Highlights

� LTC Provider Preparation for ICD-10 Implementation—Find the latest information on page 2.

� Final Steps to Complete the PASRR Process—For the latest news about completing the PASRR process see page 4.

No. 52

What’s New 2

LTC Provider Preparation for ICD-10 Implementation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2Comptroller Texas Identification Number (TIN) Conversion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

In This Corner 3

Long Term Care Home Page on TMHP .com . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

Updates 4

Final Steps to Complete the PASRR Process . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4DADS Access and Intake Provider Updates . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4LTC Online Portal PASRR Negative Letter . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

Reminders 5

Preadmission Screening and Resident Review (PASRR) Training Webinars Available . . . . . . . . . . . . . . . . . 6Reminder for Resource Utilization Group (RUG) Training Requirements . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6Computer-Based Training (CBT) on the Texas Medicaid & Healthcare Partnership (TMHP) Learning Management System (LMS) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7Learning on Demand: NEW LTC Interactive CBT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7Spring 2014 LTC Workshops . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

Provider Resources 10

Provider Relations Representatives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10TMHP LTC Contact Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11Electronic MDS Submissions Contact Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12DADS Contact Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12Acronyms In This Issue . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16

IN THIS EDITION

Provider Bulletin, No. 57

Feb. 2014

Use of the American Medical Association’s (AMA) copyrighted Current Procedural Terminology (CPT) is allowed in this publication with the following disclosure: “Current Procedural Terminology (CPT) is copyright 2013 American Medical Association. All rights reserved. No fee schedules, basic units, relative values, or related listings are included in CPT. The AMA assumes no liability for the data contained herein. Applicable Federal Acquisition Regula tion System/Department of Defense Regulation System (FARS/DFARS) restrictions apply to gov ernment use.”

The American Dental Association requires the following copyright notice in all publications containing Current Dental Terminology (CDT) codes: “Current Dental Terminology (including procedure codes, nomenclature, descriptors, and other data contained therein) is copyright © 2012 American Dental Association. All Rights Reserved. Applicable FARS/DFARS apply.”

February 2014 2 CPT only copyright 2013 American Medical Association. All rights reserved.

What́ s New LTC Provider Bulletin, No. 57

What’s New

LTC Provider Preparation for ICD-10 ImplementationThe International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) code set will replace ICD-9-CM codes that are used to report medical diagnoses and inpatient procedures through Health Insurance Portability and Accountability Act (HIPAA) standard transactions. The effective date for implemen-tation of the ICD-10-CM code sets is October 1, 2014. After the ICD-10-CM code implementation, Long Term Care (LTC) providers will not be able to use ICD-9-CM codes for effective dates after October 1, 2014.

The new ICD-10-CM code set affects diagnosis coding for all entities that use standard transactions that are identified in HIPAA. Health-care providers, payers, clearinghouses, and billing services must be prepared to comply with the October ICD-10-CM code set implementation. In preparation for the October 1, 2014, implementation, providers are encouraged to consider the following:

� Nursing Facility providers will need to align with the federal CMS guidelines for Minimum Data Set (MDS) submission.

� Community Services providers must be prepared to submit the Medical Necessity and Level of Care (MN/LOC) Assessment using the new ICD-10-CM diagnosis codes.

� Primary diagnosis codes will be required on the Long Term Care Medicaid Information (LTCMI) section of the MDS submitted on the LTC Online Portal.

� LTC providers will be required to submit ICD-10-CM diagnosis codes on all claims.

� Making software changes required to submit assessments or claims with ICD-10-CM code sets, or meeting with any system vendors and/or clearinghouses you may have regarding changes needed for ICD-10-CM implementation.

Providers should watch for future Department of Aging and Disability Services (DADS) Information Letters related to the October ICD-10-CM code set implementation.

Additional information is available on the CMS website at www.cms.gov/Medicare/Coding/ICD10/.

February 2014 3 CPT only copyright 2013 American Medical Association. All rights reserved.

In This Corner LTC Provider Bulletin, No. 57

Comptroller Texas Identification Number (TIN) ConversionEffective March 3, 2014, the Texas State Comptroller will convert all Texas Identification Numbers (TIN) that are based on a Social Security Number (SSN) to a new format. The current TIN which begins with a “2” followed by the individual’s SSN will be converted to a new TIN consisting of a randomly assigned number that begins with a “7.” Providers will notice the new “7” TIN on paper warrants as well as addenda records for direct deposit payments beginning on March 3, 2014.

