll eaten Date Z Medeaid nian Hi 3 e End Date E beget Clam Sort tdeneine snicd Marita l clan aici i e Claim Status check one E ris ore hl EBG v ae The Start Date is usually a Friday and I Medeae m a the End Date is usually the following 4 i Raterence Fim Monday 9 System Diaries I Pending Click Display Report to see the report res 20 3 Medicaid ER amp S Print Report e Click Print to print the ER amp S report e Use the forward or backward arrows to see other pages e Th
73. eve batch requests Page 95 TDHconnect 3 0 Workbook for Acute Care Providers Submit a Batch Request Pro son Surrey l Send Hequerts Heres Hecpornees H Uei Tyche j Program Send 3 Fane Pistang Mimica Blive Sheki LILIL Pandy Piara Long Tam Las a Tent Mowe oue Faim Planing Long Tam Care Medicaid C F lipitility UDE Saim 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 A a ee Paga Gumma Deni Femur 7 Heliewe Responses Reheve Dee bytem Doeriaed Avista Appeals Cizim cs EEbDYWDD h _ _ _ E aie ME SAV 1 24 hours after request submission go to the System Totals window and select the Retrieve Responses tab Select the check box for CSI in the Download column Click Download Requests are now changed to Processed status 4 To view the downloaded response double click CS under the Medicaid folder left side of window then double click the response Page 96 PR TDHc3 0AC_05 02 04 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 e Response Report Cl
74. ial field Important Enter a number other than 9 if a different number is required by your service 7 Click Apply and click OK in the Dialing Properties window 8 In the Modem Properties window click Close Exit the 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 next section 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 or appropriate technical assistance group should test TDHconnect 3 0 to ensure that the other applications did not disable 7DHconnect 3 0 Page 16 PR TDHc3 0AC_05 02 04 v 0 4 Data Conversion 7 Data Conversion IMPORTANT e Ifthe 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 e 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 sav
75. icaid to expand a list of options H ERAS N E available for that program e Double click an option to expand a list of Finish functions available for that option e A F indicates that the user has access and an gt 4 indicates that a user does NOT have access e Change the settings by double clicking on the f or 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 Summar UserID 123456789 RRI Full Name John Smith B osion Abed Etgh likl Mnop Crst Uvwsyz Step four summarizes the functions that the user TexMedtet User ID TexMedNet Password can com plete Step 3 i E To change a selection click Back otherwise click SAPI E icibiity Finish to add the user gt Create E dit gt Delete gt Submit Batch Finish Page 44 PR TDHc3 0AC_05 02 04_v 0 4 Connecting to TMHP 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 Internet service provider 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_05 02 04 v 0 4 Using the TDHconnect System Totals Window 16 Using th
76. ick an accepted CSI response No of Requests is greater than the No Rejected Click Reports Response Report and Claim Report Click Print for a paper copy e Batch Report Select interactive or batch response click Reports gt Batch Report The report IMMEDIATELY starts printing a detailed list of ALL CSI responses from the row you selected Page 97 TDHconnect 3 0 Workbook for Acute Care Providers NOTES Page 98 PR TDHc3 0AC_05 02 04 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 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 ieHconnec Medmaid THES Pie Eat yew Toots fRragetion Help Cae Aa S o oo i TOHconmeci Medicaid ERAS Summary List i Eie Shad Dj onc 7 7 Raport Mo Check Na Provide ID ALS RunDa Repot Staha te i a SSE 4 J Reimp Firg D System a arc 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 Pogas Simmay Sand Riemer Reeve Herponiri ie Retri
77. icrosoft 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_05 02 04_v 0 4 TDHconnect 3 0 Hardware and Software Requirements 2 TDHconnect 3 0 Hardware and Software 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 e 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 e For improved performance your system should meet or exceed the recommended requirements HARDWARE Minimum RECOMMENDED PC with a Pentium II class processor ce Mine aie fs eas 128MB of RAM 128MB of RAM 100MB hard disk space for installation 100MB hard disk space for installation plus 3 times the size of the database plus 3 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 re
