Texas Medicaid - TMHP · 2008-06-18 · Texas Medicaid Bulletin, No. 169 2 March/April 2003 Significant Program and Policy Changes Coming Soon Health and Human Services Commission

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Texas Medicaid

Looking for the latest bulletin or workshop?Visit www.eds-nhic.com and find:• When workshops will be held in your area• The latest bulletins and manuals• The latest downloadable forms

What’s New?Visit www.eds-nhic.com for new information on:• 2002 Texas Medicaid Fee Schedules• HIPAA Information (Frequently Asked Questions)• For online workshop registration, visit www.eds-nhic.com/provenrl/mcwork.htm

March/April 2003 No. 169

Bulletin Contents, No. 169

Significant Program and Policy Changes Coming Soon . . . . . . . . . . . . . . . . . . . . . . . 2

All Providers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

2002 Texas Medicaid Fee Schedule ..................................................................................... 3Darbepoetin Alfa ................................................................................................................. 3Diabetic Supplies ................................................................................................................ 3Emergency Diagnosis Codes ................................................................................................ 3HIPAA Awareness ................................................................................................................ 4HIPAA Privacy ...................................................................................................................... 5Influenza Vaccine ................................................................................................................ 5Injection Pricing Fees Update ............................................................................................... 5Procedure Reimbursement Changes ..................................................................................... 6Reimbursement Procedures for Medicaid-Covered Services to Early Childhood Intervention (ECI) Providers .................................................................................................. 6Services Provided by a Physician Assistant (PA) or Advance Practice Nurse (APN) Billed as Physician or Facility Services ........................................................................................... 6Time Limits for Claims ......................................................................................................... 6Update for all Medicaid/STAR Providers of Durable Medical Equipment and Supplies ............... 6

Ambulance Providers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

Ambulance Procedure Reimbursement Changes .................................................................... 7

Dental Providers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

Dental Procedure Reimbursement Changes ........................................................................... 7

Vision Care Providers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

Ophthalmology .................................................................................................................... 7

Excluded Providers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

Forms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10

Enrolling in the Electronic Funds Transfer Program ............................................................... 10NHIC Electronic Funds Transfer Authorization Agreement ...................................................... 11Provider Information Change Form ...................................................................................... 12

www.eds-nhic.comNational Heritage Insurance Company (NHIC) is the insurer and contract administrator for the Texas Medicaid

Program under contract with the Texas Health and Human Services Commission (HHSC)

Indicates updated information

Significant Program and Policy Changes Coming Soon

Health and Human Services Commission (HHSC), through the following National Heritage Insurance Company (NHIC) publications, will be distrib-uting a substantial number of significant program and policy changes throughout the spring of 2003. These publications encompass infor-mation on Home Health policies, Health Insurance Portability and Accountability Act (HIPAA), and 2003 Health Care Procedure Coding System (HCPCS) changes.

• Toward the end of March 2003, the “Companion Guide for HIPAA” will be sent to electronic vendors and billing services.

• Toward the end of April 2003, the HIPAA Special Bulletin will be sent to all CSHCN, Family Planning, and Medicaid providers and will include significant changes to all the Medicaid programs to conform with the federal HIPAA legislation.

• In early May 2003, the 2003 HCPCS Special Bulletin will be sent to all CSHCN, Family Planning, and Medicaid providers.

Be watching for all of these important policy publications that should arrive within an eight-week time frame.

Texas Medicaid Bulletin, No. 169 2 March/April 2003

All Providers

2002 Texas Medicaid Fee Schedule

The 2002 Texas Medicaid Fee Schedules are available on the EDS Web site at www.eds-nhic.com/feesched.htm. ■

Darbepoetin Alfa

Effective for dates of service on or after December 1, 2002, procedure code J0880, Darbe-poetin Alfa, is a covered benefit of the Medicaid program and is payable at $22.25 per unit. Procedure code J0880 is limited to 100 units per day and the following diagnosis codes:

Diabetic Supplies

Effective October 1, 2002, Medicare has adopted new processing and review guidelines for submitted diabetic supplies claims. This Medicare change instructed suppliers to dispense, but not to exceed, a three-month’s supply at a time. Medicare is currently processing and paying the three-month span, which includes future dates of service. Current Medicaid guide-lines do not allow processing for service filed with future dates of service. Claims that are received that have dates of service that occur after the NHIC receipt date will be held until the last date of service is exceeded.

