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TexMedConnect - Long Term Care Manual

1. Dtl No Detail Status Service Begin Service End Date Billing Code Billed Amount Paid Amount OI Paid Amouni Applied OI Amount Billed Units me Units Estimated Paid Unit Rate Nat l EOB1 Nat l EOB2 Modifier 1 D 8 1 2014 8 1 2014 RGOOS 100 00 0 00 0 00 0 00 1 00 0 00 0 00 6 Click the Return To List link to return to Batch History The results are saved for 60 days MCO CSI Search Details New Lookup Return To List Claim Information TMHP EDI Trans No coc D A A Status Accepted 12 8 2014 4 00 49 PM MCO Name A lt p Te a MCO Phone No MCO ICN oan v2015 0127 69 TexMedConnect Long Term Care User Guide Claims Data Export If you want to request an extract of claims data for a particular date range you can use the Claims Data Export feature The maximum date range between From Dates of Service and To Dates of Service for each search is 3 months Note Claims data export is only available to users with administrative rights on their account To request the claims data to be exported 1 Click the Data Export Request link under the Claims Data Export section on the left navigation panel Long Term Care MESAV MESAV a Group Template MESAV Batch History Claims Claims Entry Individual Template Group Template Drafts Pending Batch Batch History Claim Data Export a Data Export Downloads CSI CSI Group Template Adjustments
2. TexMedConnect Long Term Care User Guide Contents Terms and Abbreviations creen 1 a IEEE 3 REQUIESMENES e oe m ERE o a A AA wo Be dos 3 Trato and SUuDDGE ac a es oe 9 x is ee eee S ere dE 4 TlexMedGonnect IDAS ecu owe 44 o HREM AAA 4 Technical Support s e soe keene het ae Eo ch bee ee eR de e lb PUR S x ed a 4 Cane Oppel eso Eos hos os ae ete E UB ease ee MES BE AN S Ps 4 Geine Sted ake eae ee eee ewe ee he eee AAA 5 hiv Du Panels bee adeno ee eee eee eee ee eee eee eee 7 MESA SU oust w teed abe eee taee ede eee anaes eee eee Ru eee d 8 Submitting a MESA Interactive ye 25 none nae oe oe AOR eee Ap db de ew dra 8 Creating a MESAV Group Template oa meo DE we hu ee ee SO ee d 11 Submitting a MESAV Group Template aw 9o soa mom p E E ARR Emo B gt 14 Viewing MESAV Baten History e uou umm GHG ee exc RO Peewee eee 17 MESAV Other Insurance OI Applicable to SGs 1 6 8 19 MESAV Medicare Eligibility lt ponia be ew Pow RP ow ee oe d d dh E a 21 Filme CM TT 22 Entermoa Claim on TexMedC onec uuu wd dor ew ao 22 Entero a Professional CAE a so s s oe om ORE UB OS Rd ROS SOPORE EOS UR de 26 Enternea Dental Clio uu a m dee OB FUROR E dE OE OR Ow ee deed 30 Entermie an Institutional Cl aaron vow os X o ee cae X E E ra 32 INGise tide Maat uuo os ORO ee ee ee FUR EORR E 45 Simca Cid sanar oe RRR SEE EP Ae owe eae Bae ee 48 Dist Chis sw B zo 533 334 4499 X3 99999 5199 45 49 Sav
3. Finish Options Please select one of the following and click finish Submit Submits the claim interactively U Save to Batch Saves the claim to batch for processing later Certification Terms And Conditions Please review the following certification and the terms and conditions The terms and conditions can be reviewed by clicking here The Providers and Claim Submitter certify that the information supplied on the claim form and any attachments or accompanying information constitute true correct and complete information The Provider and Claim Submitter understand that payment of this claim will be from Federal and State funds and that falsifying entries concealment of a material fact or pertinent omission may constitute fraud and may be prosecuted under applicable federal and or state law Fraud is a felony which can result in fines or imprisonment By checking We Agree you agree and consent to the Certification above and to the TMHP Terms and Conditions Owe Agree Save Template Save To Group o To save the claim as a draft click the Save Draft button o To save the claim as an individual template click the Save Template button o o save the claim as part of a group click the Save To Group button o To submit the claim as part of a batch refer to the Submitting a Batch section of this User Guide v2015 0127 Scenario 4 Other Insurance Finish Tab with known OI coverage For individuals i
4. 08 2009 12 03 2014 12 03 2014 12 03 2014 12 03 2014 12 03 2014 12 09 2014 12 03 2014 12 03 2014 12 03 2014 07 10 2013 05 07 2014 Rename Rename Rename Rename Rename Rename Rename Rename Rename Rename Rename Rename Rename Rename Delete Delete Delete Delete Delete Delete Delete Delete Delete Delete Delete Delete Delete Delete Creating New Group Templates To create a new Group Template 1 Click the Group Template link under the CSI on the navigation panel Heme TMHP com My Account IMHP fa Tes tedtnnnect Long Term Care AES AW MESAV Welcome to TexMedConnect Group Template i MESAY Baton History Claims Clams Entry e midia Templis Group Template a Dirafts Pending Batch TEXAS MEDICAID Batch Hietang HEALTHCARE PARTNERSHIP 54 v2015 0127 2 Select the appropriate NPI or API and contract number from the NPI API amp Contract No drop down box and click the Continue button Group Template fit TexMedConnect Long Term Care MESAWV MESAV Group Template MESAV Batch Hist Claims CMM s Claims Entry individual Templat Group Template Drafts TexMedConnect Long Term Care User Guide 3 Enter the name of a group in the New Group field choose the Claim Type from the drop down box and then click the Add Group Template button Group Template List NPI API Contrac
5. 20 21 22 23 24 25 26 27 28 29 30 31 Today 1 2 2015 10 The Principal Diagnosis code is required for institutional claims The Admitting Diagnosis is conditional for certain values in the Claim Frequency field Claim Submission Step 2 Claim Type _ Client Status A i pre Tee TT New Client Provider T T Details Other Insurance Finish Claim Claim File Indicator Code Patient Discharge Status EXE Place of Service e Claim Frequency X Diagnosis Qualifier field will be derived based on the Diagnosis Code entered Je m Q Save Template Save To Group y v Delete 38 v2015_0127 TexMedConnect Long Term Care User Guide 11 Click the Details tab You must complete all of the fields that are indicated by a red dot If the individual is in Service Group 1 6 or 8 enter the total amount paid by the individuals other insurance in the OI Paid Amount field AIT NETT TT RI Status Claim No Claim Submission Step 2 New vos Other Insurance Finish Number of details to add 1 Add New Details Row s Copy Row ina am Control Start tnd Qualifier code a 2 2 umis unt Rate ine item toi GoPay Rev Code OI Paid Amount NI API_ FirstName _ tast name risotto Derete Delete e Co Pay Applied Income Claim Total 0 00 Total Co Pay 0 00 Total Other Insurance 0 00 from Details Tab Total Other Insurance 0 00 from O
6. 2012 Yes Effective Date Termination Date Add Date Medicare Type CMS Code Federal Plan 1D Contract Number Link 2 2 2012 3 3 2012 1 1 2012 c 5555 333 CMS ID Info Contracted MADE 3 3 2009 2 2 2010 2 2 2009 A Medical Necessity No Data Levels Begin Date End Date Level Type 6 16 2010 12 31 9999 1 PR Income Co Payment No Data Managed Care No Data Messages No Data Effective Date End Date Hold Reason Code Hold Reason Description Service Group Service Group Description 12 1 2012 12 31 2012 AUD AUD Service 4 and 5 2 CLASS 20 v2015 0127 TexMedConnect Long Term Care User Guide MESAV Medicare Eligibility The Medicare section includes the policy s Effective Date Termination Date Add Date Medicare Type CMS Code federal Plan ID and Contract Number Link Medicare Electra Date Termination Date Add Date Medicare Type ir A PLA OFS Code Federal Plan TD Contract Humber Link LUTTE 12 21 2334 Liz Ll v2015_0127 21 TexMedConnect Long Term Care User Guide Filing a Claim Claims filed on TexMedConnect by Nursing Facilities that transitioned to managed care will be forwarded to a Managed Care Organization MCO If there are any issues or questions regarding a claim that has been forwarded to an MCO providers must contact the MCO directly TMHP cannot answer questions regarding claims rejected by an MCO Claims submitted by Nursing Facility providers not transitioning to manaaged care will no
7. Drafts Pending Batch Batch History Claim Data Export a Data Export Request Group Template Adjustments R and S ANSI 835 5 Enter your Submitter ID and Password and click the Submit button Claim Data Export Result Submitter ID 4 Password Y i 72 v2015_0127 TexMedConnect Long Term Care User Guide 6 The Claim Data Export Result page will display the requested file when it is ready to be downloaded Check the Select box and then click the Download button Claim Data Export Result Select File Naro ESTi4e 000629000562529002007 10 26 12 54 15 056147 csy 7 AFile Download dialog box will be displayed Click the Save button and save the file to a location on your computer The requested data will remain available for download for three months A Your computer must be able to open WinZip files Zipped files or you will not be able to open the file once you have saved it File Download Do you want to open or save this file zi Name 146000629 10 29 2012 zip Type Winzip File From portaltest2 portaltest net mcm cm While files from the Internet can be useful some files can potentially harm your computer If you do not trust the source do not open or save this file What s the risk v2015 0127 73 Claims Status Inquiry CSI Claims Status Inquiry is used to determine the status of submitted claims There are several ways to perform
8. Nor Applied Income TPI c5 C Delete 56 v2015_0127 TexMedConnect Long Term Care User Guide 5 To add an individual to the group click the Add Client button Claims Group Template Summary ALpha TMC II NPI API Sa Contract No EE Global Update Procedure Code 9 Start Date Effective February 22 2013 an Institutional claim for individuals in Service Groups 1 6 or 8 will be denied if third party insurance is a detected when the claim is submitted and the third party insurance information has not been addressed on the claim NOTE Applicable No of Units o Individual Templates for Institutional claims included in a Group Template must be updated to address OI Insurance policy End Date Unit Rate po information for LTC individuals can be viewed on the MESAW This will force TexMedConnect to use Co Pay as the client e Apply Co Pay Only responsibility for every client in the template Note that this means that all claims updated in the Group Template will utilize Co Pay O Apply Applied Income Only where appropriate If the client does not hawe an active Co Pay record TexMedConnect will calculate using an amount of 0 00 Apply Neither Co Pay Nor Applied Income TPI Select all Cto account No fast Name FirstNam LI oo Int Delete v2015 0127 57 TexMedConnect Long Term Care User Guide 6 You can define the start date an
9. Provider Report for a six month period The CIPR is available in PDF format TMHP recommends using Adobe Acrobat version 6 0 or higher to view PDF files on the TMHP website If the provider believes that the other insurance information on file is incorrect they should contact TMHP TPL at 1 800 626 4117 Option 6 1 Click the My Account link in the top right corner Home TMHP com Logged in as cor53user Log Off f TexMedConnect Welcome to TexMedConnect Long Term Care MESAV MESAV Group Template MESAV Batch History Claims Claims Entry Individual Template Group Template Drafts Pending Batch TEXAS MEDICAID Batch History Claim Data Export HEALTHCARE PARTNERSHIP Data Export Request Data Export Downloads CSI e CSI Group Template Adjustments Rand S ANSI 835 v2015 0127 93 TexMedConnect Long Term Care User Guide 2 Click the View CIPR Provider Report link a TMHP com My Account TMHP o E TMHP com Welcome to My Account This section allows a user to perform vanous maintenance activities for their TMHP account Click the appropriate link for access to the maintenance options My Account zen Online Portal Open the des ny er enon ermissians Add remove permissions and or unlink users for a Provider Identifier that you administer Create a new user for existing Provider Identifier ink an exisbing u
10. RI UE EMO PE O Se AE EY A Hs PA id AA Ee DAC ee Pet fea Peete Bondi Dam Bl is TAB ARS SS DRTCINDCLD CZ DUE IDOL AOL LDULLIOZ OS ee e DEE A B mimang da dar Qe rem md ce iu Fm Tai glo gius gs ien Tii gemy gaai Tomo Refer to the Submitting a Batch section of this User Guide for information about submitting batches 88 v2015 0127 TexMedConnect Lon g Term Care User Gui de Remittance and Status R amp S Reports R amp S Reports are generated on Mondays and cover the claims that were processed the previous week The R amp S function on the left navigation panel has two options e PDF Displays the R amp S in a PDF version of the paper R amp S e ANSI 835 Allows you to download the American National Standards Institute ANSI 835 version of the R amp S Report Ihis file is for providers who use third party billing software or third party billing agents Viewing the PDF Version To view the PDF version of the R amp S Report 1 Click the R and S link on the left navigation panel Long Term Care MESAV MESAV a Group Template a MESAV Batch History Claims Claims Entry Individual Template Group Template Drafts Pending Batch Batch History Claim Data Export Data Export Request Data Export Downloads CSI CSI Group Template Adjustments ANSI 635 ar 11727 gt j i i 89 TexMedConnect Long Term Care User Guide 2 Click the NPI API number
11. When searching by client information The following conditions apply e You must enter both a Service Begin Date and a Service End Date The End Date cannot be more than three consecutive months from the Begin Date e The Service Begin Date cannot be more than 36 months before the current date e You must complete all of the fields indicated by a red dot 1 Click the CSI link under the CSI section on the navigation panel The search criteria page will display Lookup Fee For Service Claim by Client Claim Request Provider NPI API Spee HES Y ASES b v Service Begin Date 10 1 2014 Format mm dd ccyy Service End Date 12 31 2014 hai Format mm dd ceyy Select the appropriate Request Type Client Trainee Client Information Medicaid No Y bite e Last Name EL First Name Y M I Suffix 76 v2015 0127 TexMedConnect Long Term Care User Guide 2 You must complete all of the fields that are indicated by a red dot 3 Click the Search button 4 The CSI Search Details page will display and auto populate with the client information CSI Details New Lookup Claim Information Client Information Claim No Dates of Service 8 1 2014 8 1 2014 Client Medicaid No Trainee SSN E Status Gender Effective Date 9 10 2014 Date of Birth 8 24 1984 m Service Group Patient Account No pstatus Warrant Number Medical Record No Referral No Financial Information Provider Informa
12. a CSI 1 Lookup Fee For Service Claim by Claim Request 2 Lookup Fee For Service Claim by Client Claim Request 3 Lookup Managed Care Claim by Transaction Number 4 Lookup Managed Care Claim by MCO ICN TMHP will Forward certain Institutional Claims to Managed Care Organizations MCOs These claims can be set to the following statuses e Forwarded means that the claim has been Forwarded but not yet Accepted or Rejected by an MCO e Rejected means that the claim has been rejected by TMHP or the MCO it was forwarded to e Accepted means that the claim has been Accepted by TMHP or an MCO Claims handled by TMHP not an MCO can be set to the following statuses e I In Process e TT Transferred D Denied e P Paid e A Approved for Payment e PF Paid Forced Transfer e FT Forced Transfer using PSWin e PT Paid Transfer eS Suspended e PZ Zero Net Balance to the Provider 74 TexMedConnect Long Term Care User Guide Three years of claims history are available The system returns a maximum of 250 results for each search If your search returns more than 250 results you may want to use the Claim Data export function The CSI Search screen is shown below CSI Search Format 15 digits with na spaces Lookup Fee For Service Claim by Client Claim Request p EJ Service Begin Date Y Format mm dd ccyy Service End Date Format mm dd ccyy Select the appropriate Request Type amp Client Trainee Client Info
13. down box Because multiple MCOs may have similar ICN numbering strategies you must choose the appropriate Payer Name from the drop down box and then click the Lookup button Lookup Managed Care Claim by Transaction Number iano Long Term Support Transaction Number Type Y MCO ICN v Cigna Long Term Care Molina Long Term Care Superior Mursing Facility United Healthcare Long Term Care 80 v2015 0127 TexMedConnect Long Term Care User Guide 2 Ihe MCO CSI Search Details page will display and auto populate with the MCO ICN in the Claim Information section This MCO CSI Search Details screen will be identical to the one that is generated when searching using an ETN or clicking the hyperlink from the Batch History screen TMHP will assign an Explanation of Benefits EOB Code that is specific to that MCO A description of that EOB and the telephone number of the MCO will be listed next to the EOB Code The last section on the screen the Detail Service Line will list information such as the Billing Code and in the Informational Pricing column how TMHP would have priced the claim if processed as FFS for Nursing Facility Daily Care Service Group 1 Service Code 1 and Medicare Coinsurance Service Code 3 MCO CSI Search Details Mew Lookup Return To List Claim Information TMHP EDI Trans Mo Accepted Status Date 12 4 2014 10 48 02 AM MCO Name MCO Phone No MCO ICN The following are the descriptions of the EOB Explanati