This change will only affect individuals, state employees, and sole owners who’s TIN is based on their SSN, rather than their Employer Identification Number (EIN). Entities such as partnerships, corporations, profes-sional associations, government entities, and sole owners who have their TIN set up with their EIN will not be affected by this conversion.

The Department of Aging and Disability Services (DADS) Accounting Department will not require providers to know the new TIN when calling with payment inquiries. Similarly, the Comptroller’s online “Search State Payments Issued” application will still utilize the provider’s EIN or SSN for search execution.

In This Corner

Long Term Care Home Page on TMHP.comLong Term Care (LTC) has its own dedicated section on TMHP.com. All the content found under the Long Term Care Tab at www.tmhp.com is up-to-date information resources such as news articles, LTC Provider Bulletins, User Guides, and workshop information and registration. Additionally, there are links to the different Texas Medicaid & Healthcare Partnership (TMHP) applications such as TexMedConnect, the LTC Online Portal, the Learning Management System (LMS), and the ability to search all of TMHP.com.

To locate the Long Term Care Tab, click “providers” from the green bar at the top of www.tmhp.com and then click “Long Term Care” on the yellow bar.

The Long Term Care home page features recent news articles by category and news articles that have been posted within the last seven days. In the upper right hand corner, there are links to both the LTC Online Portal and TexMedConnect. Both of these links require a User name and password.

On the left hand navigational bar, there are links to:

� Long Term Care Program Information, including frequently asked questions;

� Department of Aging and Disability Services (DADS) Information Letters;

� Reference Material, including manuals, User guides, and other publications;

� Forms, which includes the various downloadable forms needed by Long Term Care providers;

� Provider Support Services, where providers can locate their Provider Relations Representative, find all of the telephone numbers for the Contact Center and relevant state and federal offices;

� Provider Education, which lists all of the provider education opportunities offered by TMHP, workshop registration, computer-based training modules, a link to the LMS, and written workshop materials; and

� Helpful Links for Long Term Care Providers.

Providers are encouraged to frequently visit the Long Term Care home page on TMHP.com for the latest news and information.

February 2014 4 CPT only copyright 2013 American Medical Association. All rights reserved.

Updates LTC Provider Bulletin, No. 57

Updates

Final Steps to Complete the PASRR ProcessThe first step in completing the Preadmission and Resident Review (PASRR) admission process is Nursing Facility (NF) certification of the ability to meet the individual’s needs after reviewing the recommended specialized services on the PASRR Evaluation (PE). The certification questions can be found in Section D of the PL1 Screening Form. There are 2 certification questions in Section D:

� D0100N. NF is willing and able to serve individual

� D0100O. NF Admitted the individual

Once the NF has certified their ability to meet the individual’s needs, the NF must invite the Local Authority (LA) and/or Local Mental Health Authority (LMHA) to the first comprehensive care plan meeting for the newly admitted PASRR positive individual. The LA/LMHA must be contacted by the NF and informed of the date and time of the meeting. The LA/LMHA can participate in this meeting via telephone and do not need to be physically present to participate.

The LA/LMHA must participate in the first comprehensive care plan meeting for all newly admitted PASRR positive individuals regardless of service array. The LA/LMHA specialized services should be included in the individual’s comprehensive care plan.

For additional questions regarding certification or for an invitation to comprehensive care plan meetings, please email the PASRR inbox at pasrr@dads.state.tx.us.

DADS Access and Intake Provider UpdatesIn collaboration with the expansion of Aging and Disability Resource Centers (ADRCs), the Department of Aging and Disability Services (DADS) is working to implement a toll free number to provide easy access to help for long-term services and supports. Scheduled to be available this spring, the toll free number will direct callers to the ADRC serving their area based on the caller’s ZIP code.

The ADRCs have been identified as the foundation of the “No Wrong Door” system of access to long-term services and supports under the Balancing Incentive Program. DADS released a request for proposals to establish six to nine new ADRCs to expand ADRC services statewide.

Need Help?For questions about the information in this bulletin, please call the TMHP-LTC Call Center/Help Desk at 1-800-626-4117. TMHP operates the TMHP Call Center/Help Desk and provides telephone support to LTC providers. The TMHP Call Center/Help Desk is available Monday through Friday, 7:00 a.m to 7:00 p.m., Central Time (excluding holidays).

February 2014 5 CPT only copyright 2013 American Medical Association. All rights reserved.

