Long-Term Care (LTC) - TMHP

1 Long-Term care (LTC)User Guide for TexMedConnectv2022_0125 ContentsTerms and Abbreviations 4 Training and Support 6 TexMedConnect Training ..6 Technical Support .. 6 Claims Support .. 6 Getting Started 7 TexMedConnect Navigation Panel .. 8 MESAVs 9 Submitting a MESAV Interactively.

2 9 Creating a MESAV Group Template ..12 Submitting a MESAV Group Template ..16 Viewing a MESAV Batch History ..18 MESAV - Other Insurance (OI) Applicable to Service Groups (SGs) 1, 6, 8 .. 20 MESAV Medicare Eligibility ..21 Filing a Claim 22 Entering a Claim on TexMedConnect ..22 Entering a Professional Claim ..26 Entering a Dental Claim ..33 Entering an Institutional Claim .. 36 Entering a Nurse Aide Training (NAT) Claim .. 49 Saving a Claim 52 Draft Claims 52 Saving Draft Claims.

3 52 Viewing Draft Claims ..53 Individual Templates 55 Saving as an Individual Template ..55 Viewing Individual Templates ..55 Group Templates 57 Viewing Existing Group Templates ..57 Creating New Group Templates .. 58 Saving as a Group Template ..62 Batch Claims 62v2022_0125 2 Long-Term care (LTC) User Guide for TexMedConnectSaving To a Batch ..62 Submitting a Batch.

4 63 View Batch History .. 65 Claims Data Export 72 Claims Status Inquiry (CSI) 76 CSI Search: Lookup Fee For Service Claim by Claim Request ..77 CSI Search: Lookup Fee For Service Claim by Client Claim Request ..78 CSI Search: Lookup managed care Claim by Transaction Number ..79 CSI Search: Lookup managed care Claim by MCO ICN .. 82 Creating a CSI Group Template .. 84 Submitting a CSI Group Template ..87 Adjustments 90 Creating an Adjustment for a Fee-For-Service Claim.

5 90 Saving and Submitting an Adjustment .. 96 Remittance and Status (R&S) Reports 98 Viewing the PDF Version .. 98 Downloading the ANSI 835 Version ..100 Claims Identified for Potential Recoupment (CIPR) Reports 102v2022_0125 3 Long-Term care (LTC) User Guide for TexMedConnectTerms and AbbreviationsAbbreviationsTermsAPIA typical Provider IdentifierARDA ssessment Reference DateCBAC ommunity Based AlternativesCMSC enters for Medicare & Medicaid ServicesCSCommunity ServicesCSIC laim Status InquiryDLND ocument Locator NumberEDI Electronic Data InterchangeEOBE xplanation of BenefitsEOPSE xplanation of Pending StatusETNEDI Transaction Number FFSFee For ServiceFSIForm Status InquiryHHSH ealth and Human ServicesHIPAAH ealth Insurance Portability and Accountability ActHMOH ealth Maintenance Organization (Note.)

6 HMO has been changed to MCO)ICF/IIDI ntermediate care Facility/Facilities for Individuals with an Intellectual Disability or Related ConditionsICNI nternal Control NumberIDIntellectual DisabilitiesIDDI ntellectual and Developmental DisabilitiesLT CLong-Term CareMCOM anaged care Organization (Formerly HMO)MCO ICNM anaged care Organization Internal Control NumberMESAVM edicaid Eligibility and Service Authorization VerificationMNMedical NecessityNFNursing FacilityNPIN ational Provider IdentifierNPPESN ational Plan and Provider Enumeration SystemOESO ffice of Eligibility ServicesOIGO ffice of the Inspector GeneralPDFP ortable Document FormatR&SRemittance and StatusRUGR esource Utilization GroupSASS ervice Authorization SystemSCService CodeSCSAS ignificant Change in Status AssessmentSGService GroupSSNS ocial Security NumberSTAR+PLUSS tate of Texas Access Reform (STAR) + PLUSTAC Texas Administrative CodeTHCAT exas Health care Associationv2022_0125 4 Long-Term care (LTC)

7 User Guide for TexMedConnectAbbreviationsTermsTMBT exas Medical BoardTMHPT exas Medicaid & Healthcare Partnershipv2022_0125 5 Long-Term care (LTC) User Guide for TexMedConnectTraining and SupportTexMedConnect TrainingThe TexMedConnect for Long-Term care (LTC) 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 learning management system at learn . tmhp .com . Technical SupportYou can contact the tmhp Electronic Data Interchange (EDI) Help Desk at 888-863-3638, Option 4, Monday through Friday 7:00 a .m . to 7:00 p .m ., for Long-Term care technical issues . The tmhp EDI Help Desk provides technical assistance for TexMedConnect and the tmhp EDI Gateway.

8 Contact your system administrator for assistance with modem, hardware, or Internet connectivity issues .Claims SupportYou can contact the tmhp LTC Helpdesk at 800-626-4117, Option 1, then Option 2, for questions about claims, Monday through Friday 7:00 a .m . to 7:00 p .m .v2022_0125 6 Long-Term care (LTC) User Guide for TexMedConnectGetting StartedYou can access TexMedConnect from the Long-Term care Home 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 www . tmhp .com click the My Account button . 2) Enter your user name and password, and click the OK button.

9 As an option, you can save your login information by putting a check in the Remember my credentials box . v2022_0125 7 Long-Term care (LTC) User Guide for TexMedConnect3) The My Account page will open to display all of the website features to which you have access . Click the TexMedConnect link . TexMedConnect Navigation PanelAll of the available TexMedConnect Long-Term care functions are located under the Long-Term care branch in the left navigation panel . You can select any feature to which you have access . A user s access permissions 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.

10 V2022_0125 8 Long-Term care (LTC) User Guide for TexMedConnectMESAVsProviders can view Medicaid Eligibility and Service Authorization Verifications (MESAVs) electronically using TexMedConnect . To prevent claim denials, it is necessary to verify a person s eligibility for Medicaid services . Providers can interactively verify the eligibility for specific dates of service for a single person . The date range is restricted to three calendar months . The service authorization section of a MESAV indicates the billable or allowable services for the person . To verify eligibility for a group of people at one time, create a MESAV Group Template . Each MESAV Group Template can contain up to 250 people . You can create up to 100 Group Templates for each National Provider Identifier (NPI) number.