14. falsifying entries concealment of a material fact or pertinent omission may constitute fraud and may be prosecuted under applicable federal and or state law Fraud is a felony which can result in fines or imprisonment By checking We Agree you agree and consent to the Certification above and to the TMHP Terms and Conditions Save Template Save To Group To save the claim as a draft click the Save Draft button To save the claim as an individual template click the Save Template button To save the claim as part of a group click the Save To Group button P group p To submit the claim as part of a batch refer to the Submitting a Batch section of this User Guide v2015 0127 29 TexMedConnect Long Term Care User Guide 6 If there is any missing or invalid information an error message will be displayed Click the tab that is indicated in the error message Error fields are indicated with red exclamation marks Once you have made all of the necessary corrections click the Finish button in the lower right corner of the screen Claim Submission Step 2 Procedure Code is required Procedure Code must be 4 to 6 alphanumeric characters Entering a Dental Claim To enter a Dental claim 1 Click the Client tab You must complete all of the fields that are indicated by a red dot Entering a future date is not allowed in the Date of Birth field pia teteteeet tm d New claim typ
15. or pertinent omission may constitute fraud and may be prosecuted under applicable federal and or state law Fraud is a felony which can result in fines or imprisonment By checking We Agree you agree and consent to the Certification above and to the TMHP Terms and Conditions Save Template Save To Group To save the claim as a draft click the Save Draft button To save the claim as an individual template click the Save Template button To save the claim as part of a group click the Save To Group button P group P To submit the claim as part of a batch refer to the Submitting a Batch section of this User Guide v2015 0127 47 TexMedConnect Long Term Care User Guide Saving a Claim There are four options available for saving a claim 1 Save Draft Ihe claim will be added to the draft list for completion later 2 Save Template The claim will be added to the template list for faster claims creation in the future 3 Save To Group The claim will be added to a group template which includes templates for many individuals 4 Save To Batch The claim will be added to a batch of claims that can be submitted as a group Header Information Line Item Information Other Insurance Finish Finish Options Please select one of the following and click finish 8 Submit Submits the claim interactively Save to Batch Saves the claim to batch for processing later Certification Te
16. the Provider tab You must complete all required fields that are indicated by a red dot TexMedConnect auto populates the billing provider information using the NPI that was selected on the Claims Entry screen Client IN New Billing Provider m a NPI API Contact Name Contact Phone Cd amp ID Qual Other ID LL Performing Provider NPI API First Name Last Name MI Suffix Save To Group Prev Next Finish v2015 0127 27 TexMedConnect Long Term Care User Guide 3 Click the Claim tab You must complete all of the fields that are indicated by a red dot To add more diagnosis codes click the Add New Diagnosis button To view the diagnosis description click the magnifying glass icon The Qualifier field is based on the diagnosis code entered Claim Type E Professional New Diagnosis Qualifier field will be derived based on the Diagnosis Code entered ME Tn E NN NN Save Draft Save Template Save To Group Next Finish 4 Click the Details tab You must complete all of the fields that are indicated by a red dot To add a blank row click the Add New Detail row s button To duplicate an existing row highlight the row and click the Copy Row button To delete a row scroll over and click the Delete link at the end of the row New TE Provider Status Claim No Claim Submission Step 2 Professional Client Provider
17. to view the R amp S Report 90 S STMHP com Remittance and Status Re Home TMHP com Legged in as My Account Log Om The Texas Medicaid amp Healthcare Partnership TMHP website provides Remittance and Status R amp S reports and the COF report that can be viewed printed or downloaded R amp S Reports are organized by National Provider Identifier NPI for Acute Care Providers and by Provider Number for Long Term Care Providers For Acute Care Providers reports are further organized by Program Type The COF report is organized by National Provider Identifier NPI for the Applicable Providers and by Provider Number that are required to certify funds TMHP will maintain three months 12 calendar weeks of your most current R amp S reports online After the first 12 week imitation has been reached TMHP will begin archiving reports weekly as new reports are posted Providers are encouraged to save R amp S reports each week as required by the Texas Medicaid program TMHP will maintain the most current and the previous COF report online The oldest COF report will be removed when the next report is generated Providers are encouraged to save the COF report on a quarterly basis To open the R amp S and the COF report PDF files you need Adobe Acrobat Reader software on your machine TMHP recommends using Adobe Acrobat version 6 0 to view PDF files on the TMHP website HPL APT 1 Name Address Taxonomy Code Banefit
18. view a batch history 1 Click the Batch History link under the Claims section on the navigation panel Navigation fat TexMedConnect Long Term Care MESAY a MESAY Group Template MESAV Batch History Claims Claims Entry Individual Template Group Template Drafts Pending Batch CSI eSI Group Template Adjustments R ands 2 AMSI 635 2 Choose the appropriate NPI or API and contract number from the NPI API amp Contract No drop down box and click the Continue button Batch History v2015 0127 63 TexMedConnect Long Term Care User Guide 3 Click on a Batch ID to view the list of claims included in that batch 4 64 Note The Claim Count column indicates the total number of processed claims not necessarily the total number of paid claims Batch History NPI API Contract No Batch ID Claim Count Total Billed An Transmission Date Status Submitted By GS94L58R G394L 58W G484MGG4 G484MGG5 G514MGGH a514MGGV G524MGHS8 G524MGH9 G524MGHA Processed Processed Processed Processed Processed Processed Processed Processed Processed al Al papa sp RA Mo RAR 200 00 200 00 159 09 159 09 159 09 100 00 318 18 120 00 200 00 08 27 2014 03 52 59 PM 08 27 2014 03 54 10 PM 09 05 2014 03 31 04 PM 09 05 2014 03 47 48 PM 09 08 2014 01 58 05 PM 09 08 2014 04 24 17 PM 09 09 2014 11 04 12 AM 09 09 2014 11 18 10 AM 09 09 2014 11 41 18
19. AM You will see a list of the Claims for the Batch you clicked The Claims listed can be a mix of claims to different MCOs and to TMHP Claims can be set to the following three statuses e Forwarded means that the claim has been Forwarded but not yet Accepted or Rejected by an MCO e Rejected means that the claim has been rejected by TMHP or the MCO it was forwarded to e Accepted means that the claim has been Accepted by TMHP or an MCO Claims handled by TMHP can also be set to the following statuses e I In Process e T Transferred e D Denied e P Paid e A Approved for Payment e PF Paid Forced Transfer e FT Forced Transfer using PSWin e PT Paid Transfer e S Suspended e PZ Zero Net Balance to the Provider In addition to the status of the Claims and other information there is a Payer Name column The Payer Name column will display the name of the MCO that the claim was Forwarded to Rejected or Accepted by The Payer Name column will display FTHMP when the claim is accepted by TMHP If the column is blank that indicates that TMHP has Rejected the claim Batch History List of Claims G534MJ70 Payer Name NPI API Contract No Status Client Account No Rejected Accepted AN 318 18 BatchID G534MJ7O FirstName Start Date Of Service Billed Amount User ID 07 30 2014 159 09 Institutional 07 30 2014 159 09 Institutional v2015_0127 TexMedConnect Long Term Care User Guide 5 C
20. Claim 13 4 Other Insurance Finish Number of details to add E Add New Detalis Raw s Copy Row Delete e Co Pay O Applied Income Claim Total 0 00 Total Co Pay 30 00 28 v2015 0127 TexMedConnect Long Term Care User Guide 5 Click the Other Insurance Finish tab Note Other Insurance information is not required on a Professional Claim only an Institutional Claim a Click either the Submit radio button or the Save to Batch radio button b Check the We Agree box c Click the Finish button d Ifthe claim is submitted successfully an Internal Control Number ICN will be displayed at the top of the page This is also known as a claim number l mE Claim Type _ _Client_ EZ ANN Status Claim No Claim Submission Step 2 Professional New Finish Options Please select one of the following and click finish Submit Submits the claim interactively Save to Batch Saves the claim to batch for processing later Certification Terms And Conditions Please review the following certification and the terms and conditions The terms and conditions can be reviewed by clicking here The Providers and Claim Submitter certify that the information supplied on the claim form and any attachments or accompanying information constitute true correct and complete information The Provider and Claim Submitter understand that payment of this claim will be from Federal and State funds and that
21. Coda Type Ca Ca Cal Ca Ga Ga I ca Description NPI API Provider Number NPI API Provider Number NPI API Provider Number MPL APL Provider Number NPL APL Provider Number NPL APL Provider Number NPI API Provider Number NPI API Provider Number MPI API Pravider Number Modified 6 24 2010 12 09 46 PM 6 24 2010 12 23 53 PM 6 24 2010 12 26 30 PM 6 24 2010 12 10 36 PM 6 24 2010 12 24 36 PM 6 24 2010 12 31 13 PM 6 24 2010 12 18 19 PM 6 24 2010 12 31 08 PM 6 24 2010 12 16 14 PM File Size Associate additonal National Provider Identifiers Acute Care Providers or Provider Numbers Long Term Care or change your delivery options on the My Account page You must be a Provider Administrator to change configuration For more information or for problems please contact the EDI Helpdesk at 1 888 863 3638 v2015 0127 Downloading the ANSI 835 Version TexMedConnect Long Term Care User Guide You can access the 835 non pending Electronic Remittance and Status ER amp S Report and the pending ER amp S Report through TexMedConnect To download the ANSI 835 version of the R amp S Report follow these steps 1 Click the ANSI 835 link on the left navigation panel Long Term Care MESAY MESAV Group Template MESAV Batch History Claims Claims Entry Individual Template Group Template Drafts Pending Batch Batch History Claim Data Export Data Export Request Data Export Downloads C
22. ES 7 AA NEST MCI CCS ET El 120 IV LOL FI 592 83 5 00 0100 0 00 EB 1 1 2012 1 1 2512 11 00 42 03 554 16 435 57 6106 4 00 Diana AFERRA Applied neome Claim Total 451 33 Total Applied Income 1436 97 Total Other Insurance 15 50 from Dietas Tab Tobal Ciber Tauren ham Aher Irmurance Fino Tab Save Draft Seve Tamclate Save To Grown v2015 0127 87 TexMedConnect Long Term Care User Guide Saving and Submitting an Adjustment All adjustments must be submitted as batches 1 To save a Professional or Dental claim adjustment as a batch click the Finish tab click the Save to Batch radio button check the We Agree box and click the Finish button in the lower right corner EE ee NETT N ee TS Claim Submission Step 2 mofa ona Adjunt Client Provider Claim Details Other insurance Ponies l Finish Uplrons Picasa selec one of tha followeng and click Finish Submit Certification Terms And Conditions Daada vider E Tella mig cartlizab n and the tar aod cena ton Tha beris afd esndibeng cat Es faved Ey dedos g hara Tha Previdare and Claim Zobrrottas earth Ehak Eha inferrmaben Pugled en tha claim Ferr and any SCRE amp RGR Ir farmatieon trata ER fore and esmpglana inFeermab sn Tha Provider a d Chasen Subenitter uc daratand Phat Brace nf tee claim vill h form adersi amd xata Fur and that Falzihring entries enrasalrment od a material fact nr partisent neigsian may
23. Entering a future date is not allowed in the Service Date field Claim Submission Step 2 Client Provider Claim Other Insurance Finish Humber of details to add 1 Add Naw Details Reel aj Copy Kem Line Item Contro Service Date Place of Service AS E A EA EA AO Oral Cavity cod AO MET TS E B w Co Pap Applied Income Claim Total 40 00 Total Co Pay 0 50 Sava Graft Save Template To add more rows click the Add New Detail Row s button To copy the information from the previous detail click the Copy Row button To delete a row scroll over and click the Delete link at the end of the row v2015 0127 31 TexMedConnect Long Term Care User Guide 5 Click the Other Insurance Finish button Note Other Insurance information is not required on a Dental Claim only an Institutional Claim a Click the Submit radio button b Check the We Agree box in the Certification Terms and Conditions section c Click the Finish button in the lower right corner of the screen d Ifthe claim is submitted successfully an Internal Control Number ICN will be displayed at the top of the page This is also known as a claim number Claim Submission Step 2 Client Provider Claim Details Other Insurance Finish Finish pt bie Please select one of the following and click Finish 9 Submit bro the claim interactive anwr la Batch Certificati
24. Manage Provider Accounts Administer a Provider Identifier Become a Provider Administrator for a Provider Identifier authorization required Administer a Provider Enrollment Transaction Open the provider enrollment application Account Settings My Profile Modify your profile information Change Password Change your account password It is recommended that you do this every 30 days Help TMHP com Security Enhancement Training Guide Effective May 26 2005 TMHP implemented new security features on TMHP com A training guide has been developed by TMHP to assist providers during the initial security setup of administrators users and permission levels for access to Protected Health Information PHI Providers can access the training quide in an amp dobeL Portable Document Format PDF at TMHP com Security Training Guide ww O Ready as E Done B 0 Internet a 6 v2015 0127 TexMedConnect Long Term Care User Guide Navigation Panel All of the available transactions are located under Long Term Care in the left navigation panel You can select any activity to which you have access A user s access rights determine which options are available in the left navigation panel The provider administrator will grant access rights to the account The complete details of how to setup access rights can be found in the TMHP Website Security Provider Training Manual v2015_ 0127 7 TexMedConnect Long Term Care User Gu
25. Not having the insurance company claim disposition information available for the claims to be submitted for Medicaid individuals could cause a denial for lack of OI information If as a result of filing the insurance claim it is discovered that the insurance information on the MESAV is incorrect for the individual the TMHP Third Party Liability TPL Resource Line will be available to handle updates to the insurance information Dial the LTC Help Desk at 1 800 626 4117 and choose Option 6 LTC Other Insurance for answers to incoming LTC Other Insurance Referral Inquiries 19 TexMedConnect Long Term Care User Guide MESAV Results General Disc Client Information Em Payment is not based solely on any single piece of information listed below This data may change Outstanding claims may affect the number of units Nursing Facility clients with managed care eligibility segments must have service authorizations verified by the appropriate MCO INI Client No Trainee SSN Mo NPI API DOB Gender SSN Name Address County Medicare No 01 01 1950 Eligibility From 8 6 2012 M Eligibility Through 8 10 2012 Medicaid Client No Social Security Number c ow c FORT WORTH TX 761060000 Date of Birth am Tarrant Last Name First Name M I Suffix Service Authorization Information Details Effective End Date Referral Status Client Units Units Proc Date Numb