Reminders LTC Provider Bulletin, No. 57

LTC Online Portal PASRR Negative LetterOn February 27, 2014, the Long Term Care (LTC) Online Portal will be updated to generate Preadmission Screening and Resident Review (PASRR) Negative Letters. This letter is generated for individuals who have been found to be ineligible for PASRR specialized services when the Local Authority/Local Mental Health Authority (LA/LMHA) is completing the PASRR Evaluation (PE).

This PASRR Negative letter lists the LA/LMHA, along with their contact information, that performed the evaluation on the individual. If the individual or their legally authorized representative (LAR) has additional information to give to the LA/LMHA, or would like to request a Fair Hearing, they can contact the evaluators listed in the letter within 90 days to start the Fair Hearing process.

Additional information about Fair Hearings can be found in the Long Term Care Local Authorities Preadmission Screening and Resident Review (PASRR) Workshop User Guide or the Long Term Care Nursing Facility/Hospice Workshop User Guide.

Reminders

Preadmission Screening and Resident Review (PASRR) Training Webinars AvailableThe Department of State Health Services (DSHS) PASRR program staff and the Department of Aging and Disability Services (DADS) PASRR Unit staff have created several PASRR webinars which are available online. Local Mental Health Authorities (LMHAs) can learn more about the definition of Mental Illness by accessing the webinar at: PASRR Definition of Mental Illness per the Code of Federal Regulations (CFR). Referring Entities (REs) can learn how to complete the PASRR Level 1 (PL1) Screening Form by watching the webinar at: DSHS Adult Mental Health Division Recorded Webinar for Preadmission Screening and Resident Review (PASRR) Redesign - PL 1 Screening Form Completion.

For more information, users can access the DSHS PASRR Training home page at www.dshs.state.tx.us/mhsa/pasrr/training/.

Nursing Facility staff can access a three-part webinar series regarding PASRR changes to process and procedures affecting them by visiting the DADS PASRR training page at www.dads.state.tx.us/providers/pasrr/training/. The webinars are titled: PASRR Changes (published April 1, 2013), Completion of the PL1 Screening Form (published May 16, 2013), and PASRR Processes (published June 17, 2013). Click on one of the titles above to view the webinar of your choice.

All webinars are available at no cost. Please note these webinars are not located on the Texas Medicaid & Healthcare Partnership (TMHP) Learning Management System (LMS).

February 2014 6 CPT only copyright 2013 American Medical Association. All rights reserved.

Reminders LTC Provider Bulletin, No. 57

Reminder for Resource Utilization Group (RUG) Training RequirementsProviders are reminded that RUG training is required for registered nurses (RNs) who sign assessments as complete. RNs must successfully complete the required RUG training to be able to submit Minimum Data Set (MDS) and Medical Necessity and Level of Care (MN/LOC) assessments on the Long Term Care (LTC) Online Portal. Training is valid for two years and must be renewed by completing the online RUG training offered by Texas State University.

It can take from two to seven business days to process and report completions of RUG training from Texas State University to the Texas Medicaid & Healthcare Partnership (TMHP), depending on current volume of enrollments and completions.

To register for the RUG training, or for more information, visit:

www.txstate.edu/continuinged/CE-Online/RUG-Training.html.

Computer-Based Training (CBT) on the Texas Medicaid & Healthcare Partnership (TMHP) Learning Management System (LMS)The following LTC-specific CBTs are currently available on the TMHP LMS:

� LTC Online Portal Basics CBT. This interactive CBT provides a basic overview of the LTC Online Portal, including an overview of the features of the blue navigational bar and the yellow Form Actions bar. Demonstrations and simulations appear throughout the CBT to provide opportunities for hands-on experience.

� Long Term Care (LTC) Community Services Waiver Programs. This CBT teaches providers how to submit LTC Community Services Waiver assessments.

� TexMedConnect for Long Term Care (LTC) Providers. This CBT teaches providers how to use TexMed-Connect to verify a client’s eligibility, create claims, and find claim status.

The LTC Community Services Waiver Programs CBT has been updated to include additional information about Medicaid Team roles, the Fair Hearing process, and Resource Utilization Group (RUG). New demonstrations have been added to show how to correct an assessment, and how to find an assessment that requires provider action.

Accessing the TMHP LMSThe TMHP LMS can be accessed through the TMHP website at www.tmhp.com/Pages/Education/Ed_Reg.aspx, or directly at http://learn.tmhp.com.

Users must have a User name and Password to access CBTs in the LMS. To obtain a User name and Password, providers must create an account by clicking the Registration link at the top left-hand corner of the LMS home page. After creating an account, providers can access all available CBT materials in the LMS.