78. ide of the lt Bold Italic gt TDHconnect System Totals window Page 102 PR TDHc3 0AC_05 02 04 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 Foiconnect Medicaid Appeals hits Search Fie Edt Yew Reports Jook Navigaton Help Joe peace segon ae ToHconect z5 Seanch Cetera Bie Shedd Clam No p Prowicker I P Faen No Ciam Sumur 2g ope sae _ Family Planning Cycle Statt hate Cycle End Data T Long Tem Care lt ie ua T Medea Chan t csi S ER S On i Pala Appeals F i D Medicare e Sa 4 Raimos Fier 2 Spetem i f Jz Hi i a 3 3 E e Important If you have not signed up to receive ER amp S reports you may do so by filling out an 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 4 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 Patient tab has three additional fields not found on claims See section section 21 4 Appeal Fields on page 104 For Frequency Code select 7 for an appeal or 8 for a void re
79. ient General Information Sex Date of Birth Date of Death i i Address Street City State Page 56 PR TDHc3 0AC_05 02 04_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 e Select the Provider tab e Click the magnifying glass icon to autopopulate the fields in the provider database or enter the fields manually Required fields appear in bold type lf 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 Prowider Status Claim Humber New Patient Provider Claim Diagnosis l Details Other Insurance Billing Provider pe Provider ID pa Last Organization Hame pa First Name S uffi Address City State IP Code ID type Other ID Phone Ho OE OO Provider Facility Referring and Other Provider Facility D Provider ID D Name ID type Other ID Semice Location Address City State IP Code Gem ee Page 57 TDHconnect 3 0 Workbook for Acute Care Providers 18 2 2 2 Referring and Other
80. in see section 14 2 Database Utilities on page 35 for instructions Page 34 PR TDHc3 0AC_05 02 04 v 0 4 TDHconnect 3 0 System Maintenance 14 TDHconnect 3 0 System Maintenance 14 1 System Functions Overview TDHconnect 1 To view system functions double click the System folder in TDHconnect Explorer Fie Edit Reports Security wie 2 The System folder expands The options are e Database Utilities k T i Password Admin istration CICC e Scheduling Family Planning e Security Admin istration Long Term Care Medicaid TexMedNet Medicare e TexMedNet Info rmation Reference Files l l System Note While TexMedNet functions are now performed by the TMHP Database Utilities EDI Gateway the way to access these functions in passed Manin TDHconnect 3 0 remains the same Scheduling Security Admir TexMedh et TexMedNet Info 14 2 Database Utilities 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 7DHconnect 3 0 database 1 Expand the System folder in TDHconnect Explorer 2 Double click Database Utilities The Database Utilities dialog opens with four tabs Compress Purge Mapper and Back up P
81. it uncheck the View readme check box and click Finish When prompted to restart the computer select Yes want to restart my computer now and click Finish Important The next time 7DHconnect is opened the version of the Service Pack is listed along with the name TDHconnect 3 0 Page 20 PR TDHc3 0AC_05 02 04 v 0 4 Opening and Logging on to TDHconnect 3 0 9 Opening and Logging on to TDHconnect 3 0 Important Each user must have a unique 7DHconnect 3 0 user ID and password Additional user IDs can be created in TDHconnect 3 0 using the security function 12 1 Double click the TDHconnect 3 0 icon on your desktop The TDHconnect Version 3 0 Login dialog opens TOHconnerct 2 Inthe User ID field enter admin in lowercase letters and press lt TAB gt 3 Inthe Password field enter password in lowercase letters The password field is always case sensitive 4 Click OK TDHconnect 3 0 starts admin password Note When logging on the following error messages may be encountered e admin is currently logged on to TDHconnect e TDHconnect ts 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_05 02 04_v 0 4 10 TDHconnect 3 0 Log On Error Messages
82. lanning 4 4 j Lang Tem are L Medco THERAPELITIC ULTRASOUND OF VESS j Relerence Files THERAPEVTIC ULTRASOUND OF HEART i te aa THERAPEUTIC ULTRASOUND OF PERI wid EP rcrewher i Uelmonca Cah OTHER THERAPEUTIC ULTRASOUND 00 t i Symen IMPLANTATION GF CHEMOTHERAPELIT 00 l Fie Codes E r Fiii Tira eee a Aidolind Column res Procechme Papo Cocke fe Slat Wih Cortana a Chee ST Cea 1 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 2 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 3 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 4 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 bi