26. Portable Document Format PDF file To print the PDF click the PDF icon at the top right of the screen If you want to print a paper copy of the results click the Print button on your browsers toolbar Mew Lookup Retum with Search criteria TE EIE UII Payment is not based solely on ary may change Outstanding claims miy affect the number j yy A m Til E LI qe mam Ve y PTHOLEBU H Ad E HPI API BU PEEL Eb fhrough SSH Medica Client No Name Social Security Hinmnber Auldress hate of Birth County Last Man Medware Ho Firat Hare MI Solo 10 v2015 0127 TexMedConnect Long Term Care User Guide Creating a MESAV Group Template The Group Template feature allows you to create a list of individual s for whom you would like to verify eligibility To create a MESAV group template and add an individual 1 Click the Group Template link under the MESAV section on the navigation panel ne TexMedConnect 2 Long Term Care MESAV MESZAV MESAV Batch History Claims a Claims Entry 2 Individual Template Group Template Drafts Pending Batch 2 Batch History CSI Cal Group Template a Adjustments R and E 2 ANSI 635 2 The MESAV CSI Group Template screen will open Choose the appropriate NPI or API and contract number from the NPI API amp Contract No drop down box and then click the Continue button MESAV CSI Group Template Sel
27. R and S ANSI 835 2 Choose the NPI or API and contract number from the NPI API amp Contract No drop down box and click the Continue button Claims Data Export Select NPI API A Contract Mo 70 v2015 0127 TexMedConnect Long Term Care User Guide 3 Enter your Submitter ID Password Service Begin Date and Service End Date and then click the Request Data button The date range must be no more than three months long The Service Begin Date cannot be more than three years prior to current date Ifyou do not know your Submitter ID and Password contact the EDI Helpdesk at 1 888 863 3638 from 7 00 a m to 7 00 p m Monday through Friday The requested data will be available on the next business day Claims Data Export Submitter ID Password e Service Begin Date 9 o Format mmiddiyyyy Service End Date e Format mmidd yyyy Date range cannot span a length of time greater than three months Service Begin Date cannot be more than three years prior to current date Request Data v2015 0127 71 TexMedConnect Long Term Care User Guide 4 To download the requested data click the Data Export Downloads link under the Claims Data Export section on the left navigation panel Long Term Care MESAV MESAV a Group Template MESAV Batch History Claims Claims Entry Individual Template Group Template a
28. Rum ueteri 3 Pe es AH Mun Pd WI HE y lil Eod so brim larg Darii Tire nma iU ELE La alor LLL L t r HE Atii faerie d Ui mb TRA 7 pedem ei E See LAS Pacta Caa cura LEE es Fees djs Per Ma A Pal p BAD RA Fle ap DH vins oim ppc eH Ds aM Pal Garage S Up Hass khl dr Pe Bape slices Te eet Fara fee SLE DE ull Nora Pr Ense Casa tontos A nn A i B parare lif sil aed nn 2 A AAPP pst teed q Pag da i Pug pedi sepe m ues rl RAI Mat weep Papas fusca ra FORD Pl se Te a rd deed m Rapp Pee dm Bises li rra Ela Per rg Mal He bsac died aps Sos bn dnd paradise e Une Rule tees Lidel isy ae aL muU Ee shined honey Bem BI DRE ulla Remus er pone us ER endo Poner miter Don Baal aT iki dicta eed das pei Me Helene Fem Hacer bh ie ae Momm Sud Ere Less teg dfe miari adr rere iilor ni Himlens Pari arios Pa fatal copaysdeviacf him eee qum eee a ri liar ri Experalbor gt cr 4a EDAD r ra Hees Farb Tedd kmni laris Chg teed rt prime mani qual Dog wu z ad adam Dodd ey nda ir im Pha cart Sede Fa dTa Seed Banni me ede cele Hr Peed ede Aena E Pis a Tun Gebo rie a eS D Ua a Tal CUu Mikis PaT does eT E Chau a Iren n deese Dum Um scm har de Td Tiy ot Turn allem Tal Tub ee Paetos beT D dace n Dam e uoces sb rea acu ee a pies eee a eee x Tub jubent hee uat Pisink Cigar ee mid new EU itn Porra acd o Pere Racborel uu AL E A ee ee ee A A ee mue DEN FE DEINER PEA Cw PA ee AE APS E AA PT DU ee A DL ee E EL AA UA OE AAA PL
29. SI a CSI Group Template Adjustments R and S ANSI 835 v2015 0127 91 TexMedConnect Long Term Care User Guide 2 Enter your Submitter ID and Password and click the Download button If you do not know your Submitter ID and Password contact the EDI Helpdesk at 1 888 863 3638 from 7 00 a m to 7 00 p m Monday through Friday Home TMHP com My Account TMHP Navigation fal TexMedConnect ANSI 835 Acute Care Eligibility Eligibility Step 1 Client Group List EV Batch History Claims e Ensure that you have a program to unzip the zip file Download WinZip Here Step 2 Claims Entry Individual Template e Enter your Submitter ID and Password Draft e Click Download to retrieve your files Pending Batch Batch History Step 3 CSI RAS IMPORTANT Click SAVE when you see the File Download prompt vigila e Clicking Cancel or leaving this page prior to clicking save will cause your files to be lost ANSI 835 Submitter ID Password Example of File Download prompt click Save DO NOT click Cancel and DO NOT leave this page prior to clicking save File Download Do you want to open or save this file ul Name ansi835 8 2 28 2013 zip Type Winzip File From localhost Cancel harm your computer If you do not trust the source do not open or Y While files from the Internet can be useful some files can potentially save this file What s the
30. STREET ANY TOWN TX 01234 5678 Performing Provider APLI APT First Hama 0123456789 FRANK Claim Tab Choose a Claim File Indicator Code from the drop down box Choose a Place of Service from the drop 9 down box Professional claims do not require a diagnosis code but institutional claims do m a a ETT ES Claim Submission Step 2 Professional JOHN DOE 1234567890 00000000 New Client Provider Details Other Insurance Finish Claim Place of Service amp Claim File Indicator Code Diagnosis Add Naw Dispari AA EN Save Template ave To Group 86 v2015_0127 TexMedConnect Long Term Care User Guide 10 Details Tab On the details tab the system will auto populate the negative row s with the data that was initially paid on the initial claim Ihe fields Unit Unit Rate and Line Item Total will be auto populated and read only The fields OI and AI Co Pay on the negative row s will always be auto populated with 0 The user will not attempt to modify these fields on the negative row s If the initial claim to be adjusted had multiple details all the claim detail rows will show up as negative line details If the provider does not wish to adjust all the rows on the initial claim they will delete the rows they do not wish to adjust by using the Delete button on the right side of the row The line item total will be in parentheses If the adjustment is to return the entire amount of the claim there is no need
31. To Group Next Finish v2015 0127 39 TexMedConnect Long Term Care User Guide When submitting an Institutional Claim there are four scenarios for the Other Insurance Finish section They are Scenario 1 Other Insurance Finish tab The options that are available on the Other Insurance Finish tab are the same as a Professional claim unless the individual is in Service Group 1 6 or 8 Note For individuals with Medicare in Service Group 1 Service Code 3 Extended Care Facility enter either the Medicare Part A or Part C amount in the Medicare Information section The Medicare attestation box must also be checked when billing for SG 1 Service Code 3 a Click the Submit radio button b Check the We Agree box in the Certification Terms And Conditions section c Click the Finish button in the lower right corner of the screen Status Claim No Claim Submission Step 2 Instituti New Client Provider Claim Details NET Finish Options Please select one of the following and click finish Submit Submits the claim interactively _ Save to Batch Saves the claim to batch for processing later Certification Terms And Conditions Please review the following certification and the terms and conditions The terms and conditions can be reviewed by clicking here The Providers and Claim Submitter certify that the information supplied on the claim form and any attachments or accompanying informa
32. aid Client No Format 123456789 Social Security Number Format 123 45 5789 or 123456789 Date of Birth el Format mm dd ccyy Last Name First Name 3 You must also enter additional information in any of the following field combinations Medicaid Client No and Last Name Medicaid Client No and Date of Birth Medicaid Client No and Social Security Number Social Security Number and Last Name Social Security Number and Date of Birth Last Name First Name and DOB If you perform more than one interactive MESAV the NPI or API and contract number on the MESAV Entry page will default to the last one that you used v2015_0127 9 TexMedConnect Long Term Care User Guide 4 Click the Submit button MESAV Entry Please enter the required information and click Submit to view the eligibility of the client MPI API amp Contract Mo 9 Eligibility Start Date E Format mm dd ccyy Eligibility End Date 9 A Format mm dd ccyy Client Information Please enter one of the following valid field combinations Medicaid Client and Last Name or Medicaid Client and DOB or Medicaid Clientz and SSN or SSN and Last Name or SSN and DOB or Last Name First Name and DOB Medicaid Clhent No Format 123456789 Social Security Number Format 123 45 6789 or 123456789 Date of Birth mn Format mm dd ccyy Last Name First Name 5 Ihe MESAV results screen will allow you to print the MESAV results in a
33. aim click the Adjustments link under the CSI section on the navigation panel Navigation fat TexMedConnect Long Term Care MESAY MESAY Group Template a MESAV Batch History Claims Claims Entry a Individual Template 2 Group Template Drafts Pending Batch Batch History CSI SI Group Template Adjustments R and S a ANSI 835 M v2015 0127 TexMedConnect Long Term Care User Guide 2 Enter the claim number and click the Lookup button Adjustment To proceed please search for the claim to be adjusted Lookup Fee For Service Claim by Claim Request no spaces Lookup Fee For Service Claim by Client Claim Request Provider NPI API Y Service Begin Date 9 5 Format mm dd ccyy Service End Date Y r2 Format mm dd ccyy Select the appropriate Request Type 8 Client Trainee Client Information Medicaid No 9 Last Name Y First Name 9 M I Suffix Lookup Managed Care Claim by Transaction Number Incem Lo Transaction Number Type Y T v2015 0127 83 TexMedConnect Long Term Care User Guide 3 If you do not know the claim number you can search for the claim using the individual s information Enter the required information and click the Search button The date range must be no more than three months long You must enter both a Service Begin Date and a Service End Date The Service Begin Date cannot be more than 36 months before the current date Yo
34. aim Submitter wrdargstand that payment ef thin daim will ba fram F adaral and Seats funda and rab Falaifying enirias rsncaalman t of a metal Fact or partinant Bonen may ensure fraud and may ba prosacuhied under anplcakla federal and ar stab law Fraud dl a Paloma which ean PhiiivlE in Hnes es imgeelaanimenb Buy checking We Agres you agde acd goniant to the Carita on above bid te the THEE Term ard Condon mmm em 60 v2015 0127 TexMedConnect Long Term Care User Guide Submitting a Batch To submit a batch 1 Click the Pending Batch link under the Claims section on the navigation panel Navigation fat TexMedConnect Long Term Care MESA E MESA Group Template MESSY Batch History Claims Claims Entry a Individual Template Group Template Drafts Batch History CSI Piel Group Template Adjustments R and S ANSI 8355 2 Select the appropriate NPI or API and contract number from the NPI API amp Contract No drop down box and click the Continue button 3 The Pending Batch page will display for the selected NPI or API and contract number The pending batch list shows the claims that are ready to be submitted Clicking a column heading will sort the list by the data in that column Pending Batch List of Claims NPI API Contract No Client Account No Last Name First Name Start Date Of Service Billed Amount Claim Form User ID 10 01 2012 2 738 70 Insti
35. aintenance February 22 23 2013 2 7 2013 Single Service Authorization System SSAS Deployment for ICF IID Providers Has Been Postponed 2 7 2013 MDS 3 01s here Provider Support Services Provider Education Helpful Links Need Help E ia ie Desk is here to Recent News Articles 1 800 626 4117 DADS Information Letters System Information y zz j Long Term Care Information Letter 13 04 Scheduled System Maintenance March 10 2013 Implementation of the Cost Avoidance Project 1 23 2013 February 2013 1 10 2013 Scheduled System Maintenance February 10 General 2013 12 28 2012 Reminder Scheduled System Maintenance February 10 2013 2 5 2013 v2015 0127 5 TexMedConnect Long Term Care User Guide 2 Enter your User name and Password and click the OK button As an option you can save your log in information by putting a check in the Remember my credentials box niormation of inte 3 The My Account page will open to display all of the website features to which you have access Click the TexMedConnect link Home TMHP com My Account TMHP E fS TMHP com Welcome to My Account This section allows a user to perform various maintenance activities for their TMHP account Click the appropriate link for access to the maintenance options Logged in as Log Off My Account LTC Online Portal View R amp S COF Reports Submit_Forrn TexMedconnect Inquire about a form status
36. ason the other insurance carrier denied the claim If you believe the information on file at TMHP for this client is invalid please call the TMHP Third Party Liability department at 1 800 626 4117 Option 6 Real time insurance updates are viewable upon click of the Insurance Refresh tool Please note Any data entered on this tab during your current user session will be lost when the Insurance Refresh tool is clicked Q Insurance Refresh If you believe the information on file at TMHP for this client is valid but requires an update please click the Update Policy button Modified information will be sent to the TMHP Third Party Liability department for verification prior to permanently updating TMHP records Check the client s MESAV within 10 business days for updated policy information Please note This claim will be processed using the information currently on file at TMHP Other Insurance Policy 1 Effective Date Termination Date Company Name Company Address Company City Company State Company ZIP Code Company Phone v Subscriber Relationship to Client Subscriber First Name Subscriber Last Name Subscriber SSN Subscriber DOB Employer Name Subscriber Policy v E Group Number 9 Other Insurance Disposition 9 Other Insurance Billed Date Attestation checking this box you attest to the fact that you understand that Federal regulat
37. button Ifyou want to copy the information from the previous detail click the Copy Row button 46 v2015 0127 TexMedConnect Long Term Care User Guide 3 Click the Other Insurance Finish button Note Other Insurance information is not required on a Nurse Aide Training Claim only an Institutional Claim a Click the Submit radio button b Check the We Agree box in the Certification Terms and Conditions section Click the Finish button in the lower right corner of the screen c Ifthe claim is submitted successfully an Internal Control Number ICN will be displayed at the top of the page This is also known as a claim number Claim Submission Step 2 NAT New Header Information Line Item Information Resear a ric Finish Options Please select one of the following and click finish 8 Submit Submits the claim interactively Save to Batch Saves the claim to batch for processing later Certification Terms And Conditions Please review the following certification and the terms and conditions The terms and conditions can be reviewed by clicking here The Providers and Claim Submitter certify that the information supplied on the claim form and any attachments or accompanying information constitute true correct and complete information The Provider and Claim Submitter understand that payment of this claim will be from Federal and State funds and that falsifying entries concealment of a material fact