For questions about the content in the CBTs above, call the TMHP Call Center/Help Desk at 1-800-626-4117 or 1-800-727-5436. For CBT log in or access issues, email TMHP Learning Management System (LMS) support at TMHPTrainingSupport@tmhp.com.

February 2014 7 CPT only copyright 2013 American Medical Association. All rights reserved.

Reminders LTC Provider Bulletin, No. 57

Learning on Demand: NEW LTC Interactive CBT

LTC Online Portal Basics Interactive CBTLong Term Care (LTC) providers and other LTC users or staff can access the new LTC Online Portal Basics CBT via the TMHP Learning Management System (LMS). This new, interactive CBT gives LTC providers the basic tools needed to access and use the LTC Online Portal. The LTC Online Portal is used to submit forms, screenings, evaluations, and the LTCMI section of the MDS Assessment. In addition to interactive simulations and demonstrations, the CBT provides an overview of the portal features including the navigation and form actions tools.

After completing this CBT, providers should be able to:

� Follow the requirements for obtaining and using the National Provider Identifier (NPI) and the Atypical Provider Identifier (API).

� Describe the features and benefits of the LTC Online Portal.

� Understand general information for the LTC Online Portal, including required fields, unlocking forms, entering dates, History trail, error messages, and time-out.

� Create an administrator account on the LTC Online Portal.

� Login to the LTC Online Portal.

� Use the features of the blue navigational bar.

� Use the features of the yellow Form Actions bar.

To access the LTC Online Portal Basics CBT:

1. Go to http://learn.tmhp.com.

2. Login to the LMS with the ID and Password established in the previous account creation step.

3. Click the “CBT” icon.

4. Locate and click the “Long Term Care Online Portal Basics” CBT from the list (descending alphabetical order).

5. Click the “View now” button to start the CBT.

February 2014 8 CPT only copyright 2013 American Medical Association. All rights reserved.

Reminders LTC Provider Bulletin, No. 57

Spring 2014 LTC Workshops - Live!Long Term Care (LTC) workshops will be offered in the spring of 2014. Two series of LTC workshops are offered: one for Nursing Facility (NF) and Hospice providers, and one for Community Services Waiver Programs providers.

Providers are encouraged to monitor the Texas Medicaid & Healthcare Partnership (TMHP) website at www.tmhp.com for announcements of upcoming workshops this spring.

The schedule for all LTC training opportunities will be posted on the TMHP website 30 days prior to the first workshop scheduled for each session. An “LTC News” notice will be posted when dates and locations are announced for both workshop series.

Providers can check workshop schedules and register online for LTC Workshops at www.tmhp.com/Pages/Education/Ed_Reg.aspx.

Because seating and materials are limited, providers are encouraged to check seat availability and register at least ten days prior to the workshop date. Online registration helps providers select LTC workshops to avoid inadvertently traveling to an acute-care workshop.

LTC NF/Hospice Provider WorkshopThe spring 2014 LTC NF/Hospice workshop is now delivered in a live presentation format and includes information that will enable the provider to submit forms, screenings, and assessments accurately and efficiently. This course offers providers a better understanding of the functions and benefits of using the LTC Online Portal to complete and submit the Long Term Care Medicaid Information (LTCMI) associated with the Minimum Data Set (MDS). These workshops will contain IMPORTANT updates on the Preadmission Screening and Resident Review (PASRR) process. Workshop topics include:

� National Provider Identifier (NPI) requirements for form and assessment submissions.

� Basic portal functions.

� Medical Necessity (MN) process including the fair hearing process.

� LTCMI.

� Minimum Data Set (MDS) submission process.

� The PASRR process, including:

� The Medical Necessity determination on the PASRR Evaluation;

� TMDS LTCMI rejection process; and

� Understanding how and when PASRR alerts are generated, and how to respond to alerts.

� How to prepare and complete Purpose Codes, Evaluation and Management (E&M), and Department of Aging and Disability Services (DADS) Forms 3071, 3074, 3618, and 3619.

� Assessment statuses.

� Managing the provider workflow.

� Resource material and policy/procedural updates.

� Texas State University Resource Utilization Group (RUG) training requirements.

February 2014 9 CPT only copyright 2013 American Medical Association. All rights reserved.

