Volume XXXI, Number 2
February 2016

Upcoming Enhancements to the LTC Claims Management System

Texas Medicaid & Healthcare Partnership (TMHP) is planning significant enhancements to the Long Term Care (LTC) Claims Management System on April 29, 2016. These enhancements are designed to more closely align the TMHP claim systems with those of the managed care organizations (MCOs), and therefore potentially reduce the amount of claim denials and rejections.

If a third party vendor is used for claims submission, it is the responsibility of the provider to notify those vendors about the upcoming changes to the Claims Management System so that software updates can be made if needed.

When these enhancements are implemented, the following changes will be reflected in the claim submission process:

  • A validation will be added to ensure that an International Classification of Diseases, Ninth Revision, (ICD-9) External Cause of Injury code or ICD-10 External Cause of Morbidity code is submitted in the third diagnosis field in both TexMedConnect and the TMHP Electronic Data Interchange (EDI).
  • A modification will be made to the Other Insurance (OI) submission validations in TexMedConnect and EDI to allow entry of the Employer Name or Group Number, but not both.
  • Based on the value contained in the provider file (Billing NPI [National Provider Identifier]), the Tax ID will auto populate in TexMedConnect.
  • A heading for Tax ID will be added in TexMedConnect.
  • A validation of the Attending Provider NPI field will be added in both TexMedConnect and EDI.
  • Additional edits will be added to reject or deny claims submitted with dates of service

(DOS) spanning both fee-for-service and managed care segments. Providers must submit separate claims for fee-for-service DOS and managed care DOS.

TMHP will continue to update providers about these enhancements through articles on the TMHP website at www.tmhp.com.

For more information, call the LTC Help Desk at 1-800-626-4117, Option 1.

“COMMITMENT TO CARE” – THCA 2016 Spring Conference & Resource Fair

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 Legislative Update

Notice: Before you e-mail your legislator, make sure you have the latest address.  As of February 1, House and Senate e-mail addresses have been updated from @house.state.tx.us and @senate.state.tx.us to @house.texas.gov and @senate.texas.gov

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 Commitment to Care

If you have any questions about the THCA Commitment to Care Initiative or would like to share your facilities successes please contact Gloria Bean-Williams by email or call (512) 458-1257.

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State / THCA News

  • Upcoming Enhancements to the LTC Claims Management System

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Announcements & Recognition

 Visit, Like and Follow THCA….

Are you familiar with THCA’s Website, Facebook Page & Twitter Account? We utilize these portals to provide information & tools for long term care providers / caregivers, family members, LTC advocates, and to share the wonderful events, celebrations, etc. that take place in Texas Nursing, Rehabilitation & Assisted Living facilities!

Visit our Website, “Like” our Facebook page and “Follow” us on Twitter! And please encourage your staff to as well!

THCA Web Site 

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THCAPAC

?’s About THCAPAC…Contact Us

Ron Payne,
THCAPAC Co-Chair

Mark McKenzie,
THCAPAC Co-Chair

Gina Muniz,
THCAPAC Liaison

Scot Kibbe,
THCAPAC Liaison

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Business Member / Vendor / Exhibitor News

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Region News

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Education

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Calendar