38. can also download Electronic Remittance and Status ER amp S Reports and the Claims Identified for Potential Recoupment CIPRR Report TexMedConnect can interactively accept individual claims that are processed in seconds Requirements You must have an Internet connection and either Internet Explorer 6 0 7 0 8 0 or 9 0 to access TexMedConnect TMHP only offers technical support for TexMedConnect when it is used with one of these versions of Internet Explorer Note Please refer to the article Update TexMedConnect Incompatible with Internet Explorer 9 on the TMHP website at www tmhp com for information about troubleshooting Internet Explorer incompatibility Training and Support TexMedConnect Training The TexMedConnect for Long Term Care Providers computer based training CBT module is an online course that can be reviewed at your own pace It is available in the Provider Education section of the TMHP website at www tmhp com Technical Support You can contact the TMHP Electronic Data Interchange EDI Help Desk at 1 888 863 3638 Monday through Friday 7 00 a m to 7 00 p m for Long Term Care technical issues Ihe TMHP EDI Help Desk provides technical assistance for TexMedConnect and the TMHP EDI Gateway Contact your system administrator for assistance with modem hardware or Internet connectivity issues Claims Support You can contact the TMHP LTC Helpdesk at 1 800 626 4117 Option 1 for questions about claims Monday throug
39. cial Information Provider Information Total Billed Amount 175 00 Pravider NPI API Total Paid Amount 218 60 Provider Hame Total Applied Other Insurance Amount 760 00 Medicare Patient Days Budget Number Private Patient Days Yo Medicaid Patient Days Ye in Service End i3 miling odo Billed Auman Paid Anvount OT Paid Arnos Applied 01 Ad LI te Sra 2012 EE E Rant 104 30 20 00 130 00 1 00 G Verify that all of the required fields that are indicated by a red dot are populated for each tab 7 Client Tab Verify that the information is correct and that there is a referral number on the claim Claim Submission Step 2 Professional JOHN DOE 1234567890 00000000 Provider Claim Details Other Insurance Finish Client Identification Numbers amp Chent ID Patient Account No Medical Record No 0122455788 Aa Name and Address a JOHN Y Street Address 122456 MAIN AVE Client General Information Gender v2015 0127 85 TexMedConnect Long Term Care User Guide 8 Provider Tab Choose the ID qualifier from the ID Qual drop down box and enter the Other ID number in the Other ID field MTS E AA ETT ES 1234557 890 00000000 Haw Claim Submission Step 2 Professional JOHN DOE Provider Claim Details Other Insurance Finish Billing Provider NPI 1234567890 4 Cantact Name Contact Phone NPI API AAA amp Other ID Marne REGIONAL MEDICAL CENTER 1134567550 ID am Address 124587 FIRST
40. ck the Save Changes button Note The Other Insurance Policy will be validated by the TMHP Third Party Liability department before being added to the Other Insurance database h Ifyou need to add an Other Insurance policy click the Add Policy button to display the Other Insurance Policy field Note The Other Insurance Policy will be validated by the TMHP Third Party Liability department before being added to the Other Insurance database i Check the box under Attestation j Click either the Submit radio button or the Save to Batch radio button k Check the We Agree box in the Certification Terms and Conditions section D Click the Finish button 43 TexMedConnect Long Term Care User Guide Claim Submission Step 2 Client Provider Claim Details Other Insurance Finish TMHF records indicate that this cheng has the follipaing Leng Term Care relevant other insurance coverage for the date s of service billed on this claim In order for this claim to be considered for Medicaid reimbursement the identified third party resources must be bled prior to Medicasd and the resulting disposin must be entered below IF amy of the identified thad party resources are mot hable for the services billed an thes claim you must indicate the reason the ether insurance canner denied the claim If you believe the information on file at THP for this client e invalid please call the TMHP Third Party Liabili
41. ck the Select AII box TMHP Navigation MESAV CSI Group Template ftTexMedConnect NPI API Contract No MESAV MESAV Group Template MESAV Batch History Claims From Date of Service Format mm dd yyyy Claims Entry To Date of Service Format mm dd yyyy Individual Template Group Template Select All FirstName Last Name Client Date of Birth Drafts E Pending Batch Batch History CSI SEMI Group Template Delete Delete Delete Delete Adjustments Rand S ANSI 835 Delete Delete Delete Delete Delete Delete Delete Delete DOT Delete i i Delete l MM PW TW FW T PW TW P Tw w mmm Y Delete O Delete 6 Delete Delete Delete Delete Delete Delete Delete EN Tw DW w Ww i Ww Delete Delete Submit MESAV Batch A 16 v2015 0127 TexMedConnect Long Term Care User Guide Viewing a MESAV Batch History To view a MESAV Batch History 1 Click the MESAV Batch History link under the MESAV section on the navigation panel Navigation oY TexMedConnect Long Term Care MESAY n MESA 2 Group Template Claims Claims Entry 2 Individual Template Group Template Drafts Pending Batch Batch History CSI CSI 2 Group Template Adjustments R and ANSI S835 2 Choose the appropriate NPI or API and contract number from the NPI API amp Contract No drop down box and
42. click the Continue button Mesav Batch History Select NPI API amp Contract No Continue gt gt v2015 0127 17 TexMedConnect Long Term Care User Guide 3 Click the Batch ID of the Claim that you would like to view 18 Batch History NPI API Batch ID G184L 8C7Z G244L BSX G254LCS2 G2 4LEBU G3 4LIU3 G3 4LIUG G3 4LIU7 G3 4LIUA G374LIUB G3 4LIUC GO654MVIN Go654MVJO G654MVIP H144PPGP H184TXMH Contract No Claim Count Total Billed Amount Submitted By Processed Processed Processed Processed Processed Processed Processed Processed Processed Processed Processed Processed Processed Processed Processed UJ e e Hk RM e e m e PR FY RM e A 5 477 40 3 800 32 10 00 2 748 70 10 00 3 800 32 10 00 2 738 70 3 800 32 120 00 2 748 70 2 748 70 3 800 32 2 738 70 8 216 10 08 06 2014 01 03 57 PM 08 12 2014 11 51 16 AM 08 13 2014 04 11 45 PM 08 14 2014 08 35 09 AM 08 25 2014 09 37 49 AM 08 25 2014 10 17 28 AM 08 25 2014 10 25 21 AM 08 25 2014 10 28 15 AM 08 25 2014 10 32 19 AM 08 25 2014 10 38 17 AM 09 22 2014 12 34 54 PM 09 22 2014 12 42 28 PM 09 22 2014 12 42 28 PM 11 10 2014 11 12 12 AM 11 14 2014 02 07 00 PM v2015 0127 4 The MESAV will open in a new window Review the Status for each client number you selected dE A Payment is not based solely on any single piece of information listed below This data may change Outsta
43. click the Save Draft button o To save the claim as an individual template click the Save Template button o To save the claim as part of a group click the Save To Group button o To submit the claim as part of a batch refer to the Submitting a Batch section of this User Guide 41 TexMedConnect Long Term Care User Guide 42 Scenario 3 Other Insurance Finish Tab add OI policy The Other Insurance Policy will be validated by TMHP Third Party Liability department before being added to the OI database However any Other Insurance Paid Amount will be taken into consideration on the submission of the claim a Enter the required fields as indicated by the red dots b Check the box under Attestation c Click the Submit radio button d Check the We Agree box in the Certification Terms And Conditions section e Click the Finish button in the lower right corner of the screen Client Provider Claim Details Other Insurance Finish TMHP records indicate that this client has the following Long Term Care relevant other insurance coverage for the date s of service billed on this claim In order for this claim to be considered for Medicaid reimbursement the identified third party resources must be billed prior to Medicaid and the resulting disposition must be entered below If any of the identified third party resources are not liable for the services billed on this claim you must indicate the re
44. conos fraud amd may ba proaanuterd onde applicable fedas and or state law Fraud ix a Talmey which ran result i uad es imprint By checking Wa Ege vods agree ar coran bo De Ce izaben above and bo Ehe TMHP Teed ace Cendilisa 13 Save Template 2 For Institutional Claims check the box under Attestation click the Save to Batch radio button check the We Agree box and then click the Finish button Note For claims in Service Group 1 6 and 8 the OI Paid Amount entered in the Details tab will have to equal the OI Paid Amount in the Other Insurance Finish Tab Claim Submision Step 2 Client Provider Claim Details DM rr Als Pal a ar Hung Wap rakhe a j HL Lora d Fee ar eles lr kipi ir Ma Macs Le moda Ten Don Aa ES Ba ime E Per Mr eee Pe daba Pd pi ns cwm al Ha RO ven e Mela sal ar ray depre al Da cell aia y Are e PA jas aum acm A Lal n er Dua incom led Re Pa A v5 Hal id Tub ri Pa SP A Aa ad Pa Fg T p elec Dua cU mm Re Pla RE TMP Mir Dog PEE gp Asahi raum sel Wa TS TRAN PaSy La deepest BOC ELL OECD Dus 5 Das oap eee pl mcr sanno ee pih scd eI WR Cee a emgR Dee uada See Lay fili lee ih Ta Tak B pas Se int a oH Nap a mue Pa Lek sas Dees DaS m ae Dree T pte bala The abes AA a THESE Mir Dum al lel Bul ere B gee ar Ce Pha Uplate Phe A Hidlad Aree ad ba das Be Tha PH TRAN Pay Lab laa Mi eee iu 15 becas epee PAS ees Lak Pus Hara PL eee J hara days Mir pla Bii cles pinna ae TROR Fh sT
45. d end date the number of units and the unit rate for all of the claims in the template You must click one of the three radio buttons Apply Co Pay Only or Apply Applied Income Only or Apply Neither Co Pay Nor Applied Income O If you choose Apply Co Pay Only TexMedConnect will use Co Pay as the individuals responsibility for every individual in the template This means that all of the claims that are updated in the template will use Co Pay where it is appropriate to do so If the individual does not have an active Co Pay record TexMedConnect will make calculations using an amount of 0 00 If you choose Apply Applied Income Only TexMedConnect will use Applied Income as the individual responsibility for every individual in the template This means that all claims updated in the Group Template will utilize Applied Income where appropriate If the individual does not have an active Applied Income record TexMedConnect will calculate using an amount of 0 00 If you choose Apply Neither Co Pay Nor Applied Income TexMedConnect will use no individual responsibility for every individual in the template This means that the individual responsibility field will be set to zero whether or not the individual has an active individual responsibility record The total payment calculated by TexMedConnect will be higher than the actual payment if any of the claims should have had individual responsibility deducted Claim
46. der the MESAV section on the left navigation panel 14 adadgati s f TexMedConnect 2 Long Term Care MESAV 2 MEZAV MESAV Batch History Claims Claims Entry 2 Individual Template Group Template Drafts Pending Batch Batch History CSI Sl Group Template Adjustments R and 5 ANSI 535 v2015_0127 TexMedConnect Long Term Care User Guide 2 Choose the appropriate NPI or API and contract number from the NPI API amp Contract No drop down box and click the Continue button MESAV CSI Group Template Select NPI API amp Contract No 3 Select one of the templates listed under Name of the group to open the group list MESAV CSI Group Template NPI API Contract No 9 NewGrop dco Name of the group Created Date Last Updated Date 10 01 2008 10 16 2008 Delete 10 01 2008 09 02 2014 Delete 10 08 2008 08 14 2009 Delete 10 08 2008 10 08 2008 Delete 4 Enter a date range in the From Date of Service and To Date of Service fields The date range can be up to three months long MESAV CSI Group Template NPI API Contract No From Date of Service o Format mm dd yyyy To Date of Service Format mm dd yyyy C MESAV CSI Delete Submit MESAV Batch v2015 0127 15 TexMedConnect Long Term Care User Guide 5 Check the individual boxes of the templates that you want to submit or to submit all of the templates che
47. e client Provider status Claim No Claim Submission Step 2 Client Provider Claim Details Other Insurance Finish Client Identification Numbers Client ID Patient Account No q Name and Address First Name Last Name Suffix Street Address Street Address 2 State Zip vv Client General Information Gender Date Of Birth Referral No E Save Template 30 v2015 0127 TexMedConnect Long Term Care User Guide 2 Click the Provider tab You must complete all of the fields that are indicated by a red dot TexMedConnect auto populates the billing provider information using the NPI that was selected on the Claims Entry screen You can enter the NPI API and contact name in the Performing Provider section but it is not required Claim Submission Step 2 Client Mee Claim Details Other Insurance Finish Billing Provider API a Hanse NPT API ID Quad Other ID m ind Addresn Performing Provider NPEL API First Mina Last hiami MI Zufizx Zava Drait Lava Tamclata 3 Click the Claim tab You must choose a claim File Indicator Code and Place of Service Claim Submission Step 2 Client Provider Claim Details Other Insurance Finish Claim Claim File indicator Code e Place of Service MC eles aid T Sob Hipika 4 Click the Details tab You must complete all of the fields that are indicated by a red dot
48. e Mir Gis sss x tee eet so ERR P eb BE WS oe ES E 49 Viene Dian CIAS e se esponsor oe P DS E EORR PCR PU 50 Individual Temp ates e aa a ken c P EORR AR ee ee es ee OA Bom S R 51 Saving as an Individual Templates lt c 4395 6656855 4 05 9 95 51 Viewing Individual Templates s s s x RE m Romo dom dum adii HED 51 Group Templates sosa errors oe E RUE X CEU ae Be ed 53 Viewing Gtoup Templates s cd es nomas poraa 1 53 Creating New Group Templates s s sa csa sacate ee odia P B ee E 54 Saving asa Group eniplate subes pr ooga mh gpk grda daw SUM 59 Batch CMe a 23 3 x209 xx o mo EO a eee ee eee ees 60 boue To Batch eu escasos er PR Uo x RE Ow P ve x EE X PS P 60 oi e aa as ee ae ee eA ee a ee a 61 View Datch Esto 2 2x 4 39 Seen errar 63 Clans Data Export s rocosas sora bee RO eee eee 70 Claims Status Inguity Col a isis th eom RU AR PORE REG SS se Ex 74 CSI Search Lookup Fee For Service Claim by Claim Request 75 CSI Search Lookup Fee For Service Claim by Client Claim Request 76 CSI Search Lookup Managed Care Claim by Transaction Number 77 CSI Search Lookup Managed Care Claim by MCO ICN less 80 onn n MM eee a ee ew ee A 82 Creating an Adjustment for a Fee For Service Claim 82 Saving and Submitting an Adjustment s s se es eas rra Eee eed ee ee X edes E 88 Remittance and Status R amp S Reports ee 89 Viewing the PDF Version
49. e statuses for a claim e Forwarded e Accepted by the MCO or e Rejected by the MCO MCO CSI Search Details New Lookup Return To List Claim Information Status Accepted Status Date 12 4 2014 10 48 02 AM MCO Name res y A fae MCO Phone No as oe 78 v2015 0127 TexMedConnect Long Term Care User Guide contact information of the MCO that received claim is located in the Claim Information section NOTE If there are any issues or questions regarding a claim that has been forwarded to an MCO providers must contact the MCO directly TMHP cannot answer questions regarding claims Rejected by an MCO MCO CSI Search Details Mew Lookup Return To List Claim Information TMHP EDI Trans Mo E HEN Status Date 12 4 2014 10 48 02 AM MCO Name MCO Phone No LLIIL 3 MCO ICN 5 The name and contact information of the MCO is identified in multiple places on the screen Once a claim has been Forwarded to the MCO providers must work directly with the MCO regarding any issues with the claim When TMHP Forwards a claim to an MCO TMHP will assign an Explanation of Benefits EOB Code that is specific to that MCO A description of that EOB and the telephone number of the MCO will be listed next to the EOB Code v2015 0127 79 TexMedConnect Long Term Care User Guide The last section on the screen the Detail Service Line will list information such as the Billing Code and details in the Informational P
50. ealth Care Institution not Defined Elsewhere in this Code List Save Template Save To Group 36 v2015 0127 TexMedConnect Long Term Care User Guide 7 Choose the appropriate facility type from the Place of Service drop down box 29 nb tetetet te tet New Claim Type Client Status EOS Claim Submission Step 2 Client Provider Te Details Other Insurance Finish Claim Claim File Indicator Code 9 Patient Discharge Status 9 Place of Service Claim Frequency v 21 SNF Inpatient Including Medicare Part A laim Place of Service 22 SNF Inpatient Medicare Part B 28 Swing Bed Nursing Facility 32 Home Health Inpatient Qualifier field will be derived based on the Diagnosis Code entered rd 74 Outpatient Rehabilitation Center 75 Comprehensive Outpatient Rehabilitation Center Add Na Diagnosis 79 Clinic Other code Description 81 Hospice Special Facility ATA o Es q 86 Residential Facility 89 Special Facility Other Delete Diagnosis Save Template Save To Group 8 Choose the appropriate claim frequency from the Claim Frequency drop down box Choose 1 Admit Through Discharge Claim when the claim will cover the entire duration of the stay Choose 2 Interim First Claim if this is the first claim billed for the individual Choose 3 Interim Continuing Claim for all dates of service between the first and last claims Choose 4 Interim Last Claim if th