Reminders LTC Provider Bulletin, No. 57

LTC Workshop for Community Waiver ProvidersThe Community Services Waiver Programs Workshop will be delivered in a live presentation format. This workshop provides information that will assist Community Services Waiver providers in submitting assessments accurately and efficiently. This course describes how to use the LTC Online Portal to complete and submit the Medical Necessity and Level of Care (MN/LOC) Assessment.

The spring 2014 LTC Workshop for Community Waiver providers offers information on:

� Medicaid team roles.

� National Provider Identifier (NPI)/Atypical Provider Identifier (API) requirements for form submission and billing.

� Basic portal functions.

� Identify and follow the MN process, including the fair hearing process.

� LTCMI section.

� Submitting Medical Necessity and Level of Care (MN/LOC) Assessments for state Medicaid payment.

� Identify the Texas State University RUG training requirements.

� Locate resource material and find policy and process updates.

� Identify assessment statuses.

� Manage provider workflow.

Provider Resources

February 2014 10 CPT only copyright 2013 American Medical Association. All rights reserved.

Provider Resources LTC Provider Bulletin, No. 57

Provider Relations RepresentativesWhen Long Term Care (LTC) providers need help, the Texas Medicaid & Healthcare Partnership (TMHP) is the main resource for general inquiries about claim rejections/denials and how to use automated TMHP provider systems (the LTC Online Portal and TexMed-Connect).

Providers can call TMHP at 1-800-925-9126 with questions and to request on-site visits to address particular areas of provider concern. TMHP workshops and computer-based training (CBT) for LTC Community Services Waiver Programs and Nursing Facility (NF)/Hospice providers are also offered specifically for LTC providers. For current schedules check the Provider Education Home Page on the TMHP website at www.tmhp.com/Pages/Education/Ed_Reg.aspx.

The map on this page, and the table below, indicate TMHP provider relations representatives and the areas they serve. Additional information, including a regional listing by county, is available on the TMHP website at www.tmhp.com/Pages/SupportServices/PSS_Reg_Support.aspx.

Territory Regional Area Representative

1 Amarillo, Childress, Lubbock Kendra Davila

2 Midland, Odessa, San Angelo Stacey Best

3 Alpine, El Paso, Van Horn Isaac Romero

4 San Antonio, Kerrville, Del Rio, Eagle Pass Elizabeth Tolbert

5 Brownsville, Harlingen, McAllen, Laredo Denis Sanchez

6 Corpus Christi, San Antonio, Victoria, Carrizo Springs Alan Brown

7 Austin, Waco, Bastrop, San Marcos Kim Gauquier

8 Abilene, Witchita Falls Alisa Hinton

9 Dallas, Fort Worth, Denton, Grayson, Corsicana Vanessa Whitley

10 North Dallas Tyler Carrita Mitchell

11 Houston, Bryan College Station, Palestine, Longview Linda Wood

12 Marshall, Nacogdoches, Beaumont, Galveston Gene Allred

13 Houston, Katy Stephen Hirschfelder

14 Northeast Texas Carrita Mitchell*Austin, Dallas, Houston, and San Antonio territories are shared by 2 or more provider representatives. These territories are divided by ZIP Codes. Refer to the TMHP website at www.tmhp.com for the assigned representative to contact in each ZIP Code.

February 2014 11 CPT only copyright 2013 American Medical Association. All rights reserved.

Provider Resources LTC Provider Bulletin, No. 57

TMHP LTC Contact InformationThe Texas Medicaid & Healthcare Partnership (TMHP) Call Center/Help Desk operates Monday through Friday from 7 a.m. to 7 p.m., Central Time (excluding TMHP-recognized holidays).

When calling the TMHP Call Center/Help Desk, providers are prompted to enter their 9-digit Long Term Care (LTC) provider number using the telephone keypad. When the 9-digit LTC provider number is entered on the telephone keypad, the TMHP Call Center/Help Desk system automatically populates the TMHP representative’s screen with that provider’s specific information, such as name and telephone number.

Providers should have their 4-digit Vendor/Facility or Site Identification number available for calls about Forms 3618 and 3619, Minimum Data Set (MDS), Medical Necessity and Level of Care (MN/LOC) Assessment, and Preadmission Screening and Resident Review (PASRR).

Providers must have a Medicaid or Social Security number and a medical chart or documentation for inquiries about a specific individual.