Refer to: CMS-Pub. 60B, transmittal B-02-037, change request 2133 for more information. ■

Emergency Diagnosis Codes

Effective for claims in process on or after January 1, 2003, these codes are considered emergency diagnoses:

Diagnosis Codes

042 20300 20301 2387 2733

280–2859 40300 40301 40310 40311

40390 40391 40402 40403 40412

40413 40492 40493 5820–5822 5824

5829 58281 58289 585 586

7140 79001 99680 99811 V420

V451 V560 V5631 V5632 V568

V581 ■

Diagnosis Code Description

643 Excessive vomiting in pregnancy

64301 Mild hyperemesis gravidarum, delivered

64391 Vomiting of pregnancy NOS, delivered

644 Early or threatened labor

64511 Post-term pregnancy, delivered

64521 Prolong pregnancy, delivered

646 Other complications of pregnancy, not elsewhere classified

64601 Papyraceous fetus, delivered

64611 Edema in pregnancy, delivered

64612 Edema in pregnancy, delivered with P/P

64621 Renal disease NOS, delivered

64622 Renal disease NOS, delivered with P/P

64641 Neuritis, delivered

64642 Neuritis, delivered with P/P

64651 Asymptomatic bacteriuria, delivered

64652 Asymptomatic bacteriuria, delivered with P/P

64661 Genitourinary infection, delivered

64662 Genitourinary infection, delivered with P/P

64681 Pregnancy complication NEC, delivered

64682 Pregnancy complication NEC, delivered with P/P

64691 Pregnancy complication NOS, delivered

647 Infectious and parasitic conditions in the mother classifiable elsewhere, but complicating pregnancy, childbirth or the puerperium

64701 Syphilis, delivered

64702 Syphilis, delivered with P/P

64711 Gonorrhea, delivered

64712 Gonorrhea, delivered with P/P

64721 Other venereal disease, delivered

64722 Other venereal disease, delivered with P/P

64731 Tuberculosis, delivered

64732 Tuberculosis, delivered with P/P

64741 Malaria, delivered

64742 Malaria, delivered with P/P

64751 Rubella, delivered

64752 Rubella, delivered with P/P

64761 Other viral disease, delivered

64762 Other viral disease, delivered with P/P

64781 Infectious disease NEC, delivered

64782 Infectious disease NEC, delivered with P/P

64791 Infection NOS, delivered

64792 Infection NOS, delivered with P/P

64861 Cardiovascular disease NEC pregnancy, delivered

64862 Cardiovascular disease NEC, delivered with P/P

64871 Bone disorder, delivered

64872 Bone disorder, delivered with P/P


March/April 2003 3 Texas Medicaid Bulletin, No. 169

HIPAA Awareness

Congress has enacted the Health Insurance Portability and Accountability Act of 1996 (HIPAA) to reform health care insurance and simplify health care administrative processes. As a Medicaid provider, you will be required to comply with HIPAA Electronic Data Interchange (EDI) and Privacy regulations. Entities covered by HIPAA (“covered entities”) must comply with the HIPAA EDI and Privacy regulations. Covered entities include health plans (health insurers, HMOs, Blue Cross/Blue Shield, Medicare, Medicaid, ERISA), health care providers (hospitals, physicians, clinics, contracted providers who conduct certain transactions in electronic form), and health care clearinghouses.

The Texas Medicaid Program filed an extension with the Centers for Medicare and Medicaid Services (CMS) and will implement HIPAA EDI requirements by October 16, 2003. HIPAA requires covered entities exchanging covered transactions to comply with national EDI standards. You can find extensive information about “covered entities” and “covered transactions” on the CMS Web site: www.cms.gov/hipaa.