51. eated Last Updated 12 01 2014 12 03 2014 10 03 2014 10 03 2014 11 25 2014 09 18 2014 08 25 2014 09 15 2014 10 03 2014 Delete Delete Delete Delete Delete Delete Delete Delete Delete v2015 0127 TexMedConnect Long Term Care User Guide Group Templates Viewing Group Templates 1 Click the Group Template link under the Claims section on the navigation panel Group Template Long Term Care MESAV MESAV Select NPI API amp Contract No Group Template MESAV Batch Hist Claims Claims Entry Individual Templat Tree Tempe Drafts 2 Select the appropriate NPI or API and contract number from the NPI API amp Contract No drop down box and click the Continue button i 4 Group Template Long Term Care MESAV MESAV Group Template v2015 0127 53 TexMedConnect Long Term Care User Guide 3 Under the Template Name column click the template name on which you want to work Group Template List NPI API Contract No NewGrup Claim Type Professional Template Name Institutional Institutional Professional NAT Professional Institutional Professional Institutional Professional Institutional Institutional NAT Professional Professional 04 06 2009 10 30 2013 04 08 2009 12 03 2014 04 08 2009 02 25 2013 05 12 2009 05 12 2009 12 10 2008 02 11 2013 07 14 2009 07 01 2009 04 08 2009 04 06 2009 Template Type as Institutional 10 30 2013 04
52. ect NPI API amp Contract No Continue gt gt v2015 0127 11 TexMedConnect Long Term Care User Guide 3 Ifyou have already created a group and want to add an individual to one of the existing Group Templates click the link from the list that is displayed under the Name of the group column and skip to Step 5 MESAV CSI Group Template NPI API Contract No New Group Ss LA Grou Name of the group Created Date Last Updated Date de 10 01 2008 10 16 2008 Delete Ds 10 01 2008 09 02 2014 Delete am 10 08 2008 08 14 2009 Delete e 10 08 2008 10 08 2008 Delete 4 Ifyou have not created a group or want to add an individual to a new Group Template enter the New Group name of your choice and dick the Add Group button MESAV CSI Group Template NPI API Contract No Lew Group CL A Grou Jj 5 To add an individual to the Group Template click the Add Client button MESAV CSI Group Template Go Bak NPI API INI Contract No MN From Date of Service s Format mm dd yyyy To Date of Service 5 Format mm dd yyyy C MESAV CSI Delete Submit MESAV Batch 12 v2015 0127 TexMedConnect Long Term Care User Guide 6 The Add Client page will open Enter the individual s information If you do not have the individual s Client Number you must use one of the following combinations to find the individual Social Security N
53. edicare Part A Total Amount based on standard rate Medicare Part C Total Amount q checking this box you attest to the fact that the Medicare Part A or Part C documentation to support this claim is kept on file You further attest that the Medicare Part A or Part C inrormation entered on this claim is true and accurate and that you understand that Medicaid is the payer of last resort Finish Options Please select one of the following and click finish Submit Submits the claim interactively J Save to Batch Saves the claim to batch for processing later Certification Terms And Conditions Please review the following certification and the terms and conditions The terms and conditions can be reviewed by clicking here The Providers and Claim Submitter certify that the information supplied on the claim form and any attachments or accompanying information constitute true correct and complete information The Provider and Claim Submitter understand that payment of this claim will be from Federal and State funds and that falsifying entries concealment of a material fact or pertinent omission may constitute fraud and may be prosecuted under applicable federal and or state law Fraud is a felony which can result in fines or imprisonment By checking We Agree you agree and consent to the Certification above and to the TMHP Terms and Conditions Save Draft Save Template Save To Group o To save the claim as a draft
54. ep 2 Client 22 57 22 Claim Details Other Insurance Finish Billing Provider NPI Qa Taxonomy Other Taxonomy Contact Name Contact Phone Do ID Qual Other ID s Name NPI API Attending Provider 9 NPI API First Name Last Name MI Suffix Save Template Save To Group 3 The Taxonomy drop down box is auto populated with three values Taxonomy codes further define the type classification or specialization of the health care provider If a provider attempts to submit a claim to TMHP without a valid taxonomy code regardless of the date of service the claim will be rejected and providers will receive an error message According to the Centers for Medicare and Medicaid Services all health care providers must select a taxonomy code s when applying for an NPI The values in the Taxonomy drop down box are Other 814000000X for Skilled NFs and 313M00000X for Other NFs Choose the provider taxonomy code that was used by your facility when it initially applied for a National Provider Identifier NPI If neither of the two auto populated codes apply choose Other If you choose Other a text box called Other Taxonomy will display and is required NOTE If an API was chosen the Taxonomy field will not display 34 v2015 0127 TexMedConnect Long Term Care User Guide m Claim Type Client Provider status Claim No Claim Submission Step 2 In
55. er Control No Paid Code 6 16 2010 12 31 9999 11424135 Active 2 CLASS 16 Weekly 6 50 Begin Date End Date Coverage Code u Program Type Coverage Category 12 1 2011 12 31 9999 R 23 1 Policy Information Insurance Company Name Subscriber First Name Insurance Company Address Subscriber Last Name Insurance Company City Relationship to Client Insurance Company State Employer Name Insurance Company ZIP Code Subscriber Policy Number Insurance Company Phone Number Group Number Lines of Coverage Type of Coverage Termination Date Coverage Type 1 2 2 2012 3 3 2012 ves Long Term Care Relevant Policy Information Insurance Company Name Subscriber First Name Insurance Company Address Subscriber Last Name Insurance Company City Relationship to Client Insurance Company State Employer Name Insurance Company ZIP Code Subscriber Policy Number Insurance Company Phone Number Group Number Lines of Coverage Type of Coverage Effective Date Termination Date Coverage Type 1 2 2 2012 3 3 2012 Yes Policy Information Insurance Company Name THIRD INSURANCE COMPANY NAME Subscriber First Name Insurance Company Address 123 INSURANCE ADORESS Subscriber Last Name Insurance Company City AUSTIN Relationship to Client Insurance Company State Employer Name Insurance Company ZIP Code Subscriber Policy Number Insurance Company Phone Number Group Number Lines of Coverage Type of Coverage Termination Date Long Term Care Relevant 1 2 2 2012 3 3
56. f a template has not been used for 365 days it will be deleted from the system A maximum of 100 group templates can be created for each NPI or API and contract number Each group template can store up to 250 claims FM This will force TexMedConnect to use Co Pay as the client V Apply Co Pay Only responsibility for every client in the template Note that this means P f that all claims updated in the Group Template will utilize Co Pay X Apply Applied Income Only where appropriate If the client does not have an active Co Pay oo record TexMedConnect will calculate using an amount of 0 00 t Apply Neither Co Pay Nor Applied Income Update Group Template Select AIM Client wo Account No Last Name First Nam Delete Saving as a Group Template To create a group template enter the information for a claim but before you submit the claim 1 Click the Save To Group button Save Template Save To Group 2 Enter a group template name and click the Save button Ifyou enter the name of an existing template the claim will be added to that existing group template Ifyou enter the name of a new group template a new template will be added to the Group Template list To modify the settings for the new template see the Group Templates section of this User Guide Group Template List NPI API Contract No New Group claim Type N Professional Template Name Template Type UserID hese Insti
57. ge for the date s of service on file at TMHP If you are aware of additional Long Term Care relevant other insurance coverage for this client that is not on file at TMHP you are required to add that coverage on the claim and enter the disposition information To enter a new policy click the Add New Policy button Attestation Cry checking this box you attest to the fact that you understand that Federal regulations dictate that the Medicaid Program is the payer of last resort and that the client has no al third party coverage that is relevant to the service s billed on this claim You further attest that all Other Insurance information entered on this claim is true and accurate when present and that every Explanation of Benefits EOB received from the other insurance carrier s is kept on file Medicare Information Claims for Nursing Facility Medicare Skilled stays must be billed separately from other claims When billing a Medicare Skilled stay an amount must be entered in only one of the fields below For clients with traditional Medicare enter the total coinsurance amount due per the Medicare Remittance Advice in the Medicare Part A Total Amount field For clients with non traditional Medicare Part C enter the total copay deductible amount due per the Medicare Part C Explanation of Benefits EOB in the Medicare Part C Total Amount field The amount entered below must equal the sum of all Medicare Skilled stay detail lines on this claim M
58. h Friday 7 00 a m to 7 00 p m TexMedConnect Long Term Care User Guide Getting Started You can access TexMedConnect from the Long Term Care page of the TMHP website To use TexMedConnect you must already have an account on the TMHP website If you do not have an account you can set one up using the information provided in the TMHP Website Security Provider Training Manual 1 On the Long Term Care screen click the Log In to TexMedConnect button ta TEXAS MEDICAID amp HEALTHCARE PARTNERSHIP TMHP ASTATE MEDICAID CONTRACTOR Log In to LTC Online Portal Log Into TexMedConnect Long Term Care Home TexMedConnect AA AAAXXAXNAN Long Term Care Home Page Get started with Program Information FAQ The Texas Department of Aging and Disability Services DADS administers programs providing LTC mc m E c Services and Institutional Care to eligible clients The Texas Medicaid amp Healthcare Partnership filing Click DADS Information Letters TMHP LTC team supports the LTC provider community in submitting claims through the Claims Med X Management System CMS TMHP also supports providers as they submit forms via the LTC Online gt d Reference Material Portal Forms Below are links to the current news for Long Term Care providers Click here to view past news articles News Articles Last 7 Days Reminder Scheduled System Maintenance February 10 2013 2 5 2012 Click here for forms and Scheduled System M
59. ide MESAVs Nursing Facility individuals with managed care eligibility segments must have service authorizations verified by the appropriate MCO NFs should contact MCOs directly to determine service authorizations NFs can use the Managed Care eligibility section at the bottom of the MESAV to verify enrollment with an MCO Submitting a MESAV Interactively To verify an individual s eligibility 1 Click the MESAV link under the MESAV section on the navigation panel fat Tex MedConnect 2 Long Term Care MESAY Group Template a MESAW Batch History Claims Claims Entry Individual Template Group Template Drafts Pending Batch Batch History CSI E SI Group Template Adjustments R and S ANSI S35 8 v2015 0127 TexMedConnect Long Term Care User Guide 2 Complete the following required fields Provider NPI API amp Contract No National Provider Identifier NPI Atypical Provider Identifier API Eligibility Start Date Eligibility End Date MESAV Entry Please enter the required information and click Submit to view the eligibility of the client Eligibility Start Date a Format mm dd ccyy Eligibility End Date Y S Format mm dd ccyy Client Information Please enter one of the following valid field combinations Medicald Client and Last Name or Medicaid Client and DOB or Medicaid Client and SSN or SSN and Last Name or S5N and DOB or Last Name First Name and DOB Medic
60. ider Claim Detais A 00000000 0000 0 0 TMHP records indicate that this client has the following Long Term Care relevant other insurance coverage for the date s of service billed on this claim In order for this claim to be considered for Medicaid reimbursement the identified third party resources must be billed prior to Medicaid and the resulting disposition must be entered below If any of the identified third party resources are not liable for the services billed on this claim you must indicate the reason the other insurance carrier denied the claim If you believe the information on file at TMHP for this client is invalid please call the TMHP Third Party Liability department at 1 800 626 4117 Option 6 Real time insurance updates are viewable upon click of the Insurance Refresh tool Please note Any data entered on this tab during your current user session will be lost when the Insurance Refresh tool is clicked Q Insurance Refresh If you believe the information on file at TMHP for this client is valid but requires an update please click the Update Policy button Modified information will be sent to the TMHP Third Party Liability department for verification prior to permanently updating TMHP records Check the client s MESAV within 10 business days for updated policy information Please note This claim will be processed using the information currently on file at TMHP Client has no known Long Term Care relevant other insurance covera
61. ider Status Claim No Claim Submission Step 2 See New Client Provider Details Other Insurance Finish Claim Claim File Indicator Code i i Place of Service Claim Frequency 01 Discharged to home or self care routine discharge 02 Discharged transferred to a short term general hospital for inpatient care 03 Discharged transferred to Skilled Nursing Facility SNF with Medicare Certification in Anticipation of Skilled Care Diagnosis 04 Discharged transferred to an intermediate care facility ICF 06 Discharged transferred to home under care of organized home health service organization in anticipation of covered skilled care Qualifier field will be derived based on the Diagnosis Code enti me o 5 21 Discharged transferred to Court Law Enforcement add 30 Still Patient New Diagnosis 43 Discharged transferred to a federal health care facility 51 Hospice medical facility T Q 62 Discharged transferred to an inpatient rehabilitation facility IRF including rehabilitation distinct part units of a hospital Delete 63 Discharged transferred to a Medicare certified long term care hospital LTCH 64 Discharged transferred to a nursing facility certified under Medicaid but not certified under Medicare 65 Discharged transferred to a psychiatric hospital or psychiatric distinct part unit of a hospital 69 Discharged transferred to a Designated Disaster Alternative Care Site 70 Discharged transferred to another Type of H
62. ions dictate that the Medicaid Program is the payer of last resort and that the client has no additional third party coverage that is relevant to the service s Died on this claim You further attest that all Other Insurance information entered on this claim is true and accurate when present and that every Explanation of Benefits EOB received from the other insurance carrier s is kept on file Medicare Information Claims for Nursing Facility Medicare Skilled stays must be billed separately from other claims When billing a Medicare Skilled stay an amount must be entered in only one of the fields below For clients with traditional Medicare enter the total coinsurance amount due per the Medicare Remittance Advice in the Medicare Part A Total Amount field For clients with non traditional Medicare Part C enter the total copay deductible amount due per the Medicare Part C Explanation of Benefits EOB in the Medicare Part C Total Amount field The amount entered below must equal the sum of all Medicare Skilled stay detail lines on this claim Medicare Part A Total Amount based on standard rate Medicare Part C Total Amount q O checking this box you attest to the fact that the Medicare Part A or Part C documentation to support this claim is kept on file You further attest that the Medicare Part A or Part C information entered on this claim is true and accurate and that you understand that Medicaid is the payer of last resort