83. ld to the right of the Daily ai al interval selector The Age menu is not used to send requests ok Cancel 7 Click Apply and click OK to schedule 14 4 3 Get Responses Tab Scheduler Options Database History Use the Get Responses tab to schedule Tine ceatse tme RE the retrieval of batch responses Note If Send Requests have been scheduled consider scheduling Get Responses on the following day 1 Open the Get Responses tab and click Add The Event Scheduler dialog opens Event Scheduler Eq 2 Select an event type in the Type menu Select a date in the When menu when Enter the time hour minute second AM or PM in the field below the 11 20 2003 date Use the format E HH MM SS AM or PM Interval Age Set how often the event repeats in the Interval menu If Irregular is pay f ST oS selected enter the number of days in the field to the right of the interval selector LK cancel Apel The Age menu is not used to send requests Click Apply and OK to schedule Page 40 PR TDHc3 0AC_05 02 04 v 0 4 TDHconnect 3 0 System Maintenance 14 4 4 Database Tab 3 Scheduler Use the Database tab to schedule the automatic execution of database maintenance functions such as backup compress or purge 1 Open the Database tab and click Add The Event Scheduler dialog opens 3 Event Scheduler sa 2 Select an event type in the Type menu Select a dat
84. ll bar on the right side of the Terma of Use text box to scroll through the text Py otcepi iba the fered of ure FHU Fill Be allewed gtesd ft pipea FSpects and information Erortegted by federal and erate law contained in che secure portion of this 9 After you have read and FEDAL TE Lely set horkiecd PATS0ES in laviul poadtasion of pecetord peerided EY TEHF T PIDIL Such Pare MA REET ARG BSE ERS BREA PETELE SF ELA PERS LES TES Liss understood the General Terms GE this website is pub pect to thE Germ of use contained Here itia Cee Fou Batt atttpted Che tered 85 uae Fou Fill Bt Be esred L eaten Such Ceres ein Jain Ehen Pau access the fice angcker tims TENP kas che fight at any time to change or and Conditions select the mdify the tered of wee which Fill be posted on this website Any wee of the weboite by TSU AES mei tied etme Bate Geen feasted will Be deemed 4 FEnSELEuLe aeepiante BY Peo w check box next to l agree to 0 I agree to these terms these terms 10 Click Activate Account Your account is now activated 11 An Account Activation Confirmation dialog opens to confirm that your User Name and Password have been sent to the e mail address that was specified in your request Page 10 PR TDHc3 0AC_05 02 04 v 0 4 Accessing the TMHP Website 12 Write down your User Name and Password and put it in a safe place Note If you do not receive your User Name and Password within 24 hours please contact the TMHP E
85. llation sequence is interrupted TDHconnect 3 0 does 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 in the TDHconnect 3 0 installation CD ROM e 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 opens Online Support e If Internet Explorer is NOT installed use the TDHconnect 3 0 CD Send Feedback 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 gt Control Panel Double click Add Remove Programs In the Install 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 gt Control Panel Double click Add Remove Programs In the Install Uninstall tab click Install
86. lled amount to add 5 Click OK when finished 6 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 database 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 TDHconnect File Edit Reports Security wiew Tools Communications Navigation Help OS Va Se HGR Rake Feo eu Eo TDHconnect System Totals l HE le CIDE Family Planning Long Tern Care Medicaid Medicare Reference Files System F FE EE EE E E Frogram Summary Send Requests Category Download r LTC Reference Codes Biling Codes Semice Codes Semice Group LTC Procedure Codes ltem Codes EOE LTC Crosswalk AILLTC Reference Codes LTC System C21 Reference Codes Diagnosis Codes DAG Codes Edit Audit Codes EOB Codes Dee OOOUOOUOOUOOUOOUOOOOO 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 aga
87. m 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 oe Se 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 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 e 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 e Transmission Detail Click an accepted batch claim response has Transmit Type B anda Transmission ID and the No of Requests is greater than the No Rejected Click Reports Transmission Detail A list of claim responses in that batch is displayed Click Print for a paper copy e Interactive Sum
88. mary Click Reports and Interactive Summary The Interactive Transmission Report dialog opens interactive lransmnswn Heport Erte begim date io inansmitnon oske Erte erding dale lor bariennon platii e Input a range of beginning and ending transmit dates and click OK e A report of claim responses is displayed Click Print for a paper copy e 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 e 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_05 02 04 v 0 4 Medicaid and Family Planning Claims e Completed Claims Click Reports and Completed Claims A detailed list of ALL completed claims IMMEDIATELY starts printing e Rejected 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 Page 92 PR TDHc3 0AC_05 02 04 v 0 4 Medicaid Claim Status Inquiry 19 Medicaid Claim Status Inquiry