Privacy provisions must be implemented by April 14, 2003. Enhancements will be made to TDHconnect 2.0 to ensure that providers submit HIPAA-compliant transactions on and after October 16, 2003. These enhancements will require changes to the infor-mation providers input. Watch for important information on HIPAA in future bulletins, banner messages, and provider workshops. Visit the following Web sites for information and other helpful links:

64881 Abnormal glucose tolerance, delivered

64882 Abnormal glucose, delivered with P/P

64891 Other current condition, delivered

64892 Other current condition, delivered with P/P

653 Disproportion

654 Abnormality of organs and soft tissues of pelvis

655 Known or suspect fetal abnormality affecting management of mother

657 Polyhydramnios

65951 Elderly primigravida, delivered

65961 Elderly multigravida, delivered

65971 Abnormal fetal heart rate/rhythm, delivered

65981 Complicated labor NEC, delivered

65991 Complicated labor NOS, delivered

660 Obstructed labor

675 Infections of the breast and nipple associated with childbirth

67501 Infection nipple, delivered

67502 Infection nipple, delivered with P/P

67511 Breast abscess, delivered

67522 Mastitis-delivered with P/P

67581 Breast infection NEC, delivered

67582 Breast infection NEC, delivered with P/P

67591 Breast infection NOS, delivered

67592 Breast infection NOS, delivered with P/P

676 Other disorders of the breast associated with childbirth and disorders of lactation

67601 Retracted nipple, delivered

67602 Retracted nipple, delivered with P/P

67611 Cracked nipple, delivered

67612 Cracked nipple, delivered with P/P

67621 Breast engorged, delivered

67622 Breast engorged, delivered with P/P

67631 Breast disorder NEC, delivered

67632 Breast disorder NEC, delivered with P/P

67641 Lactation fail, delivered

67642 Lactation fail, delivered with P/P

67651 Suppressed lactation, delivered

67652 Suppressed lactation, delivered with P/P

67661 Galactorrhea, delivered

67662 Galactorrhea, delivered with P/P

67681 Lactation disorder NEC, delivered

67682 Lactation disorder NEC, delivered with P/P

67691 Lactation disorder NOS, delivered

67692 Lactation disorder NOS, delivered with P/P ■


Important dates to rememberPrivacy Implementation Date: April 14, 2003EDI Implementation Date: October 16, 2003

Center for Medicare and Medicaid Services

www.cms.gov/hipaa

NHIC Provider Workshops www.eds-nhic.com/provenrl/mcwork.htm

NHIC Provider Relations Training Specialists

www.eds-nhic.com/provenrl/imagemap.html

HIPAA Frequently Asked Questions (FAQs)

www.eds-nhic.com/HIPAA.htm

Approved HIPAA Implemen-tation Guides and Current Listing of Reason and Remark Codes

www.wpc-edi.com/hipaa/hipaa_40.asp

Health and Human Services Commission

www.hhsc.state.tx.us/NDIS/NDISTaskForce.html


HIPAA Privacy

Health Insurance Portability and Accountability Act (HIPAA) Privacy Regulations must be implemented by all covered entities not later than April 14, 2003. HHSC has been assessed to be a HIPAA-covered entity. Accord-ingly, effective April 14, 2003, NHIC will be operating as a HIPAA Business Associate of HHSC as defined by the federally mandated rules of the HIPAA.

The HIPAA Privacy regulations are intended to protect individually identifiable health information by:

• Restricting disclosure of protected health information

• Establishing certain administrative requirements

• Establishing requirements for business partners

• Establishing certain rights of individuals with respect to their personal health information

In accordance with HIPAA privacy regulations, the State of Texas must make a Notice of Privacy Practices (Notice) available to all Texas Medicaid households. As one of the steps in this process, the State of Texas will be mailing an Explanation of Medicaid Privacy Rights and a Privacy Notice to each enrolled Medicaid household in March 2003.

The Notice will inform Texas Medicaid clients of:

• HHSC privacy policies, client rights, and responsibil-ities under HIPAA Privacy

• Client complaint procedures should they believe their Protected Health Information (PHI) has been handled inappropriately

• The use and/or disclosure of their PHI for purposes other than treatment, payment, and health care operations will first require the written permission of the client

Be aware that the Medicaid clients you serve will have this information before the effective date of the rule, April 14, 2003. Clients will be instructed to contact the Medicaid hotline at 800-252-8263 if they feel they need more information or if they want to file a complaint based on how their PHI is being handled.