63. is is the last claim billed for the individual 1 32 09 0 5 HHH tept New Claim Type_ Client Provider ES Claim Submission Step 2 Client Provider Details Other Insurance Finish Claim Claim File Indicator Code Patient Discharge Status Place of Service e w 1 Admit Through Discharge Claim 2 Interim First Claim 3 Interim Continuing Claim 4 Interim Last Claim Diagnosis Qualifier field will be derived based on the Diagnosis Code entered Delete Add New Diagnosis E Q Save Template Save To Group v2015 0127 37 TexMedConnect Long Term Care User Guide 9 Depending on the value in the Claim Frequency field you selected the Admit Date field may be required The admit date is the date that the individual is admitted to the facility Claim Submission Step 2 Claim Type Client KETTE esum tbt pepp ete te New Client Provider Details Other Insurance Finish Claim Claim File Indicator Code 9 Patient Discharge Status 9 Place of Service Claim Frequency Admit Date MC Medicaid v 07 Left against medical advice or discontinued care Diagnosis Qualifier field will be derived based on the Diagnosis Code entered Add New Diagnosis BETTE Description El a Save Template Save To Group v 81 Hospice Special Facility 4Interim Last Claim January 2015 Sun Mon Tue Wed Thu Fri Sat 28 29 1 1 MB 3 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19
64. jected Claim Submission Step 2 e Se EOB from MCO for Rejected Claim e Claim Detail 1 Testing EOB Description for detail Client Client Identification Numbers Client ID Patient Account No Medical Record No g Name and Address amp First Name Last Name MI Suffix Street Address Street Address 2 9 City State Zip s e e 0 0 a JIM A Client General Information Gender Date Of Birth Referral No VS ee 8 Save Template Save To Group Finish v2015 0127 67 TexMedConnect Long Term Care User Guide c Ifthe status of the claim that you clicked was Accepted and the Payer is an MCO the MCO CSI Search Details page will display Once a Forwarded Claim has been Accepted by an MCO the MCO ICN field will populate Ihe MCO ICN is a unique identifier that the MCO assigns to a Forwarded Claim The Header EOBs and descriptions returned by the MCO for the Accepted Claim will be displayed in the EOB EOPS codes messages column If the MCO does not return the description of the EOB it will appear as blank The provider will need to use the MCOs EOB crosswalk to interpret the EOBs MCO CSI Search Details New Lookup Return To List Claim Information TMHP EDI Trans No Status Accepted Status Date 12 8 2014 4 00 49 PM MCO Name 9 o MCO Phone No cbar MCO ICN The following are the descriptions of the EOB Explanation of Benefits EOPS Explanatio
65. lick the Status of a claim to view the details of that claim Batch History List of Claims Gb34MJ7O NPI API Contract No Status TTE T TNNT EEES ASE Of Service Billed Amount User ID Rejected 07 30 2014 159 09 Institutional Accepted 07 30 2014 159 09 Institutional HC NE 2220 18 BatchID G534MJ70 a If the status of the claim that you clicked was Forwarded o The Forwarded claim will have a 28 alphanumeric EDI Transaction Number ETN This is not the same as the internal control number ICN associated with FFS claims o The first eight characters of the EDI Transaction Number ETN are the same as the Batch ID o The claim will remain in the Forwarded status until the MCO responds with either an Accept or Reject As you can see in the image below the name and contact information of the MCO is identified in multiple places on the screen Once a claim has been Forwarded to the MCO providers must work directly with the MCO regarding any issues with the claim When TMHP Forwards a claim to an MCO TMHP will assign an Explanation of Benefits EOB Code that is specific to that MCO A description of that EOB and the telephone number of the MCO will be listed next to the EOB Code The last section on the screen the Detail Service Line will list information such as the Billing Code and in the Informational Pricing column how TMHP would have priced the claim if processed as FFS for Service Group 1 Service Code
66. me TMHP com My Account IMHP Logged in as ik TexMedConnect Claim Submission Step 1 Acute Care Eligibility Eligibili a Client Group List EV Batch History Claims Claim Type 9 Claims Entry f Client No Individual Template Draft Pending Batch Proceed to Step 2 gt gt Batch History a CSI v2015_0127 23 TexMedConnect Long Term Care User Guide 4 Asan option you may enter a Client No at this time Click the Proceed to Step 2 button Note Although a client number is not required providing one saves time The system will use the client number to auto populate many of the required fields If a client number is not entered you must manually enter information into the required fields under the Client tab MESAV Batch History Claims Claim Submission Step 1 Claims Entry Individual Template Group Template NPI 9 2 Drafts Pending Batch Claim Type 9 Batch History Claim Data Export 2 Data Export Request Data Export Downloads CSI Proceed to Step 2 gt gt a CSI Group Template 24 v2015 0127 TexMedConnect Long Term Care User Guide 5 The Claim Submission screen will display for the claim type that you selected and default to the Client Tab The type of claim you are working on is indicated in the Claim Type box in the upper right of the screen You must complete all required fields indicated by a red dot on each tab If you e
67. n Service Groups 1 6 or 8 Tex MedConnect will display any known Long Term Care relevant OI coverage currently on file with TMHP a Verify the OI information is valid and correct b Fill in all required Other Insurance Policy information as indicated by a red dot c Choose the appropriate option in the Other Insurance Disposition drop down box If no response has been received and it has been more than 110 calendar days since the billing date choose No response initial bill for services or No response subsequent bill for services d Ifyou chose Paid in the Other Insurance Disposition drop down box choose an option in the Other Insurance Disposition Reason drop down box as shown below and if applicable enter the Other Insurance Paid Amount Note The amount entered in this field must match the total amount entered on the Details tab in the OI Paid Amount field e Ifyou chose Denied in the Other Insurance Disposition drop down box choose an option in the Other Insurance Disposition Reason drop down box f Enter the appropriate date in the Other Insurance Billed Date field If you choose either of the No response options in the Other Insurance Disposition drop down box the Other Insurance Billed Date must be at least 110 calendar days prior to the submission date g Ifyou need to update the Other Insurance policy click the Update Policy button to display the Other Insurance Policy fields Once information is updated cli
68. n of Pending Status codes that appear on this claim EOB EOPS codes messages EOB EOB Description Code oe mae has been identified as the Medicaid Managed Care Organization that will process this claim They can be reached at or questions about processing of this claim 50 EOB from MCO for Accepted Claim is claim has been accepted to ee mm ww for processing Contact ee ee ww at for questions related to this claim The following data is for informational purposes For actual payments please contact the MCO Service Service End Billing Billed Informational OI Paid Applied OI Paid Begin Date Date Code Amount Pricing Amount Amount Applied 1 7 30 2014 7 30 2014 RG003 159 09 0 00 0 00 0 00 169 35 12 00 00 AM 12 00 00 AM 68 v2015 0127 TexMedConnect Long Term Care User Guide d Ifthe status of the claim that you clicked was Accepted and the Payer is TMHP the CSI Search Details page will display CSI Details New Lookup Claim Information Client Information Claim No Hd Client Medicaid No Trainee SSN Effective Date 9 10 2014 Date of Birth 8 24 1984 Service Group Patient Account No Tn Warrant Number Medical Record No Referral No o m Financial Information Provider Information Total Billed Amount Provider NPI API II 0 Total Applied Other Insurance Amount e Medicare Patient Days 9 o Budget Number Private Patient Days 0 Medicaid Patient Days 9 o 0
69. nding claims may affect the number of units nt No Trainee SSN PI API igibility From igibility Through edicaid Client No Ocial Security Number h uffix INQUIRY INFORMATION Status Service Service Group Description Control No Proc Proc Type Description Agent Title Message Description Service Code Effective Year Month Max Units Available Coverage Code Secondary Coverage Code Coverage Category Information Insurance Company Name Type of Coverage effective Date MEDICARE SUPPLEMENT POLICY MEDICARE cms Code Federal Contract Number Link Begin Date lend Date Level MESAV Other Insurance Ol Applicable to SGs 1 6 8 For Nursing Facility SG 1 non state ICF IID SG 6 and Hospice SG 8 providers there is a LTC TMC MESAV screen titled Other Insurance Policies Providers in service groups 1 6 and 8 can view the policies that an individual in their care has for the service dates entered on the MESAV The OI section contains all active lines of coverage that have been reported to TMHP Each listing contains detailed information about the insurance company subscriber information and the lines of coverage types of coverage effective date termination date fields and whether or not the coverage is LTC relevant The OI information should be used to assist providers in filing claims with insurance companies and obtaining the disposition of those claims as paid or denied
70. ntered the client number on the Claims Entry screen many of these fields will be auto populated If necessary most fields can be edited Once the claim has been submitted successfully an Internal Control Number ICN will be displayed at the top of the page This is also known as a claim number o A Client Provider Status Claim No Claim Submission Step 2 New Client Client Identification Numbers Client ID Patient Account No Medical Record No y Mame and Address First Name Last Name Suffix ARO AS L3 Street Address Street Address 2 City State Z AAA AO De EY P Client General Information Gender amp Date Of Birth Referral No EA PB oo Save Template Save To Group Prev Finish v2015 0127 25 TexMedConnect Long Term Care User Guide Entering a Professional Claim To enter a professional claim 1 Click the Client tab You must complete all required fields that are indicated by a red dot Entering a future date is 26 not allowed in the Date of Birth field Claim Type _ Status New Client Identification Numbers Client ID Patient Account No Medical Record No ATA y Mame and Address amp First Name ast Name Suffix L L3 Street Address Street Address 2 City State o Jo JEFE JL vl Client General Information Claim No Finish v2015_0127 TexMedConnect Long Term Care User Guide 2 Click
71. on Terms And Conditions Hass review the following certification and the terme and conditiong Tha terms and conditions can be read by clicking berg The Providers and Claim Subenitter derby hal tha interrater dappled en them clacen fesrm and bey abltichmantg er eceompanmyinma err enngbtube ud foreach amd comelaba imiesmabsen The Dresser aad Ciaim Submitter sndergtand that paymant of thig claim will ba fromm Federal and State fanda and that falsifying entries ccnzealment cf a material fact or pertineant omission may conatituta fraud and may ba provecuted under applicable federal and or mate lar Fraved ia amp Palas which cam null in Times Or PDA By checking Wa Agres you agree and contani to the Certification above and to tha TMHP Terms and Conditions To save the claim as a draft click the Save Draft button To save the claim as an individual template click the Save Template button To save the claim as part of a group click the Save To Group button To submit the claim as part of a batch refer to the Submitting a Batch section of this User Guide Entering an Institutional Claim TMHP will forward certain Institutional Claims to Managed Care Organizations MCOs These claims can be set to the following statuses e Forwarded means that the claim has been Forwarded but not yet Accepted or Rejected by an MCO e Rejected means that the claim has been rejected by TMHP or the MCO it was fo
72. on of Benefits EOPS Explanation of Pending Status codes that appear on this claim EOB EDPS codes messages EOB Description has been identified as the Medicaid Managed Care Organization that will process this claim They can be reached at for questions about processing of this claim AHOOLAC EOB from MCO for Accepted Claim This claim has been accepted to Amerigroup Long Term Support for processing Contact Amerigroup Long Term Support at 800 454 3730 for questions related to this claim The following data is for informational purposes For actual payments please contact the MCO Service Service Billing Billed Informational OT Paid Applied Paid Begin End Date Code Amount Pricing Amount OI Applied Date Amount 7 30 2014 7 30 2014 RGODS 159 09 0 00 0 00 169 35 12 00 00 12 00 00 Ex IV eS v2015 0127 81 Adjustments Creating an Adjustment for a Fee For Service Claim An adjustment is a change made to a previously paid claim Adjustments reimburse the Department of Aging and Disability Services DADS for overpayments and to reimburse providers if units were underbilled and must be paid correctly Only claims that are set to status Paid can be adjusted using TexMedConnect If you submit an Adjustment you must return the amount that you were paid not the amount that was billed NOTE Providers must contact managed care organizations MCO directly to make adjustments 1 To make an adjustment on a Fee For Service cl
73. plate Adjustments R and S AMZIS35 Choose the appropriate NPI or API and contract number from the NPI API amp Contract No drop down box and click the Continue button Draft List Select NPI API amp Contract No If there are multiple drafts you can click a column heading to sort the list by that column category Click a Draft Name to view the saved claim Once a claim from the draft list has been submitted that draft claim is removed from the draft list After 45 days drafts will automatically be deleted from the draft list A maximum of 50 drafts can be created for each NPI or API and contract number Drafts NPI API 4 Contract No Draft Name Claim Type User ID Last Updated Expedited 07 28 2009 07 28 2009 v2015_0127 TexMedConnect Long Term Care User Guide Individual Templates Saving as an Individual Template To save an individual claim as a template complete a claim and then 1 Click the Save Template button Save Template Save To Group 2 Enter a template name and click the Save button The claim will be added to the Individual Template list 3 Templates do not disappear when they are used However they will be removed if they have not been used for 365 days 4 A maximum of 1 000 individual claim templates can be created for each NPI or API and contract number Viewing Individual Templates To view individual templates 1 Click the Individual Templa
74. ricing column how TMHP would have priced the claim if processed as FFS for Nursing Facility Daily Care Service Group 1 Service Code 1 and Medicare Coinsurance Service Code 3 MCO CSI Search Details New Lookup Return To List Claim Information Status Forwarded Status Date 12 8 2014 4 07 46 PM MCO Name MCO Phone No MCO ICN The following are the descriptions of the EOB Explanation of Benefits EOPS Explanation of Pending Status codes that appear on this claim EOB EOPS codes messages EOB EOB Description Code 01745 has been identified as the Medicaid Managed Care Organization that will process this claim They can be reached at for questions about processing of this claim This claim has been forwarded to for processing Contact at 1 800 for questions related to this claim The following data is for informational purposes For actual payments please contact the MCO Service Service End Billing Billed Informational OI Paid Applied OI Paid Begin Date Date Code Amount Pricing Amount Amount Applied 7 30 2014 7 30 2014 RGOOS 159 09 140 57 0 00 0 00 12 00 00 AM 12 00 00 AM CSI Search Lookup Managed Care Claim by MCO ICN Providers can use an MCOs ICN to search for claims that have been forwarded to MCOs The ICN is assigned by the MCO that accepted the claim 1 In the Iransaction Number field enter the MCO ICN of the claim you are searching for choose MCO ICN from the Transaction Number Type drop
75. risk TexMedConnect Ready 3 Click the Save button and download the file to any location on your computer F File Download Do you want to open or save this file g Mame ansi835 8 z2 28 2013 zip Type Winzip File From localhost Cancel harm Your computer IF you do not trust the source do not open ar Q9 While files from the Internet can be useful same files can potentially save this tile whats the risk Note Third party software vendors third party billing services and providers who program their own software can find information about all of the requirements for EDI ANSI X12 file types in the EDI Companion Guides which are located on the EDI page of the TMHP website at www tmhp com 92 v2015 0127 TexMedConnect Long Term Care User Guide Claims Identified for Potential Recoupment CIPR Reports TMHP provides Claims Identified for Potential Recoupment CIPR Provider Reports to Long Term Care providers that can be downloaded and viewed As TMHP becomes aware of individuals third party insurance policies with retroactive dates of coverage claims previously reimbursed by Medicaid will be identified if the claim would have processed differently based on the third party resource Ihe CIPR Provider Report contains this list of impacted claims along with the insurance company information for the corresponding policy Reports are generated on a weekly basis and TMHP maintains each CIPR