For questions, providers should call the TMHP Call Center/Help Desk at the following telephone numbers:

� Austin local telephone number at (512) 335-4729

� Toll free telephone number (outside Austin) at 1-800-626-4117 or 1-800-727-5436

For questions about... Choose... � General inquiries � Using TexMedConnect � Claim adjustments � Claim status inquiries � Claim history � Claim rejection and denials � Understanding Remittance and

Status (R&S) Reports � Forms

� Forms 3071 and 3074 � Forms 3618 and 3619 � Resource Utilization Group (RUG)

levels � Minimum Data Set (MDS) � LTC Medicaid Information (LTCMI) � Medical Necessity and Level of Care

(MN/LOC) Assessment � PASRR Level 1 Screening and

PASRR Evaluation submission and status messages

Option 1: Customer service/general inquiry

� Medical necessity Option 2: To speak with a nurse � TexMedConnect – technical issues,

account access, portal issues � Modem and telecommunication

issues � Processing provider agreements � Verifying that system screens are

functioning

� American National Standards Institute (ANSI) ASC X12 specifi-cations, testing, and transmission

� Getting Electronic Data Interchange (EDI) assistance from software developers

� EDI and connectivity � LTC Online Portal, including

technical issues, account access, portal issues

Option 3: Technical support

February 2014 12 CPT only copyright 2013 American Medical Association. All rights reserved.

Provider Resources LTC Provider Bulletin, No. 57

For questions about... Choose... � Electronic transmission of Forms

3071, 3074, 3618, and 3619 � Form Status Inquiry � Technical issues � Transmitting forms

� Interpreting Quality Indicator (QI) Reports

� Current Activity (formerly Weekly Status Report)

� MDS submission problems � MN/LOC Assessment submission

problems

Option 3: Technical support

� Individual appeals � Individual fair hearing requests

� Appeal guidelines Option 5: Request fair hearing

LTC other insurance information and updates Option 6To repeat this message Option 7

Electronic MDS Submissions Contact InformationIf you have questions about electronic Minimum Data Set (MDS) submissions, contact the QIES Technical Support Office (QTSO) at help@qtso.com or 1-888-477-7876.

DADS Contact Information

If you have questions about... Contact...12-month claims payment rule Community Services - Community Services Contract Manager

Institutional Services (NFs)—Provider Claims Services: (512) 438-2200, Option 1

IDD Services—Provider Claims Services: (512) 438-2200, Option 1Community Services contract enrollment Email: communityservicescontracts@dads.state.tx.us

Voice mail (512) 438-3550Hospice Services contract enrollment Email: communityservicescontracts@dads.state.tx.us

Voice mail (512) 438-3550ICF/IID and Nursing Facility contract enrollment (512) 438-3556Days paid and services paid information for cost reports

Use TexMedConnect to submit a batch of CSIs

Rate Analysis contacts Website: www.hhsc.state.tx.us/rad/long-term-svcs/index.shtml. Contact information is listed by program

How to prepare a cost report (forms and instructions)/approved rates posted contact

Website: www.hhsc.state.tx.us/rad/long-term-svcs/index.shtml then select appropriate program

How to sign up for, or obtain direct deposit/electronic funds transfer

Accounting: (512) 438-4310, (512) 438-5595, or (512) 438-4684

How to obtain IRS Form 1099-Miscellaneous Income

Accounting: (512) 438-3189 or (512) 438-4215

February 2014 13 CPT only copyright 2013 American Medical Association. All rights reserved.

Provider Resources LTC Provider Bulletin, No. 57

If you have questions about... Contact...Medicaid eligibility, applied income, and name changes

Medicaid for the Elderly and People With Disabilities (MEPD) worker

Integrated Eligibility and Enrollment (IEE) Call Center at telephone number 2-1-1

Website: www.hhsc.state.tx.us/Help/HealthCare/seniors.shtmlPASRR Policy Questions

• PASRR Level 1 Screening Form (PL1)• PASRR Evaluation (PE)

DADS PASRR Unit 1-855-435-7180Email: pasrr@dads.state.tx.usWebsite: www.dads.state.tx.us/providers/pasrr/index.html

DSHS PASRR Office 1-866-378-8440Email: pasrr@dshs.state.tx.usWebsite: www.dshs.state.tx.us/mhsa/pasrr/

Payment Issues – If payment has not been received after more than 10 days from the date of billing

DADS Payment Processing Hotline (512) 438-3989

Personal Needs Allowance (PNA) PNA Hotline (512) 438-2200, Option 2Service Authorization questions for Local Authorities (LA)

DADS Assigned Regional Claims Management Coordinator

Service Authorization questions for Guardianship Program

Bill McDonald (512) 438-2008

Deductions and provider-on-hold questions for Institutional Services (Nursing Facilities)