For you to prepare to respond to questions on this topic, you may want to view the DHS mail-out to clients by viewing the NHIC Web site at www.eds-nhic.com, For more information on privacy regulations, visit the Centers for Medicare and Medicaid Services (CMS) Web site at www.cms.gov/hipaa. ■

Influenza Vaccine

Effective for dates of service on or after January 1, 2003, procedure code 1-90660 is not a benefit of the Texas Medicaid Program. Additionally, procedure codes 1-90657, 1-90658, and 1-90659 are no longer diagnosis-restricted. Providers need to follow the current Advisory Committee on Immunization Practices (ACIP) guidelines relating to prevention and control of influenza.

Effective for dates of service on or after February 1, 2003, County Indigent Health Care Program providers may be reimbursed for the following influenza vaccines:

Effective for dates of service on or after March 1, 2003, the following provider type and place of service (POS) changes affect procedure codes 1-90657, 1-90658, and 1-90659 (influenza vaccine): Provider types CCP Provider; Hospital - Long Term, Limited, or Specialized Care, Private Full Care, Private, Outpatient Service/Emergency Care Only; Rehabilitation Centers; Rural Health Clinic - Hospital Based are not payable in POS 1-Office, 2-Home, and 4-Nursing Facility (SNF/ICF). Provider types: Advanced Practice Nurse, Physician (DO), Physician MD, Physician Group (DOs only), Physician Group (MDs only and multispecialties), Regis-tered Nurse/Nurse Midwife, and CCP provider are not payable in POS 5-Outpatient Hospital. ■

Injection Pricing Fees Update

Effective for dates of service on or after December 1, 2002, the following codes were approved for a fee adjustment. The maximum fee for EPO injec-tions was changed from $8.51 to $11.36. The affected procedure codes and prices are as follows:

Privacy www.aspe.cms.gov/adminispwww.hhs.gov/ocr/hipaa

Other Helpful Links www.hipaadvisory.comwww.hipaacomply.com ■

Procedure Code Description

1-90657 Influenza virus vaccine, split virus, 6 through 35 months dosage, for intramuscular or jet injection use

1-90658 Influenza virus vaccine, split virus, 3 years and above dosage, for intramuscular or jet injection use

1-90659 Influenza virus vaccine, whole virus, for intramuscular or jet injection use


NewAllowable

Q9920 Injection of EPO, per 1,000 units; at patient HCT of 20 or less

$11.36

Q9921 Injection of EPO, at patient HCT of 21 $11.36





Procedure Reimbursement Changes

Effective for dates of service on or after January 1, 2003, the following procedure codes are no longer a payable benefit of the Medicaid program:

Reimbursement Procedures for Medicaid-Covered Services to Early Childhood Intervention (ECI) Providers

In response to direction from the Texas Legislature to maximize Medicaid funds for ECI services and assure compliance with federal authorizing legislation, the ECI State Office has implemented new reimbursement procedures for ECI programs. Effective September 1, 2002, the ECI State Office identified ECI services delivered to infants and toddlers enrolled in Medicaid with the newly developed centralized database for children enrolled in ECI. The ECI State Office will reduce reimbursements it pays to ECI programs by the potential Medicaid rate identified in the database.

The ECI State Office will make those deductions regardless of the amount of Medicaid collections actually reported to the ECI State Office by ECI Programs. To assure efficiency with Medicaid reimbursement for covered services, the ECI State Office is working with HHSC to modify and streamline the claims procedures for ECI programs both in fee-for-service and managed care delivery systems.

ECI programs will be informed of any new procedures or changes to the Medicaid claims process either through banner messages or in the Texas Medicaid Bulletin. Additionally, ECI State Office and HHSC will provide educational and training opportunities for ECI programs, NHIC staff, and Medicaid managed care organizations If you have questions about the changes planned in relation to ECI services and Medicaid claims, contact Catherine Coffey, ECI State Office, 512-424-6811, [email protected]. Look for future ECI articles in upcoming bulletins. ■

Services Provided by a Physician Assistant (PA) or Advance Practice Nurse (APN) Billed as Physician or Facility Services

Effective on or after December 1, 2002, services provided by PA and/or APN being billed as physician or facility services should be indicated with the following modifiers:

The use of the modifiers will identify if a PA or APN performed the service. The current modifiers of PA and AS that are used to denote assistant at surgery should continue to be used. ■

Time Limits for Claims

For claims payment to be considered, providers must adhere to the time limits described in Section 4 of the 2003 Texas Medicaid Provider Procedures Manual. Claims received after the specified time limits are not considered for payment as the Medicaid program does not provide coverage for late claims. Unless otherwise stated in Section 4, NHIC must receive claims within 95 days from each date of service or date of discharge for inpatient hospital stays. NHIC must receive appeals within 180 days of the date of denial notification.