76. rmation Medicaid No Y Last Mame First Name M I Transaction Number Y Transaction Number Type Select ko Lookup CSI Search Lookup Fee For Service Claim by Claim Request 1 To search for a Claim by Claim Request enter the Claim Number in the Claim Number field and click the Lookup button CSI Search Lookup Fee For Service Claim by Claim Request Claim Number Format 15 digits with na spaces v2015 0127 75 TexMedConnect Long Term Care User Guide 2 he CSI Details page will display and auto populate most of the fields including the status of the Claim New Lookup Claim Information Client Information Claim No Client Medicaid No Trainee SSN Dates of Service Status Effective Date 9 10 2014 Date of Birth Service Group 1 Patient Account No Warrant Number Medical Record No Referral No Financial Information Provider Information Total Billed Amount Provider NPI API Total Paid Amount Provider Name Total Applied Other Insurance Amount Medicare Patient Days Budget Number 88 Private Patient Days 9 o Medicaid Patient Days 9 o rmm Detail Status Service End Date Billing Code Billed Amount Paid Amount OI Paid Amount Applied OI Amount Billed Units paid Units Estimated Paid Unit Rate Nat l EOB1 Nat l EOB2 Modifier 1 1 D 0 00 0 00 0 00 0 00 0 00 8 1 2014 8 1 2014 100 00 1 00 CSI Search Lookup Fee For Service Claim by Client Claim Request
77. rmation entered en this claim rs true and accurate and that yeu understand that Medicaid is the payer of last resort Finish Options Please select one of the followeng and dick finesh aa to Batch Saved the clits r batch for processing Later Certification Termz And Conditions Fiais rines the following certification and the terra and conditigns The kerma and condibona can ba reviewsd by clicking bers Tha Providers and Claim Submitter cartify that the infornaton gugppliad on the claim form and any attacherants or accompanying information congtitute true connect and complete information The Provider and Claim Submiter understand that payment of chia clair will ba hom Federal and State Funds and that falsifying entries concealment of a material Fact of pertinent omission may constitute fraud and may be prosecuted under applicable federal and or state lam Fraud kr a felony BAL can result im lines er imgpraenmant By checking We Agrea you agree and consent to the Cartificalian above and to the TMHP Temna and Canditiana qo Save Cra Save Template Save To Greup o To save the claim as a draft click the Save Draft button o To save the claim as an individual template click the Save Template button o To save the claim as part of a group click the Save To Group button o To submit the claim as part of a batch refer to the S
78. rms And Conditions Please review the following certification and the terms and conditions The terms and conditions can be reviewed by clicking here The Providers and Claim Submitter certify that the information supplied on the claim form and any attachments or accompanying information constitute true correct and complete information The Provider and Claim Submitter understand that payment of this claim will be from Federal and State funds and that falsifying entries concealment of a material fact or pertinent omission may constitute fraud and may be prosecuted under applicable federal and or state law Fraud is a felony which can result in fines or imprisonment By checking We Agree you agree and consent to the Certification above and to the TMHP Terms and Conditions L We Aqree Save Draft Save Template Save To Group 48 v2015 0127 TexMedConnect Long Term Care User Guide Draft Claims Saving Draft Claims To save a claim as a draft 1 Click the Save Draft button at the bottom of the screen Header Information Line Item Information Other Insurance Finish Finish Options Please select one of the following and click finish 8 Submit Submits the claim interactively oy Save to Batch Saves the claim to batch for processing later Certification Terms And Conditions Please review the following certification and the terms and conditions The terms and conditions can be reviewed by clicking here The Pro
79. rwarded to e Accepted means that the claim has been Accepted by TMHP or an MCO Claims handled by TMHP not an MCO can also be set to the following statuses e I In Process e TT Transferred D Denied e P Paid e A Approved for Payment e PF Paid Forced Transfer e FT Forced Transfer using PSWin e PT Paid Transfer e S Suspended e PZ Zero Net Balance to the Provider 32 v2015 0127 TexMedConnect Long Term Care User Guide To enter an Institutional claim 1 Click the Client tab You must complete all of the fields that are indicated by a red dot Entering a future date is not allowed in the Date of Birth field After you have completed all of the required fields click the Next button to move to the Provider tab Claim Type_ Client Provider Status Claim No _ Claim Submission Step 2 New A Provider Client Identification Numbers amp Client ID amp Patient Account No Medical Record No S Name and Address amp First Name amp ast Name MI Suffix Street Address Street Address 2 City State Zip o Ja JH JW Client General Information Gender Date Of Birth Referral No cc aj RM rt Save Template Save To Group EY Finish Md v2015_0127 33 TexMedConnect Long Term Care User Guide 2 Click the Provider tab You must complete all of the fields that are indicated by a red dot Claim Type Status Institutional New Claim Submission St
80. s Group Template Summary ALpha TMC II Go Back NPI API Contract No Global Update Submit Procedure Code 9 Start Date Effective February 22 2013 an Institutional claim for individuals in Service Groups 1 5 or 8 will be denied if third party insurance is End Date detected when the claim is submitted and the third party insurance information has not been addressed on the claim NOTE Applicable No of Units Individual Templates for Institutional claims included in a Group Template must be updated to address OI Insurance policy Unit Rate information for LTC individuals can be viewed on the MESAV This will force TexMedConnect to use Co Pay as the client e Apply Co Pay Only responsibility for every client in the template Note that this means O Apply Neither Co Pay Nor Applied that all claims updated in the Group Template will utilize Co Pay C Apply Applied Income Only where appropriate If the client does not have an active Co Pay record TexMedConnect will calculate using an amount of 0 00 Income Update Group Template TPI select AIM Client wo Account No Last Name First Nam 58 Delete v2015_0127 TexMedConnect Long Term Care User Guide 7 When you have entered all the required information click the Update Group Template button to apply that information to all of the claims in the group A template will remain in the system as a template after each use However i
81. s 1 and 3 v2015 0127 65 TexMedConnect Long Term Care User Guide 66 MCO CSI Search Details New Lookup Return To List Claim Information TMHP EDI Trans No Status Forwarded Status Date 12 8 2014 4 07 46 PM MCO Name Y A MCO Phone No MCO ICN The following are the descriptions of the EOB Explanation of Benefits EOPS Explanation of Pending Status codes that appear on this claim EOB EOPS codes EOB EOB Description Code 01745 s has been identified as the Medicaid Managed Care Organization that will process this claim They can be reachedat for questions about processing of this claim is claim has been forwarded to efor processing Contact at or questions related to this claim The following data is for informational purposes For actual payments please contact the MCO Dtl Service Service End Billing Billed Informational OI Paid Applied OI Paid No Begin Date Date Code Amount Pricing Amount Amount Applied 1 0 00 7 30 2014 7 30 2014 RGOO3 159 09 140 57 0 00 18 52 12 00 00 AM 12 00 00 AM v2015 0127 TexMedConnect Long Term Care User Guide b Ifthe status of the claim that you clicked was Rejected you will see a yellow message box at the top of the screen listing the Rejected EOBs Ihe MCO may choose to list EOBs with a description If a description is not present then only the EOB number will be displayed Claim Type Provider Status Claim No cina a Re
82. sasas pierda sd tap rana b cie oo wen 89 Downloading the ANSI 833 Versi s sp oe paaa e 91 Claims Identified for Potential Recoupment CIPR Reports 93 Terms and Abbreviations AM NwpkaProwderMenfer OOOO ARD AwesmenRfeeneDate OO O EDI HewnkDwaltehame OOOO O cos Eplmtonof emft OOOO HIPAA HesthinsurancePorabiltyandAccunbliyAd Intermediate care facility facilities for individuals with an intellectual disability or related conditions a MN Medical Necessity ooo NF Nursing Facility OOOO ner NMmlProwderdemifer Office of Eligibility Services OES Office of Eligibility Services OIG Office of the Inspector General Portable Document Format s SCSA Significant Change in Status Assessment ICF IID ICN C SG Service Group SSN Social Security Number STAR PLUS State of Texas Access Reform STAR PLUS TAC Texas Administrative Code THCA Texas Health Care Association TMB Texas Medical Board TMHP Texas Medicaid amp Healthcare Partnership Introduction TexMedConnect is a free online claims submission application provided by Texas Medicaid amp Healthcare Partnership TMHP Technical support and training for TexMedConnect are also available free of charge from TMHP Providers can use TexMedConnect to submit claims Medicaid Eligibility and Service Authorization Verifications MESAVs Claim Status Inquiries CSI and Adjustments Providers
83. ser 3 Click the NPI API to view the CIPR Report List of NPI API NPI API Contract Number 0000012345 000000012 REGIONAL MEDICAL CENTER 0000098765 110000000 COUNTY CLINIC 4 Click on a File Name hyperlink to view CIPR Provider Reports Click the Date Created column heading to sort NPI 0000012345 Contract Number 0000000012 Name REGIONAL MEDICAL CENTER File Name E E es 2 CIPR 20121220 pdf 12 20 2012 5 KB 000000012 CIPR 20130103 pdf 01 03 2013 5 KB 94 v2015 0127 IMHP TEXAS MEDICAID HEALTHCARE PARTNERSHIP A STATE MEDICAID CONTRACTOR The 7exMed Connect Long Term Care User Guide is produced by TMHP Training Services Contents are current as of the time of publishing and subject to change Providers should always refer to the TMHP and DADS websites for current and authoritative information
84. stitutional n Details Other Insurance Finish Billing Provider 313M00000X NPI Q COOMA o other Taxonomy E Name NPI API Contact Name Contact Phone 7 ID Qual Other ID rums LL Ln Attending Provider 9 NPI API First Name Last Name MI Suffix 4 The Attending Provider is required to enter their NPI API and name Claim Type Institutional New Claim Submission Step 2 Other Insurance Finish Billing Provider Contact Name Contact Phone NENNEN ID Qual Other ID NPI APT Attending Provider NPI API First Name Last Name MI Suffix Lo JL dL LIE v2015 0127 35 TexMedConnect Long Term Care User Guide 5 Click the Claim tab You must complete all of the fields that are indicated by a red dot Choose the appropriate indicator from the Claim File Indicator Code drop down box ected pth Getetet te 16 New SNC Provider Status J Claim No Claim Submission Step 2 Client Provider Claim Details Other Insurance Finish Claim Claim File Indicator Code Patient Discharge Status Place of Service Claim Frequency v Yv vr Diagnosis Qualifier field will be derived based on the Diagnosis Code entered Add New Diagnosis I Q Delete Save Template Save To Group 6 Choose the appropriate status from the Patient Discharge Status drop down box Claim Type client Prov
85. t No Institutional Insbtutional Institutional Institutional v2015 0127 10 01 2008 05 21 2008 02 03 2002 05 21 2008 03 13 2009 ONO Ja FA 2003 03 21 2008 05 13 2005 Rename Rename Rename Rename Mala te Delate Delete Delete Delete 55 TexMedConnect Long Term Care User Guide 4 After you have created the Group Template the Group Template Summary page will display To add an individual go to step 5 To return to the Group Template List page click the Go Back button Claims Group Template Summary ALpha TMC II Start Date Effective February 22 2013 an Institutional claim for individuals in Service Groups 1 6 or 8 will be denied if third party insurance is End Date detected when the claim is submitted and the third party insurance information has not been addressed on the claim NOTE Applicable No of Units Individual Templates for Institutional claims included in a Group Template must be updated to address OI Insurance policy Unit Rate 1 information for LTC individuals can be viewed on the MESAV This will force TexMedConnect to use Co Pay as the client e Apply Co Pay Only responsibility for every client in the template Note that this means that all claims updated in the Group Template will utilize Co Pay Q Apply Applied Income Only where appropriate If the client does not have an active Co Pay record TexMedConnect will calculate using an amount of 0 00 O Apply Neither Co Pay
86. t be forwarded Users may submit the following claim types e Professional e Dental e Institutional e Nurse Aide Training NAT Entering a Claim on TexMedConnect These are the basic steps that are used to begin the process of submitting all claim types Professional Dental Institutional and NAT 1 Click the Claims Entry link under the Claims section on the navigation panel Home TMHP com Logged in as Long Term Care MESAV Welcome to TexMedConnect MESAV Group Template MESAV Batch History Claims Individual Template Group Template Drafts Pending Batch M H P Batch History Claim Data Export TEXAS M EDICAID Data Export Request HEALTHCARE PARTNERSHIP 22 v2015 0127 TexMedConnect Long Term Care User Guide 2 Alist of NPIs APIs contract numbers and related data will be displayed according to the users login information Select the appropriate NPI API and contract number from the NPI drop down box Home MESAV Batch History i Claims Claim Submission Step 1 Claims Entry 2 Individual Template Group Template Drafts Pending Batch Claim Type a Batch History Claim Data Export Client No fs Data Export Request a Data Export Downloads CSI Proceed to Step 2 gt gt CSI Group Template 3 Choose the appropriate claim type from the drop down box Ho
87. te link under the Claims section on the navigation panel Templates are displayed by NPI Individual Template List Drafts Select NPI API amp Contract No Pending Batch Batch History Claim Data Export Data Export Request Data Export Downloads CSI v2015 0127 51 TexMedConnect Long Term Care User Guide 2 Choose the appropriate NPI or API and contract number from the NPI API amp Contract No drop down box and click the Continue button Claims a Claims Entry Individual Template Group Template Drafts Pending Batch Batch History Claim Data Export Data Export Request Data Export Downloads CSI v Select NPI API amp Contract Mo Individual Template List 3 Ifthere are multiple drafts you can click a column heading to sort the list by that column category Click on the 52 template name to open it Individual Template NPI API Contract No Template Name COR135 EDI Test CPT REV dental dental TaxonomycodeBatch Testin Inst Taxonomycode Batch Testing Multiple Plan Codes Multiple Plan Codes E0015 Multiple Plan Codes E0016 Multiple Plan Codes E0016 Addon SC1 Professional Taxonomy Batch Testing Claim Type Institutional Dental Dental Institutional Institutional Institutional Institutional Institutional Professional 11 25 2014 09 04 2014 10 03 2014 10 03 2014 08 21 2014 08 21 2014 08 21 2014 08 25 2014 10 03 2014 UserID Cr
88. ther Insurance Finish Tab Save Template Save To Group To add more rows click the Add New Detail Row s button To copy the information from the previous detail click the Copy Row button To delete a row scroll over and click the Delete link at the end of the row 12 Click the Other Insurance Finish tab Claim Type Claim Submission Step 2 Client Provider Claim Details Rue i AAA Finish Options Please select one of the following and click finish O Submit Submits the claim interactively ry A Save to Batch Saves the claim to batch for processing later Certification Terms And Conditions Please review the following certification and the terms and conditions The terms and conditions can be reviewed by clicking here The Providers and Claim Submitter certify that the information supplied on the claim form and any attachments or accompanying information constitute true correct and complete information The Provider and Claim Submitter understand that payment of this claim will be from Federal and State funds and that falsifying entries concealment of a material fact or pertinent omission may constitute fraud and may be prosecuted under applicable federal and or state law Fraud is a felony which can result in fines or imprisonment By checking We Agree you agree and consent to the Certification above and to the TMHP Terms and Conditions L We Agree Save Template Save