Institutional Services (NFs)—Provider Claims Services: (512) 438-2200, Option 3

Website: https://hhsportal.hhs.state.tx.us/wps/portalDeductions and provider-on-hold questions for Community Services

Community Services Contract Manager or IDD Services: (512) 438-4722

Invalid or inappropriate recoupments for nursing facilities and hospice services

Provider Claims Services: (512) 438-2200, Option 3

Status of warrant/direct deposit after a claim has been transmitted to Accounting (fiscal) by TMHP

Please Note: Allow 5-7 business days for processing of claim(s) before verifying payment information

Comptroller’s website: https://ecpa.cpa.state.tx.us Choose the State-to-Vendor-Payment Info-Online-Search link.

Accounting (512) 438-3938 When calling Accounting, provide the document locator number (DLN) assigned by TMHP

Texas State University Resource Utilization Group (RUG) training

The Office of Continuing Education:

Online course: (512) 245-7118

Website: www.txstate.edu/continuingedLong Term Care (LTC) Third Party Resources (TPR) including torts and trusts and/or annuities for which the state is the residual beneficiary

Provider Claims Services: (512) 438-2200, Option 4

Website: https://hhsportal.hhs.state.tx.us/wps/portal

Community Care for the Aged and Disabled Programs (CCAD), Community-Based Alternatives (CBA), Community Living Assistance and Support Services (CLASS), Deaf Blind with Multiple Disabilities (DBMD), Medically Dependent Children Program (MDCP), Home and Community-based Services (HCS), Texas Home Living Waiver (TxHmL), and Hospice ProgramsCLASS Program Policy

CLASS Interest Line

(512) 438-3078 or CLASS@dads.state.tx.us

1-877-438-5658CBA Program (512) 438-2578 or cba@dads.state.tx.us

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If you have questions about... Contact...HCS Program Policy (512) 438-2339 or hcs@dads.state.tx.usMDCP Program

MDCP Interest List Line

(512) 438-5645 or mdcp@dads.state.tx.us

1-877-438-5658TxHml Program Policy (512) 438-5234 or txhml@dads.state.tx.usDBMD Program Policy

DBMD Interest Line

(512) 438-2622 or dbmd@dads.state.tx.us

1-877-438-5658Waiver/CCAD financial or functional eligibility criteria

Caseworker or Case Manager. For more contact information visit: www.dads.state.tx.us/services/index.cfm

Waiver/CCAD service authorization issues Caseworker or Case Manager. For more contact information visit: www.dads.state.tx.us/services/index.cfm

Waiver/CCAD Program policies/procedures Contract Manager. For more contact information visit: www.dads.state.tx.us/services/index.cfm

Hospice policy questions (512) 438-3519 or (512) 438-4345Hospice Program service authorization issues Provider Claims Services: (512) 438-2200, Option 1

Website: https://hhsportal.hhs.state.tx.us/wps/portalHome and Community-based Services (HCS) and Texas Home Living Waiver (TxHmL) billing, policy, payment reviews, cost report repayment

Billing: Misti Hair, (512) 438-4934 misti.hair@dads.state.tx.us

Billing and Payment Hotline: (512) 438-5359 HCS.TxHmL.bpr@dads.state.tx.us

HCS, TxHmL, CLASS, or DBMD Program Enrollment/Utilization Review (PE/UR): Intellectual Disability-Related Conditions (ID/RC) Assessment Purpose Codes, Level of Need, Level of Care, and Individual Plan of Care (IPC)

HCS or TxHmL: (512) 438-5055, Fax: (512) 438-4249

CLASS or DBMD: (512) 438-4896, Fax: (512) 438-5135

Vendor Holds for HCS/TxHmL (512) 438-5652Consumer rights (consumer/family complaints concerning HCS and TxHmL waiver)

Consumer Rights and Services: 1-800-458-9858

Email: CRSComplaints@dads.state.tx.us

Website: www.dads.state.tx.us/services/crs/index.htmlInvalid or inappropriate CCAD recoupments Provider Claims Services: (512) 438-2200, Option 4

Intermediate Care Facility/Facilities for Individuals with an Intellectual Disability or Related Conditions (ICF/IID) and Nursing Facility ProgramsPayment information for cost reports (512) 438-3597Quality assurance fee (QAF) (512) 438-3597 or (512) 438-3624Health and Human Services Commission Network (HHSCN) connection problems