Refer to: The 2003 Texas Medicaid Provider Proce-dures Manual for additional instruction. ■

Update for all Medicaid/STAR Providers of Durable Medical Equipment and Supplies

The HHSC will not move forward with implementation of the durable medical equipment and supply changes, on March 1, 2003. These changes were published in the Texas Medicaid/STAR Programs 2003 DME Update. The publication was made available to providers through












Q9936 Injection of EPO, at patient HCT of 36 $11.36 ■

Procedure Codes

I-90996 9-A4440 J-A4615 J-A4635 J-A4636

J-A4637 J-A4640 I-J0630 I-J3530 I-J3570

9-V2630 J-W8042 L-W8042 J-W8044 L-W8044

J-W8046 L-W8046 J-W8048 9-Y3048 9-Y9603

9-Y9608 9-Y9609 9-Y9611 9-Y9612 9-Y9613

9-Y9614 ■


NewAllowable

Modifier Description

AN PA services for other than assistant-at-surgery

SA Nurse practitioner rendering service in collaboration with physician


individual mailouts and the NHIC website. HHSC is working to clarify the Texas Medicaid/STAR Programs 2003 DME Update and evaluating a new effective date.

Providers will receive notification of the new date in the near future. In the interim, the Texas Medicaid/STAR Programs 2003 DME Update has been removed from the NHIC website. A revised publication will be made available to providers with notification of the new effective date. Continue to monitor the NHIC website for information for updates on durable medical equipment and supplies.

We request that providers continue to serve clients under current policies, procedures, procedure codes, and pricing until notification and implementation of the new effective date is provided.

We appreciate your continued participation in serving the Texas Medicaid population. You may contact the National Heritage Insurance Company customer service department at 800-846-7470 if you have any questions. ■

Ambulance Providers

Ambulance Procedure Reimbursement Changes


Dental Providers

Dental Procedure Reimbursement Changes


The discontinuation of these dental codes is not part of the THSteps benefits and will have no affect on THSteps dental claims. These procedure codes are valid for THSteps dental claims when type of serivce (TOS) W, THSteps dental/orthodontia, is used. However, effective January 1, 2003, the use of TOS 9, Other/DME, purchase or used, will be discontinued. ■

Vision Care Providers

Ophthalmology

This article corrects section 34.4.27, Ophthalmology, on page 34-119 of the 2003 Texas Medicaid Provider Proce-dures Manual. The manual currently states, “Procedure code 1-Z9501 is not valid. When 1-Z9501 is billed, NHIC changes the procedure code to 1-92015.”

The statement, “Procedure code 1-Z9501 is not valid” is correct. However, if procedure code 1-Z9501 is billed, it is denied. NHIC does not change this procedure code to 1-92015. To properly bill for an eye refraction, use procedure code 1-92015. ■

Procedure Codes

9-A0080 9-A0090 9-A0100 9-A0110 9-A0120

9-A0130 9-A0140 9-A0160 9-A0170 9-A0180

9-A0190 9-A0200 9-A0222 9-Y5040 9-Y5041

9-Y5042 9-Y5043 9-Y5046 9-Y5048 9-Y5049

9-Y5053 9-Y5056 9-Y5057 9-Y5059 9-Y5063

9-Y5064 9-Y5065 9-Y5066 9-Y5067 9-Y5068

9-Y5070 9-Y5071 9-Y5073 9-Y5074 9-Y5076

9-Y5079 9-Y5080 9-Y5081 9-Y5082 9-Y5083

9-Y5084 9-Y5088 9-Y5089 9-Y5090 9-Y6107

9-Y6109 9-Y6112 9-Y6115 9-Y6116 9-Y6117

9-Y6120 9-Y6122 9-Y6126 ■

Procedure Codes

9-D1201 9-D1351 9-D2960 9-D5213 9-D5214

9-D5911 9-D5912 9-D5913 9-D5914 9-D5915

9-D5916 9-D5917 9-D5918 9-D5919 9-D5920

9-D5921 9-D5931 9-D5932 9-D5933 9-D5934

9-D5935 9-D5952 9-D5953 9-D5954 9-D5955

9-D5956 9-D5957 9-D5971 9-D5972 9-D5973

9-D5974 9-D5982 9-D5983 9-D5984 9-D5985

9-D5896 9-D6545


Excluded ProvidersIn compliance with the Medicare and Medicaid Patient Protection Act of 1987, HHSC identifies providers or employees of providers who have been excluded from state and federal health care programs.