89. tion Total Billed Amount 100 00 Provider NPI API Total Paid Amount 0 00 Provider Name Total Applied Other Insurance Amount 0 00 Medicare Patient Days o o o Budget Number Private Patient Days Medicaid Patient Days Dt No Detail Status Service End Date Billing Code Billed Amount Paid Amount OI Paid Amount Applied OI Amount Billed Units paid Units Estimated Paid Unit Rate Nat l EOB1 Nat l EOB2 Modifier 1 1 D 8 1 2014 8 1 2014 RG008 100 00 0 00 0 00 0 00 1 00 0 00 0 00 CSI Search Lookup Managed Care Claim by Transaction Number This section allows Providers to use a Transaction Number to search for claims that have been forwarded to MCOs An EDI Transaction Number ETN is needed to search for these forwarded claims An ETN is not the same as an MCO internal control number MCO ICN or as an ICN associated with Fee For Service FFS claims An ETN is a 28 alphanumeric value the first eight characters of which are the Batch ID The status of the claim is shown in the Claim Information section on the line labeled Status There are three possible statuses for a Claim that has been forwarded to an MCO e Forwarded e Accepted by the MCO or e Rejected by the MCO 1 In the Transaction Number field enter the ETN of the claim you are searching for choose TMHP EDI Trans No from the Transaction Number Type drop down box and click the Lookup button Lookup Managed Care Claim by Transaction N
90. tion constitute true correct and complete information The Provider and Claim Submitter understand that payment of this claim will be from Federal and State funds and that falsifying entries concealment of a material fact or pertinent omission may constitute fraud and may be prosecuted under applicable federal and or state law Fraud is a felony which can result in fines or imprisonment By checking We Agree you agree and consent to the Certification above and to the TMHP Terms and Conditions Save Template Save To Group o To save the claim as a draft click the Save Draft button o To save the claim as an individual template click the Save Template button o To save the claim as part of a group click the Save To Group button o To submit the claim as part of a batch refer to the Submitting a Batch section of this User Guide 40 v2015 0127 v2015 0127 TexMedConnect Long Term Care User Guide Scenario 2 Other Insurance Finish tab no known OI coverage For Providers in SG 1 6 or 8 If you are aware of additional OI coverage for the individual that is Long Term Care relevant you are required to add that coverage on the claim by using the Add Policy button a Check the box under Attestation b Click the Submit radio button c Check the We Agree box in the Certification Terms And Conditions section d Click the Finish button in the lower right corner of the screen Client Prov
91. to click the Add New Details Row s button MES A ee Claim Submission Step 2 Enstibiarae Adjusimara Client Provider Claim Other Insurance Finish Number of detada to add m Judd hes Drarailg on Cog ome a Ta provider lt pr TR AR Or Faid Amoust ee Firsthame Lasthamo wr Suffir Delete P di dnd in i z0iz in i g012 92 83 192 83 20 ico 20 00 Do Par Apcbed Income Cleo Total 592 03 Total Apphed Income hga Total Other Insurance 0 from Details Tab Total Other Insurance free Other Insurance Fanish Tab Save Draft Seve Template Save To Grup 11 To bill positive units for the same adjusted claim click the Add New Details Row s button On the new row you will add the dates of service and the accurate number of units that are to be paid After the rate is entered tab over to the Applied Income field The Applied Income or Co Pay will be calculated automatically At the bottom left of the screen the Claim Total and the Total Applied Income or Co Pay that was deducted from the positive line will display The provider will also fill in the OI field on the positive line if applicable Cisim Tepe Cent f Proider f Status ee Claim Submission Step 2 Inabtutional Adjustment Client Provider Cain Other Insurance Finish Number of details to add 1 Sud Nan Dead Ris apr Raw HMM MMM M PH EA O ERSTES T
92. tutional Edit Delete 10 04 2012 2 738 70 Institutional Edit Delete 10 01 2012 2 738 70 Institutional Edit Delete IPIE ESSE PIE 90 216 10 4 If there are more claims than can fit on one screen click the Continue button to go to the next page 5 Ifyou want to return to a previous page use your Internet browser s Back button v2015 0127 61 TexMedConnect Long Term Care User Guide 6 On the last screen of the pending batch list click the Submit Batch button All of the claims in that batch will be submitted even those created by other users Pending Batch List of Claims NPI API Contract No Client Account No Last ASES Date Of Service Billed Amount Claim Form UserID B 10 01 2012 2 738 70 Institutional View Edit Delete 10 04 2012 2 738 70 Institutional gt View Edit Delete 10 01 2012 2 738 70 Institutional View Edit Delete AN 93 216 10 Submit Batch 7 When the Batch is submitted a confirmation message will inform the user whether the submission was successful and 62 the number of claims submitted in the batch Pending Batch List of Claims NPI API Contract No The status and details for Total Billed Amount 0 00 v2015_0127 TexMedConnect Long Term Care User Guide View Batch History You can view the batch history of previously submitted claim batches Batches that are more than 120 days old are automatically deleted To
93. tutional Updated OEE Lid fi ie v2015 0127 59 TexMedConnect Long Term Care User Guide Batch Claims Saving To a Batch To save a claim as part of a batch 1 After completing a claim click the Save to Batch radio button Finish Options Please select one of the following and click finish Submit Submits the claim interactively Saves the claim to batch for processing later 2 Check the We Agree box and then click the Finish button The claim will be saved as part of a batch and you will be returned to the claims entry screen so that you can continue to enter more claims You can save up to 250 claims to a batch Pending batches that are not submitted after 45 days are deleted from the system You can view or edit claims in a pending batch before you submit them Claim Submission Step 2 Institutional Client Provider Claim Details other Insurance Finish Finish Optians Peaga galadi cee of the follgeng and check Inh Submit benito eha elaimi intazcacet Y Save to Batch awed pha claim t batch far eeocanaing eta Certification Terms And Conditions Plante aia the Pollo nirtihicabonm and ra per n candibang Tha termi and canditana cn be aiam Ey clicking heng Tha Providers mand Claim Submitter cartehy thet the information puppliad on tha claim form and any attachrantr cr accorngamnying informatica conmitute true comert and complete information Tha Provider and Cl
94. ty department at 1 200 626 4117 Option 6 Real time insurance updates are viewable upon click of the Insurance Refresh tool Please note Any data entered on this tab during your current user session will be lost when the Insurance Refresh tool is clicked a Insurance Refresh IF you believes Ehe information on File at TMHIP for tus dient et valid but requeres an update please click the Update Policy button Modified information will be sent to the TMHP Therd Party Liability department for verhcaton pror to permanently updating TMHF records Check the client s MESAV within 10 business days for updated policy information Please note This claim will be processed using the information currently on file at TMHP Other Insurance Policy 1 Upata Policy Nate All policy information will be validated by TMHP on every referral regardless of the informaban submitted on the referral Effective Date Termination Debe Company Name _ Company Address Company City _ Company State Company ZIP Code Company Phone Subsonber Relationship to Client Subscriber Forst Name Subscriber Last Name Subscriber SSM Subscriber DOB Sroup Number Other Insurance Disposibon Other Insurance Billed Date Sakae Desmi l E If you are aware of additional Lang Term Care relevara other insurance coverage for this client that es nat on file at TMHP you are required to add that cowerage on the claim and enter Ehe disposibon information To enter a ne
95. u must complete all of the fields that are indicated by a red dot Lookup Fee For Service Claim by Client Claim Request Provider NPI API 9 Service Begin Date 9 pa Format mm dd ccyy Service End Date 9 FS Format mm dd ccyy Select the appropriate Request Type amp Client Trainee Client Information Medicaid No 9 Last Name 9 First Name 9 M I Suffix 4 Click on the claim number to display the claim information CSI Search Results 84 New Lookup Batum with Search Criteria HPI Contract Ho 1234557890 Dates of Service 111152012 12 31 2012 Client He Trainee SSA 0123456709 Client Information Cliget Mo Trainee SH P i States Billed Amt Pad Amt 11 22 2042 11 2 2012 JOHN DOE 0123455785 000000123456789 110162012 111862012 JOHN DOE ii Ssma 13345671 39000000 11 28 2012 11 29 2012 JOHN DOE 0123456788 000123456789000 127102042 12 1002012 JOHN DOE 0123458788 DDDOD 1234587890 v2015 0127 TexMedConnect Long Term Care User Guide 5 Choose the appropriate Claim Type from the drop down box and click the Adjust Claim button Select the appropriate Claim Type for this Claim to Adjust Claim Type d Claim Inforr l Client Information SPIRI ER Expedited 0000001234 56788 Client Medicaid DM Trainee 55H Dates of Service 3 3 2012 s 6f2012 Name Status P Gender Effective Date 12 7 2012 Date of Birth Service Group 1 Patient Account Na Warrant Number Medical Record No Referral No Finan
96. ubmitting a Batch section of this User Guide 44 v2015 0127 TexMedConnect Long Term Care User Guide Nurse Aide Training NAT To enter a NAT claim 1 Click the Header Information tab Complete all of the required fields as indicated by a red dot The Provider No field and the NPI API field will be auto populated based on the information entered in Step 1 Note The percentages entered for Medicaid Patient Days Medicare Patient Days and Private Patient Days must total 100 percent Claim Submission Step 2 NAT New ario Line Item Information Other Insurance Finish Provider Information Service Group amp Provider No NPI API gt Jm 0 Medicaid Patient Days Medicare Patient Days Private Patient Days Trainee Information Trainee SSN Last Name amp First Name ee UN Save Template Save To Group Finish v2015 0127 45 TexMedConnect Long Term Care User Guide 2 Click the Line Item Information tab Complete all of the required fields as indicated by a red dot No future date is allowed in the Service Start Date or Service End Date fields Claim Submission Step 2 NAT qq Nev Number of details to add 2 Add New Details Bomfe _ Start Date Service End Date Billing Code ITI HEIL Unit Rate Line Item Total Delete lt Claim Total 0 00 Save Template prev ext Fish Ifyou want to add more rows click the Add New Detail Row s
97. umber Transaction Number 1234567895555555555 Transaction Number Type TMHP EDI Trans No v v2015 0127 77 TexMedConnect Long Term Care User Guide 2 Ihe MCO CSI Search Details page will display and auto populate with the ETN in the Claim Information section MCO CSI Search Details New Lookup Return To List Claim Information Status Accepted Status Date 12 4 2014 10 48 02 AM MCO Name MCO Phone No MCO ICN The following are the descriptions of the EOB Explanation of Benefits EOPS Explanation of Pending Status codes that appear on this claim EOB EOPS codes messz EOB Description 01745 has been identified as the Medicaid Managed Care Organization that will process this claim They can be reached at for questions about processing of this clairn JAHOO1AC EOB from MCO for Accepted Claim This claim has been accepted to Amerigroup Long Term Support for processing Contact Amerigroup Long Term Support at 800 454 3730 for questions related to this claim The following data is for informational purposes For actual payments please contact the MCO Service Service Billing Billed Informational OT Paid Applied Paid Begin End Date Code Amount Pricing Amount OI Applied Date Amount 7 30 2014 7 30 2014 RGOOS 159 09 0 00 12 00 00 12 00 00 A 169 35 AA 3 The status of the claim will be shown in the Claim Information section on the line labeled Status Recall that there are three possibl
98. umber and Last name Social Security Number and Date of birth Last name First name and Date of birth Add Client NPI API Contract No Client Number po Lookup Criteria Client Social Security Number or Combination of SSN and DOB TT or First Name Last Name and DOR Date of birth Ls or S5N and Last Name First name Last name 7 Click the Lookup button Add Client NPI API Contract No Lookup Criteria Client Social Security Number or Combination of SSN and DOB or First Name Last Name and DOB Client Number Date of birth ET or SSN and Last Name Last name v2015 0127 13 TexMedConnect Long Term Care User Guide 8 To add the individual click the Add to group link Add Client NPI API Client Nurnber Social Security Number Date of birth First name Last marie Contract No Lookup Criteria Client m or Combination of SSH and DOB or First Name Last Name and DOB or SSH and Last Name Fist Name PA Ce NNI Add to group E 9 The individual will be added to the MESAV Group Template that you are working on You can create up to 100 groups for each NPI or API and contract number Each group can contain up to 250 individuals You can view add and delete individuals from the list Submitting a MESAV Group Template To verify eligibility using a group template 1 Click the Group Template link un
99. viders and Claim Submitter certify that the information supplied on the claim form and any attachments or accompanying information constitute true correct and complete information The Provider and Claim Submitter understand that payment of this claim will be from Federal and State funds and that falsifying entries concealment of a material fact or pertinent omission may constitute fraud and may be prosecuted under applicable federal and or state law Fraud is a felony which can result in fines or imprisonment By checking We Agree you agree and consent to the Certification above and to the TMHP Terms and Conditions Save To Group 2 Entera name for the draft and click the Save button The claim will be added to the draft list A maximum of 500 claims can be saved as drafts DUEL multo QOLEEL AUU GCaD ILY Ladle lp Ja JE EA _ E Client General Information Gender Date Of Birth Referral No A PA E Save Draft Save Template Save To Prey Finish v2015 0127 49 TexMedConnect Long Term Care User Guide Viewing Draft Claims To view a list of all your draft claims 1 Click the Drafts link under the Claims section on the navigation panel 2 3 50 _ Navigation nt TexMedConnect 2 Long Term Care MESAV a MESAYV Group Template a MESAV Batch History Claims Claims Entry Individual Template Group Template Pending Batch Batch History CSI Ml Group Tem
100. w policy click the Add Mew Policy button Add Na Police Attestation n EF Eheckang thes box you attest to the fact that you understand that Federal regulations dictate that the Medicad Program is the payer of last resort and that the client has no addtional third party coverage that s relevant to the sernce s balled an this claim You further attest that all Other Inuranos mbormation entened on thes cdam is true amd accurate when present and that every Explanation of Benefts EOB recenved from the other insurance carrier s ia kept on File Hedicare Information Claemes for Muring Facility Medicare Skilled stays must be billed separately fram other claims When kling a Medicare Skilled stay an amount must be entered in andy one of the helds below For clients with traditional Medicare enter the fotal Hsu amount doe per the Medicare Remittance Advice in the Medicare Part A Total Amount field For clients with non traditional Medicare Part C enter the total copay deductible amount due per the Medicare Fart C Explanation of Berea EOB m the Medicare Part C Total Amount fsald The amount entered Belew must equal the sum of a Medicare SloBed stay deisi lines on thet daam Medicare Part A Toral Amount based on standard rate Medicare Part c Total Arinan F By checking this box you attest bo the fact that the Medicare Part A or Part C documentation t support this claim is kept on file You Further attest that the Medicare Part 4 or Part C info

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