(512) 438-4720 or 1-888-952-4357

ICF/IID durable medical equipment (DME), DME authorizations, Home and Community-Based Services (HCS), Texas Home Living Waiver (TxHmL), home modifications, adaptive aids, and dental services approvals

Provider Claims Services: (512) 438-2200, Option 5

Email: HCSAuths@dads.state.tx.us

ICF/IID/Residential Care (RC) individual movements/service authorization questions

(512) 438-4720 or 1-888-952-4357: request HHSC Field Support staff

Client Assessment Registration (CARE) System Help Desk for ICF/IID

1-888-952-4357: request HHSC Field Support staff

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If you have questions about... Contact...Program enrollment/Utilization Review (PE/UR), Intellectual Disability-Related Conditions (ID/RC) Assessment Purpose Codes, Level of Need, Level of Care, and Individual Plan of Care (IPC)

(512) 438-5055 Fax: (512) 438-4249

Provider contracts and vendor holds for ICF/IID (512) 438-3544Provider access to ICF/IID CARE system (512) 438-3554MDS 3.0, MDS Purpose Code E, and Forms 3618 and 3619 missing/incorrect information

Provider Claims Services: (512) 438-2200, Option 1

Website: https://hhsportal.hhs.state.tx.us/wps/portalRehabilitation and specialized therapy/emergency dental/Customized Power Wheelchair (CPWC) service authorizations

Provider Claims Services: (512) 438-2200, Option 6

Fax: (512) 438-2302

Service authorizations for nursing facilities Provider Claims Services: (512) 438-2200, Option 1

Fax: (512) 438-2301

Website: https://hhsportal.hhs.state.tx.us/wps/portalInvalid or inappropriate recoupments for ICF/IIDs HHSC Help Desk: (512) 438-4720 or 1-800-214-4175Consumer Rights and Services

Surrogate Decision Making Program (SDMP) for people receiving community-based services through the ICF/IID program

Consumer Rights and Services: 1-800-458-9858

Email: CRSComplaints@dads.state.tx.us

Website: www.dads.state.tx.us/services/crs/index.html

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Acronyms In This Issue

Acronym DefinitionADRC Aging and Disability Resource CenterAMA American Medical AssociationANSI American National Standards InstituteAPI Atypical Provider Identifier CARE Client Assessment RegistrationCBA Community-Based AlternativesCBT Computer-Based TrainingCCAD Community Care for Aged and Disabled ProgramsCDT Current Dental TerminologyCFR Code of Federal RegulationsCLASS Community Living Assistance and Support ServicesCMS Centers for Medicare & Medicaid ServicesCPT Current Procedural TerminologyCPWC Customized Power WheelchairDADS Department of Aging and Disability ServicesDBMD Deaf-Blind with Multiple DisabilitiesDLN Document Locator NumberDME Durable Medical EquipmentDSHS Department of State Health ServicesE&M Evaluation and Management EDI Electronic Data InterchangeEIN Employer Identification NumberFARS/DFARS Federal Acquisition Regulations System/Department of Defense Regulation SystemHCS Home and Community-Based ServicesHHSCN Health and Human Services Commission NetworkHIPAA Health Insurance Portability and Accountability ActICD-10-CM International Classification of Diseases, Tenth Revision, Clinical ModificationICF/IID Intermediate Care Facility/Facilities for Individuals with an Intellectual Disability or

Related ConditionsID/RC Intellectual Disability/Related ConditionIEE Integrated Eligibility and EnrollmentIPC Individual Plan of CareLA Local AuthorityLAR Legally Authorized RepresentativeLMHA Local Mental Health AuthorityLMS Learning Management SystemLTC Long Term Care

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Acronym DefinitionLTCMI Long Term Care Medicaid InformationMDCP Medically Dependent Children’s ProgramMDS Minimum Data SetMEPD Medicaid for the Elderly and People with DisabilitiesMN Medical NecessityMN/LOC Medical Necessity and Level of CareNF Nursing FacilityNPI National Provider IdentifierPASRR Preadmission Screening and Resident ReviewPE PASRR EvaluationPE/UR Program Enrollment/Utilization ReviewPL1 PASRR Level 1PNA Personal Needs AllowanceQAF Quality Assurance FeeQI Quality IndicatorQTSO QIES Technical Support OfficeR&S Remittance and StatusRC Residential CareRE Referring EntitiesRN Registered NurseRUG Resource Utilization GroupTIN Texas Identifier NumberTMHP Texas Medicaid & Healthcare PartnershipTPR Third Party ResourcesTxHmL Texas Home Living Waiver