Providers excluded from the Medicaid and Title XX programs must not order or prescribe services to clients after the exclusion date. Services rendered under the medical direction or under the prescribing orders of an excluded provider also will be denied. Providers who submit cost reports cannot include the salaries/wages/benefits of employees who have been excluded from Medicaid. Also, excluded employees are not permitted to provide Medicaid services to any patient/client.

Review the entire Exclusion List for Texas Medicaid at www.hhsc.state.tx.us/OIE/exclusionlist/exclusion.asp. Report Medicaid providers who engage in fraud/abuse by calling 512-424-6519 or 888-752-4888, or by writing to the following address:

Sharon E. Thompson, Director HHSC Office of Program Integrity

PO Box 13247Austin TX 78711-3247

Provider License No. Exclusion Date City State Provider Type Add Date

Butler, Reginald F 164995 10-Jun-02 N. Richland Hills TX LVN 19-Dec-02

Cortes, Lisa Fay 138346 10-Jun-02 Laredo TX LVN 19-Dec-02

Gietl, Steven 632061 18-Apr-01 Muncie IN RN 19-Dec-02

Anderson, Wanda Lee 167397 10-Jun-02 DeSoto TX LVN 14-Jan-03

Anselmo, Charles Joseph 15848 07-Jun-02 Groves TX PH 21-Jan-03

Barnhart, Patricia Alene 550995 18-Apr-02 Redding CA RN 14-Jan-03

Beatty, Nianne 577031 18-Jul-02 Austin TX RN 13-Jan-03

Byrd, Shirley B. Smith 220199 20-Jan-02 Midlothian TX RN 15-Jan-03

Carter, Edward Allen 600616 12-Mar-02 Abilene TX RN 13-Jan-03

Christopherson, Annette L 507966 24-Jun-02 Schertz TX RN 24-Jan-03

Cortez, Pamela Jean 141425 10-Sep-02 San Antonio TX LVN 22-Jan-03

Durso, Sam Martin 14100 07-Jun-02 Groves TX PH 22-Jan-03

Enos, Denny Woodrow 594499 25-Jul-02 Big Springs TX RN 22-Jan-03

Ervin, Carolyn Sue 032430 12-Jun-02 McCamey TX LVN 24-Jan-03

Eskridge, Sonya Marie 155256 20-Jun-02 Irving TX LVN 14-Jan-03

Gonzalez-Sanchez, Edulfo 09-Aug-00 Schwenksville PA MD 16-Jan-03

Hall, Cathalen 11-Oct-02 Houston TX LVN 13-Jan-03

Hampton, Mona Lee 19-Sep-02 Hughes Springs TX LVN 21-Jan-03

Hudson, Richard Clay 18380 08-May-02 Pampa TX PH 21-Jan-03

Johnston, Toni Diane 168755 10-Jun-02 Dayton TX LVN 16-Jan-03

Khaleq, Tory Renee 158077 11-Mar-02 Houston TX LVN 16-Jan-03

Klepper, Jeffery Ben 131008 10-Jun-02 Childress TX LVN 17-Jan-03

Lieberenz, Sarah Katalina 660750 10-Sep-02 Denver CO RN 24-Jan-03

Little, Donna Sue 636386 20-Jan-02 Charlestown IN RN 16-Jan-03

Lowe, Thomas Fulton E5654 17-May-02 Dallas TX MD 13-Jan-03

Morten, Daniel Joseph 23-Aug-01 Bruning NE 21-Jan-03

Pharo, Arlette Naylor H6509 20-Nov-01 Houston TX DO 14-Jan-03

Powell, Linda 167763 11-Jun-01 Springtown TX LVN 14-Jan-03


http://www.hhsc.state.tx.us/OIE/exclusionlist/exclusion.asp

Sarpong, Godfried Owusu 19-May-02 Houston TX Own 13-Jan-03

Schooler, Joe Frank JR C5453 04-Oct-02 Fort Worth TX MD 24-Jan-03

Schwarzentraub, R. Lee 8718 07-Jun-02 Dallas TX DDS 21-Jan-03

Sims, Lynn Frazier 516 07-May-02 Brookshire TX LC 23-Jan-03

Skinner, Deborah Gill 625358 25-Jul-02 Dallas TX RN 21-Jan-03

Smarsh, Thomas Peter 561308 25-Jul-02 Lexington SC RN 24-Jan-03

Smith, Terri Dianne 601815 20-Aug-02 Globe AZ RN 24-Jan-03

Spector, Bernard E6016 16-Aug-02 Seabrook TX MD 21-Jan-03

Spykerman, Leonard Eugene 11141 08-May-02 Magnolia TX PH 24-Jan-03

Stoehr, Barbara Ann 449561 18-Apr-02 Bemidji MN RN 15-Jan-03

Taylor, Connie Faye 546156 10-Oct-02 Gulfport MS RN 24-Jan-03