89. me 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 A few things to keep in mind as you prepare to install e Administrator rights are required when installing to a network e The system administrator must install TDHconnect 3 0 on each PC and install the databases in a common LAN location e Since there is only one database located on the server only one Compass21 User ID and password is needed e The most current DHconnect 3 0 Service Pack must be installed on each PC that has an installed copy of TDHconnect 3 0 e 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 e 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 CMS User ID fields e TDHconnect 3 0 does not support modem pools Page 14 PR TDHc3 0AC_05 02 04_v 0 4 Installing TDHconnect 3 0 6 3 Installation Steps Important Administrator rights are required when installing 7TDHconn
90. n lt CTRL gt C Copy selected text Access the Help files for information lt F1 gt l about the current window Access the Local Reference Database lt CTRL gt D Delete a record from the for the selected field database lt F2 gt Place the cursor in the field and press lt CTRL gt O Open a record from a list lt F2 gt Place the cursor beneath the cell to copy lt CTRL gt T Clear all fields on this window Copies the entire row lt F4 gt lt CTRL gt R Focus on TDHconnect Explorer Ea Copies a single cell lt F3 gt Place the cursor beneath the line to copy and press lt F4 gt lt CTRL gt V Paste selected text lt CTRL gt W Focus on Workspace Causes a window to refresh and display lt CTRL gt X Cut selected text lt F5 gt all data created simultaneously by lt ALT gt E Open Edit menu multiple users of TDHconnect 3 0 lt ALT gt H Open Help menu Inserts a new row a lt F6 gt Place the cursor on a row the new line is lt ALT gt N Open Navigation menu added below this row and press lt F6 gt lt ALT gt R Open Reports menu Deletasavow lt ALT gt V lt F7 gt 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_05 02 04 v 0 4 Setting Up Communications in TDHconnect 3 0 12 Setting Up Communications in TDHconnect 3 0 This
91. n Covered Charges may be used to report specific non covered amounts Page 76 PR TDHc3 0AC_05 02 04 v 0 4 Medicaid and Family Planning Claims Patent Provider Status Claim Humber D ef O ke Co Patient Provider l Claim Diagnosis Details Other Insurance Ctl Rev Non Covered Ey Total Charges Non Covered Charges Other Insurance Paid Met Billed 0 00 0 00 0 00 0 00 Cancel Patent Provider Status Claim Humber New Patient Provider l Claim Diagnosis Details Other Insurance Rey 2 Non Covered Total Charges Non Coyvered Changes Other Insurance Paid Net Billed Cancel 0 00 0 00 0 00 0 00 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 e Revenue codes Rev Code e Units e Total Charges Unit Price is required for revenue codes 100 219 Non Covered Charges may be used to report line specific non covered amounts Patent Provider Status Claim Humber New Patient Provider l Claim Diagnosis Details Other Insurance Hon Covered Charges Total Charges 0 00 Non Coyvered Charges 0 00 Other Insurance Faid 0 00 Met Billed 0 00 Accommodation Details Ancillary De
92. 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_05 02 04 v 0 4 Medicaid and Family Planning Claims 18 7 1 Patient Tab Required fields e Account No Medicaid No and provider defined Medical Record No e Last Name and First Name Sex Date of Birth Street Address City State and Zip Code Patent Provider Status Claim Humber Dino TTC Cf i LS Ss Patient Prowider l Claim Diagnosis Detaile Other Insurance l Patent Identification Numbers D Account Ho Ja SSN i Medicaid Ho Name la Last Hame D First Hame hal S uffi o oo Patient General Information Sex Date of Birth i Address Street City State IP Code SE IM o ox 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 Prowider Status Claim Number Do Sea es SaaS ae ESS SESS Patient Provider Claim Diagnosis l Details Other Insurance l Billing and Attending Providers Operating and Other Providers Billing Provider rz Provider ID D Last Facilty Hame Fhone Mo EA Address City State ZIP Code T2 Tax ID Ho Attending 2 Provider ID O Last Name E First Mame Ml Suffix ID type Other ID
93. or Windows 95 128MB Hard disk Drive Space Minimum RECOMMENDED 100 MB for installation 100 MB for installation 3 times the size of the existing database 3 times the size of the existing database Peripherals Item Minimum RECOMMENDED CD ROM Drive any any faster is better Display 800x600 VGA 256 colors 800x600 VGA 256 colors or better Modem 9600 bps 28800 bps or faster Additional Software Item Minimum RECOMMENDED version 4 05 or newer Adobe Acrobat Reader version 4 0 version 4 05 is included on the TDHconnect installation CD ROM version 5 0 or newer version 5 0 is included on the TDHconnect installation CD ROM version 4 01 with Microsoft Internet Explorer IE Service Pack 2 Page 109 TDHconnect 3 0 Workbook for Acute Care Providers TDHconnect Order Form Submission amp Shipping Instructions Standard delivery of the 7DHconnect 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 C UPS Overnight UPS delivery is at Provider s expense Enter your UPS Account Number below Requests submitted without a valid account number will L UPS 2nd Day Air be shipped via standard mail delivery UPS cannot deliver Before faxing or mailing this agreement ensure that all required information is completely filled out and that the agreement is signed Incomplete agr
94. ould recommend this seminar to others 5 4 3 2 1 lll 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 112 PR TDHc3 0AC_05 02 04_v 0 4
95. peals H Medicare 2 Reference Files HO System Es z ai _______ ____ __ ___ _ gt a Page 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 P Gi W le E or click File gt New on the 7DHconnect 3 0 menu bar and then the type of claim Professional Eyeglass Dental Inpatient or Outpatient Fie Ede Yew Reports Tool Mavigsto C ew Y Professional do Eyeglass Gy ose i Dental Inpatient on Cutpshent l Note The HIPAA transactions for Professional and Eyeglass claims are now transaction 837P 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 Professional on the 7DHconnect 3 0 menu bar 18 2 1 Patient Tab Click the magnifying glass icon to autopopulate the fields in the client database or enter the fields manually Required fields appear in bold type Patent Provider Status Claim Humber EL a iit Patient Provider l Claim Diagnosis Details Other Insurance Patient Identification Humbera T2 Account Ho jo SSN 2 Medicaid Ho Hame pE Last Hame pe First Name Sutfis ee o Pat
96. ps Indicator gery i iai B New Eve Hs Sphere Cylinder Near Intermediate Right E pe Lett Eve Old Eye Ax Sphere Cylinder Near Intermediate Right E pe Lett Eve a ok Cna Page 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 Tab to the POS column and use the drop down box to select place of service POS Click inside the Procedure 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 or 5 3 2 format or 5 4 1 format or 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 entered 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 memb
97. ptions Medicaid e Send Requests 4 Medicare Get Responses i Reference Files H eosin e Database Database Utilities e History Password Admin Scheduling w Security Admin TexMedet TexMedet Info 14 4 1 Scheduler Dialog Options Tab Page 38 PR TDHc3 0AC_05 02 04 v 0 4 TDHconnect 3 0 System Maintenance Scheduler Options Send Requests Get Responses Database History The Options tab is used to allow or to not allow scheduled events Important The PC must be powered on and the user must be logged into mes Scheduled Events 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 Send Requests Tab Scheduler Options Get Responses Database History The Send Requests tab is used to schedule sending a batch of requests to TMHP 1 Open the Send Requests tab 2 Click Add The Event Scheduler dialog opens Start Date Interval Cancel Page 39 TDHconnect 3 0 Workbook for Acute Care Providers Event Scheduler Eq 3 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 When date Use the format 11 20 2003 HH MM SS AM or PM Set the periodicity of the event in the Interval menu If Irregular is ret fae selected enter the number of days in the fie
98. r ID or Social Security No and Other ID corresponding to ID type Patient Provider Status Claim Humber p es Patient Provider Claim Diagnosis l Details Other Insurance Billing and Attending Providers Operating and other Providers Billing Provider Provider ID D Facility Hame Phone Ho J Address City State ZIP Code C 4 Tax ID No Attending p2 Provider ID 2 Last Hame J First Hame Ml Suffix ID type Other ID BE F Moo Cancel Page 73 TDHconnect 3 0 Workbook for Acute Care Providers 18 6 2 2 Operating and Other Provider Sub Tab Required fields if applicable e Operating Provider ID Last Name and First Name e The Other Provider ID Last Name and First Name Patient Provider S hats Claim Number SO SDSS ed SS San EES ESS Patient Provider Claim Diagnosis l Details Other Insurance l Biling and Attending Providers i Operating and other Providers Operating E pe Provider ID a Last Name J2 First Hame Ml Suffix I type Other ID EO Other Provider ID D Last Hame D First Hame Ml Suffis ID ype Other ID B O T re 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
99. r 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 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 180 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 888 863 3638 Request has been transmitted for processing Submitted requests convert to Process