Teed, Elspeth Ann 598447 20-Aug-02 Uvalde TX RN 22-Jan-03

Templet, Vicky Herrington Lynn 437695 25-Jul-02 Tampa FL RN 24-Jan-03

Vuu, Lam AC00079 16-Aug-02 Houston TX AC 22-Jan-03

Williams, Tommy E. 11-Jan-01 Lytle TX OWN 22-Jan-03

Winnett, Jamie Sue 116688 18-Apr-02 Sulphur Springs TX LVN 14-Jan-03

Woodard, Linda Lu 585158 18-Jul-02 Fort Worth TX RN 13-Jan-03 ■

Provider License No. Exclusion Date City State Provider Type Add Date


Forms

Enrolling in the Electronic Funds Transfer Program

NHICATTN: Provider Enrollment

PO Box 200795Austin TX 78720-0795

FAX: 512-514-4214

Electronic Funds Transfer (EFT) is a payment method that deposits funds for claims approved for payment directly into a provider’s bank account. These funds can be credited to either checking or savings accounts, provided the bank selected accepts Automated Clearinghouse (ACH) transactions. EFT also avoids the risks associated with mailing and handling paper checks, ensuring funds are directly deposited into a specified account.

The following items are specific to EFT:

• EFT funds are available to providers when banks open on Wednesday mornings and Thursday (if a bank holiday occurs).

• Applications will be processed within five working days of receipt.

• Prenotification to the bank takes place on the cycle following the application processing.

• Ten days after prenotification, future deposits are received electronically.

• The Remittance and Status (R&S) report furnishes the details of individual credits made to the provider’s account during the weekly cycle.

• Specific deposits and associated R&S reports are cross-referenced by both provider number and R&S number.

• The availability of R&S reports is unaffected by EFT, and they continue to arrive in the same manner and time frame as currently received.

NHIC provides the following notification according to ACH guidelines:

Most receiving depository financial institutions receive credit entries on the day before the effective date, and these funds are routinely made available to their depositors as of the opening of business on the effective date. The effective date for EFT under the Texas Medicaid Program is Wednesday (or Thursday) of each week.

However, due to geographic factors, some receiving depository financial institutions do not receive their credit entries until the morning of the effective day, and the internal records of these financial institutions will not be updated. As a result, tellers, bookkeepers, or automated teller machines (ATMs) may not be aware of the deposit, and the customers’ withdrawal request may be refused. When this occurs, the customers or companies should discuss the situation with the ACH coordinator of their institution who, in turn, should work out the best way to serve their customers’ needs.

In all cases, credits received should be posted to the customers’ account on the effective date and thus be made available to cover checks or debits that are presented for payment on the effective date.

To enroll in the EFT program, the provider should complete the Electronic Funds Transfer Authorization Agreement. A voided check or deposit slip must be returned with the agreement to the NHIC address indicated on the form.


NHIC Electronic Funds Transfer Authorization Agreement

NOTE: Complete all sections below. ATTACH A VOIDED CHECK OR A PHOTOCOPY OF YOUR DEPOSIT SLIP. Enter one Provider Number per form.