100. s Other Insurance Total ae Perform Provider ID Perf Last Name Pest First Name Pert Ml Perf Suffix E es ee o ooo S S o i ee ee a Res ee ee ee Rs ee es Me ee a re ee ee a ee ee es a ee ee Rs es a ee ee Rs es C ee ee Rs Se Cy E Total Charges 0 00 Other Insurance Paid 0 00 Net Billed 0 00 as Template Interactive Cancel Page 62 PR TDHc3 0AC_05 02 04_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 Patent Prowider Status Claim umber D J Je J Fatient Provider Claim Diagnosis Details Other Insurance Other Insurance 1 Other Insurance 2 Payment Source OF Payment ri Save as Template Interactive Cancel Page 63 TDHconnect 3 0 Workbook for Acute Care Providers 1 To list the client s other insurance open the Other Insurance tab and select the Source of Payment such as Commercial Insurance Patient Prowider Status Claim Number E oft Patient Provider l Claim Diagnosis l Details Other Insurance Other Insurance 1 Other Insurance 2 Other Insurance 3 Payrmerit Delay D Source Uf Payment I Commercial Ins Co Indicator Bill D ate Disposition lt Adjustment Reason Code Disposition Date PPO Discount Paid Amt i 0 00
101. sseeseeses 65 18 3 1 Submit Retrieve Interactive Requests ccccsccccsesesessescssssscsesessscscscssscssssesseseens 05 18 3 2 Submit Retrieve Batch Requests cccssesscsssssescsssssssssssssssescssecssscssscssesesesssens 65 18 3 2 1 Submit a Batch Request oneisnninosnneneniniaiecnian 66 18 3 2 2 Retrieve Responses to a Batch Request sesesesessessessesseeseseesererresse 66 FE VCC ASS CIIS 3 sos cia A E Medd mae aes 67 MA OVA aD id cecticstacte crete casa E ee aon eee Rae aes 67 VO Aes Ders TaD renn TEE T 68 DE A E EEE EE EEEE ENAA S 70 tood Can VAD enan aE A A I OOOO E AOOO 70 loo Details T aice T E TOAN 70 EEIEIEE os MINN E E E AA E A EA EE EE EE A eeaeadanetee 72 06 Panen Er 10 peer prin Pi Erne Eg Pee en ere er re ee 72 10602 SPROVIGE AD siiecssctunctre E E 73 18 6 2 1 Billing and Attending Providers Sub Tab uo seesssseeeseseeeeeeeeen 73 18 6 2 2 Operating and Other Provider Sub Tab o eesesesseeeseeseeeeeeeeen 74 Boo Cam T a eae en ne Re re ee ee ee eee een eee ee 74 HOO DigGQnOSIS Pal cicsecets settee ian NE NEO ENOO OEO 76 OT B21 11 ioe Ars 6 pee wpn ane mn PRS NIC E PR RTC ne tN RETO 76 18 0 551 ACCOM MOC AON Detalls cx cesssa ca sisstsiees dlacedseeststahiaaedtchdenees 76 19652 Anay Detil corun e A ETE 78 196 53 Sway Detal aane E N E CONEA 80 Outmpanent Ila eenn A T 80 B PNE a r E A 81 TO a TO VIGCT TaD a Pantie aunts eas engtiast eatin E Des areenaaal gael 81 18 7 2 1 Billing and Attending Providers eeseses
102. t P jf Run oO Bi Page 23 TDHconnect 3 0 Workbook for Acute Care Providers Ld ToHconnect Utilities Peai iau Damei Wsz The TDHconnect Utilities program starts 2 Select the Logoff User tab 3 Select the User ID in this case admin to log off 4 Click Log Off 5 Click OK admin admin 10 2 Using the Windows Task Manager to Shut Down TDHconnect 3 0 1 Click OK in the error message dialog The error message dialog 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 E Windows Task Manager File Options View Windows Help Applications Processes Performance Networking Task Status Ba TOHconnect 3 0 0a doc Microsoft Word Running 3 Select TDHconnect in the Task Manager Snagit Running Ey Hints Running d ialog isit TOHconnect Funning E workbooks aoe 4 a End Task 7DHconnect 3 0 shuts own 5 Restart TDHconnect 3 0 and log in gt end Task __Switch To mew Task CPU Usage 1 Commit Charge 266248K 865756 Page 24 PR TDHc3 0AC_05 02 04_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 Function Keys Action Actio
103. tact Center Account web page opens Register for a Workshop Page 9 TDHconnect 3 0 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 k User Name fs 6 15 characters no spaces or special characters Must be different than your EDI Submitter ID First Name iti no special characters i Last Name 4 no special characters Email i Confirm Email is Please retype your email Do not cut and paste Password fs 8 15 characters mo spaces or special characters Confirm Password fs 5 provider Type 6 Complete the following fields all fields must be completed as indicated by the red dot e Enter a User Name 6 15 alphanumeric characters do not use your EDI Submitter ID e Enter a First Name e Enter a Last Name Enter an E mail address Reenter to Confirm E mail address e Enter a Password 8 15 characters alphanumeric Reenter to Confirm Password e Select Provider Type Acute Care or Long Term Care 7 Scroll down to the General Terms and Conditions GEAR TORE AND ODT res 8 Read the GENERAL TERMS Tau haat eft do the Seite pottian cf the Texas Medieate Bee lebeare Partnership z TAH irha B Ea cae ar p Gn D a dairy x Neate AND CONDITIONS Use the Bealcicace LLC ite parent company afiiiliaces sebsidiaries segicovess comeulcarntea ea ae ea scro
104. tails Surgery Details Page 78 PR TDHc3 0AC_05 02 04 v 0 4 Patient Provider Medicaid and Family Planning Claims Status Claim Humber P E a E Patient l Provider l Claim Diagnosis Details Other Insurance Accommodation Details T p ES ce p a Total Maint Non Covered _ Charges Ancillary Details Surgery Details Total Charges Non Covered Charges Other Insurance Paid Met Billed 0 00 0 00 0 00 0 00 E TE fm oye os Te nplate Interactive Cancel Page 79 TDHconnect 3 0 Workbook for Acute Care Providers 18 6 5 3 Surgery Details Click the Surgery Details sub tab of the Details tab to enter surgery charges Optional fields e Surgical Code e Procedure Information HCPCS or ICD 9 code e Date of Service Patent Provider Status Claim Humber a e Mas Patient Provider l Claim Diagnosis Details Other Insurance Ctl No Surgical Procedure Date of Code Information Service Pince ooo Total Charges 0 00 Non Coyvered Changes 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 Outpatient The Diagnosis tab and Other Insurance tab is identical
105. tals window and select the Retrieve Responses tab Select the check box for Appeals in the Download column 3 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 gt 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 No Rejected greater than zero 2 Click Reports 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 2 Click Reports gt Appeal Detail A detailed list of the appeal is displayed 3 Click Print for a paper copy Completed Appeals 1 Click Reports gt Completed Appeals The following statement appears There are __ appeals to print Do you want to continue 2 Click Yes to print a detailed list of
106. tary dial areas cannot use 7DHconnect 3 0 To reach the TMHP EDI Help Desk available Monday through Friday 7 a m to 7 p m Central Time select one of the following methods e For Medicaid CSHCN and Family Planning technical issues call 888 863 3638 In Austin call 512 514 4150 e For Long Term Care LTC technical issues call 800 626 4117 In Austin call 512 335 4729 e Fax 512 514 4230 or 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 training specialist or attend one of the training workshops provided by TMHP Provider Relations Contact To get contact information for your training specialist call the TMHP Contact Center at 800 925 9126 or visit the TMHP website at www tmhp com For CSHCN Customer Service call 800 568 2413 For Long Term Care Customer Service call the TMHP LTC Help Desk at 800 626 4117 In Austin dial 512 335 4729 For Medicaid and Family Planning information call the TMHP Contact Center at 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 CSHCN elec
107. 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 e Select the Managed Care tab to see the HMO or Texas Health Network THN information e Select the Benefit Limits tab for the latest eyeglass hearing aid THSteps Dental and THSteps Medical claims e Select the Other Insurance tab for information on other insurers for the client To update the client s other insurance contact Third Party Resources at 800 846 7307 See also the Third Party Resources section in the Texas Medicaid Provider Procedures Manual e Include 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 e Transmission Summary Click a batch eligibility response has Transmit Type B anda Transmission ID Click Reports and Transmission Summary to display the report The number of accepted or rejected responses is listed Click Print for a paper copy e Transmission Detail Click an accepted batch eligibility response has Transmit Type B and a Transmission ID Click Reports and Transmission Detail A list of eligibility responses in that batch is displayed Click Print for a paper copy e Information Request Double click the completed row near the top of the window At least one complet
108. to select a name for the template Enter a name and click OK 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 lt F2 gt 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 NOTES 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 THSteps 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 list
109. tored 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 Os sg o EY Click Submit Requests are changed to Submitted status and are sent to TMHP Retrieve a batch request 1 24 hours after request submission open the TDHconnect 3 0 System Totals window and select the Retrieve Responses tab 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 In this example the client has Medicaid eligibility no Medicare is not a lock in client has Managed Care has benefit limits but has no other insurance 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
110. tronic or paper claims Contact Call the TMHP Contact Center at 800 925 9126 For links to Frequently Asked Questions FAQs and Medicaid workshop schedules visit the TMHP website at www tmhp com For answers to questions about Long Term Care electronic or paper claims Call the TMHP LTC Help Desk at 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_05 02 04 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 7DHconnect 3 0 software is installed The help topics provide instructions for using 7DHconnect 3 0 4 1 1 Opening the TDHconnect 3 0 Online Help File There are three ways to open the 7DHconnect 3 0 Online Help file Help what s This Shift F1 1 Click Help gt Contents and Index on the TDHconnect 3 0 menu bar Contents and Index Online Manuals 2 Click the help book icon 4 on the TDHconnect 3 0 tool bar Product Support 3 Press lt F1 gt to open related help topics related to the 7DHconnect 3 0 About ToHconmect active window 4 1 2 Using the TDHconnect 3 0 Onlin