Type of Authorization_______NEW _______CHANGE

I (we) hereby authorize National Heritage Insurance Company (NHIC) to present credit entries into the bank account refer-enced above and the depository named above to credit the same to such account. I (we) understand that I (we) am (are) responsible for the validity of the information on this form. If the company erroneously deposits funds into my (our) account, I (we) authorize the company to initiate the necessary debit entries, not to exceed the total of the original amount credited for the current pay period.

I (we) agree to comply with all certification requirements of the applicable program regulations, rules, handbooks, bulletins, standards, and guidelines published by the Texas Health and Human Services Commission (HHSC) or its health insuring contractor. I (we) understand that payment of claims will be from federal and state funds, and that any falsification or concealment of a material fact may be prosecuted under federal and state laws.

I (we) will continue to maintain the confidentiality of records and other information relating to clients in accordance with applicable state and federal laws, rules, and regulations.

Return this form to:


PO Box 200795Austin TX 78720-0795

FAX: 512-514-4214

Provider Name Medicaid Nine-Character Texas Provider Identifier (TPI)

Provider Accounting Address Provider Phone No.

Bank Name ABA/Transit No.

Bank Phone No. Account No.

Bank Address Type Account (check one)

Checking ______Savings ______

Provider Signature ________________________________ Date ___________________________________________

Title ____________________________________________ Internet ID (if applicable) __________________________

________________________________________________ ________________________________________________

Contact Name ___________________________________ Contact Phone No. _______________________________

Print Provider Name_______________________________

Input By ______________________________________________ Date_________________________________


Provider Information Change Form

To update your provider files, complete this form and mail or fax it to the appropriate entity. PLEASE PRINT OR TYPE THE INFORMATION SUBMITTED ON THIS FORM.

Date: __________________ Nine-Character Texas Provider Identifier (TPI):_______________________________

If you have more than one TPI that will also use this same information, list the other TPIs:______________________________

__________________________________________________________________________________________________________

Physical Address Accounting/Mailing Address Secondary Address (Cannot be a PO Box) (W-9 Form Required) (Plan Use Only)

______________________________ ______________________________ _________________________

______________________________ ______________________________ _________________________

______________________________ ______________________________ _________________________

______________________________ ______________________________ _________________________Telephone Telephone Telephone

______________________________ ______________________________ _________________________Fax Fax Fax

Type of Change: (please check the appropriate box below)

��Change of Physical Address, telephone and/or fax number

��Change of Billing/Mailing Address, telephone and/or fax number

��Change/Add Secondary Address, telephone and/or fax number

��Change of Provider Status (i.e., termination from plan, moved out of area, specialist, etc.), Please Explain Below:

��Other (i.e., panel closing, capacity changes, age acceptance, etc.)

Explanation Required: _______________________________________________________________________________

_______________________________________________________________________________

Tax Information: IRS ID Number (attach W-9)______________________________ Effective Date ______________________

List the exact name reported to the IRS for the above Tax ID number: ___________________________________________

Must be signed and dated or changes cannot be completed:

Provider Signature: ________________________________________ Date: ___________________________

E-mail Address: _________________________________________

Send your completed change form to:


PO Box 200795Austin TX 78720-0795

FAX: 512-514-4214

If Managed Care, please send this form via mail or fax to NHIC c/o your respective plan.

Name_________________________________________ TPI___________________


Notes:


Notes:


Notes:


ATTENTION: BUSINESS OFFICE

PRESORTED STANDARDUS POSTAGE PAID

AUSTIN TXPERMIT NO 156

Click the following links at www.eds-nhic.com for important information:

• Medicaid Workshop Schedules and FAQs

• TDH-NHIC 2002 - 2003 Publications—includes the Texas Medicaid Provider Procedures Manual, Texas Medicaid Provider Procedures Manual - Texas Health Steps, and Texas Medicaid Bulletins

• Regional Support—lists NHIC Training Specialists

Be watching for the important policy and program change publications (as listed on page 3) that will be coming your way soon.

NHICan EDS companyNational Heritage Insurance Co.12545 Riata Vista CircleAustin TX 78727-6524

Documents

Texas Medicaid - TMHP · 2008-06-18 · Texas Medicaid Bulletin, No. 169 2 March/April 2003 Significant Program and Policy Changes Coming Soon Health and Human Services Commission