111. ts and is not ready to submit to TMHP Incomplete requests convert to Completed status after completion e 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 e Processed displayed in later sections Twenty four hours after submitting a request download the request to see if it was accepted or rejected e 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 claim 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 run a Claim Status Inquiry You must have a signed Claim Status Inquiry Authorization form on file with TMHP to perform claim status inquiries Call TMHP 888 863 3638 and also see section 19 Medicaid Claim Status Inquiry on page 93 for a blank agreement form e Rejected Electronically submitted requests that received a response indicating the request has been rejected due to errors You can correct and resu
112. ue Shield Last Name ne f Starts With CIBC Autotind Text Mode Family Planning Use Find Text Instantly C Contains Long Term Care Autotind Test Medicaid seat H Crete ae a Ce ee 2 To add clients manually click Add The Client Common Setup window opens in the workspace f Exact Match Page 29 TDHconnect 3 0 Workbook for Acute Care Providers Note You must complete all fields with bold headings to successfully add a client Client Last Name First Name Ml Suffix ee es G Client Information Launch Prograrn For Address 1 Cheah Blue Shield Blue Shield Address 2 CIDC O CIC P Family Planning O Fami Planning a l flonaTemCare I Long Term Care pa aae Ae Medicaid I Medicaid a Medicare I Medicare Phone Mao Date of Birth 5er e lt hm E Account No Release of Info Indicator Patient Signature Source BE EE Fharmacy Information Name Phone Mo C E C 3 Select the check box in the Client Status column next to the appropriate Program Name Select the program in the Launch Program for Client menu this example selected Medicaid The tabs for a Medicaid client are Client Detail Associated Provider Authorization Diagnosis Other Insurance and Miscellaneous TDHconnect Client Medicaid File Edit Reports Security View Tools Communications Navigation Help MB TDHconnect H E Blue Shield Last Nam
113. ur ISP 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 e Activate My Account Find Sottware Service Packs m A Eligibility Inquire about a Claim Status e Find Publications File Library Email the Contact Center a Register for a Workshop File Library E Filter ype Mame Banner Messages EDI HIF 4 4 Long Term Care Programs TDOHcoannect i vider Manuals File Library hup Filter Porro Type Name J TOH connect Install Errors TOHeconnect Replacement Files TOHconnect Updates 9 Click Save The Save As dialog opens 10 Save the file to the desktop Connect to TMHP via the Internet see section 5 Accessing the TMHP Website on page 9 Verify that you are viewing the TMHP home page at www tmhp com Click the Find Software Service Packs link in the would like to list on the right side of the home page The TMHP File Library main page opens scroll down to locate the File Library links Click the TDHconnect link The TMHP File Library TDHconnect web page opens scroll down to locate the File Library links Click the T DHconnect Updates link The TMHP File Library TDHconnect TDHconnect Updates web page opens scroll down to locate the File Library links Select the most recent Service Pack oa 3 0 Updates Service Pack 3
114. viders 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 gt 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 e Account No Medicaid No and provider defined Medical Record No e Last Name and First Name e Sex Date of Birth Street Address City State and Zip Code Patent Provider Status Claim Humber E l e Patient Provider l Claim Diagnosis l Details Other Insurance Patient Identification Numbers D Account Ho D SSN Medicaid Ho Hedical Record Ho Name a Last Name pE First Hame MI Sutfig OOOO ee Patient General Information Sex Date of Birth i Address Street City State IP Code ee en ema Na Grea Page 72 PR TDHc3 0AC_05 02 04_v 0 4 Medicaid and Family Planning Claims 18 6 2 Provider Tab The Provider tab has two sub tabs within tt e Billing and Attending Providers e Operating and Other Providers 18 6 2 1 Billing and Attending Providers Sub Tab Required fields e Billing Provider s Provider ID Facility Name Address City State Zip Code and Tax ID No e Attending Provider s Provider ID Last Name First Name ID Type Employe

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