Appendix XVIII, STAR Kids HEART Naming Conventions

Revision 23-3; Effective May 22, 2023

This appendix outlines the screenshots Program Support Unit (PSU) staff must upload to the Texas Health and Human Services (HHS) Enterprise Administrative Report and Tracking System (HEART) case record.

PSU staff must use the HEART Naming Conventions below when uploading documents to the HEART case record. Refer to Appendix IX, STAR Kids TxMedCentral Naming Conventions, for TxMedCentral naming convention instructions.

PSU staff must add a sequence number after the naming convention when more than one of the same form or screenshot is uploaded. For example, PSU staff must name the first Form H1746-A sent or received as 1746_1, the second form sent or received as 1746_2 and the third form sent or received as 1746_3, etc.

PSU staff must upload all screenshots, forms, documents and emails marked as “Yes,” in the “Required” column in the HEART case record. PSU staff must include screenshots, forms, documents and emails marked with an “*” in the “Required” column in the HEART case record if used by PSU staff while completing the case.

Interest List Release (ILR)

Item	HEART Naming Convention	Required
TIERS Individual - Medicaid History Screenshot	TIERS ME	Yes
TIERS Individual - Managed Care Screenshot	TIERS MC	Yes
SASO Enrollment Screenshot	SASO EN	Yes
SASO Service Authorization Screenshot	SASO SA	Yes
CSIL Closure Screenshot	CSIL CLOSURE	Yes
Form 2442 (English)	2442	*
Form 2442-S (Spanish)	2442-S	*
Form 2442 Screenshot of Upload to TxMedCentral	Use TxMedCentral Naming Convention	*
Form 2602	2602	*
Form 2604 (if received through TMHP LTCOP)	LTCOP ISP	Yes
Form 2604 (if received through TxMedCentral)	Use TxMedCentral Naming Convention	Yes
Form 2606	2606	*
Form 2606-S	2606-S	*
Form H1200 (Page 1, Section A, You and Your Spouse, and Page 19, Signature Page)	1200	*
Form H1746-A (form alone or with fax confirmation page)	1746	*
Form H1746-A Fax Confirmation (if confirmation page only)	1746 CONF	*
Form H1826	H1826	*
Form H2053-B	2053B	*
Form H2065-D Generated in TMHP LTCOP (English and Spanish)	2065	*
Form H2065-D Generated Manually (English and Spanish)	Use TxMedCentral Naming Convention	*
Form H2065-D Screenshot of Upload to TxMedCentral	2065 TXMED	*
Form H2067-MC	Use TxMedCentral Naming Convention	Yes
Form H2067-MC Screenshot of Upload to TxMedCentral	2067 TXMED	Yes
Form H3676-A	Use TxMedCentral Naming Convention	Yes
Form H3676-A Upload to TxMedCentral	3676A TXMED	Yes
Form H3676-B	Use TxMedCentral Naming Convention	Yes
Emails for PSU QA Process	QA EMAIL	*
Emails to and from CCSE	CCSE EMAIL	*
Emails to and from CRU	CRU EMAIL	*
Emails to and from ERS	ERS EMAIL	*
Emails to and from IDD Unit	IDD EMAIL	*
Emails to and from ILM Unit	ILM EMAIL	*
Emails to and from MCCO	MCCO EMAIL	*
Emails to and from PSORT	PSORT EMAIL	*
MEPD Communication Tool	MEPD EMAIL	*

Note: PSU staff must upload Form 2442 or Form H2065-D in the HEART case record, as appropriate.

Money Follows the Person (MFP)

Item	HEART Naming Convention	Required
TIERS Individual - Medicaid History Screenshot	TIERS ME	Yes
TIERS Individual- Managed Care Screenshot	TIERS MC	Yes
SASO Enrollment Screenshot	SASO EN	Yes
SASO Service Authorization Screenshot	SASO SA	Yes
CSIL Closure Screenshot	CSIL CLOSURE	Yes
Form 2604 (if received through TMHP LTCOP)	LTCOP ISP	Yes
Form 2604 (if received through TxMedCentral)	Use TxMedCentral Naming Convention	Yes
Form 2606	2606	*
Form 2606-S	2606-S	*
Form H1200 (Page 1, Section A, You and Your Spouse, and Page 19, Signature Page)	1200	*
Form H1746-A (form alone or with fax confirmation page)	1746	*
Form H1746-A Fax Confirmation (if confirmation page only)	1746 CONF	*
H1826, Case Information Release	H1826	*
Form H2053-B	2053B	*
Form H2065-D Generated in TMHP LTC Online Portal (English and Spanish)	2065	Yes
Form H2065-D Generated Manually (English and Spanish)	Use TxMedCentral Naming Convention	Yes
Form H2065-D Screenshot of Upload to TxMedCentral	2065 TXMED	Yes
Form H2067-MC	Use TxMedCentral Naming Convention	Yes
Form H2067-MC Screenshot of Upload to TxMedCentral	2067 TXMED	Yes
Emails for PSU QA Process	QA EMAIL	*
Emails to and from CCSE	CCSE EMAIL	*
Emails to and from CRU	CRU EMAIL	*
Emails to and from ERS	ERS EMAIL	*
Emails to and from IDD Unit	IDD EMAIL	*
Emails to and from ILM Unit	ILM EMAIL	*
Emails to and from MCCO	MCCO EMAIL	*
Emails to and from PSORT	PSORT EMAIL	*
MEPD Communication Tool	MEPD EMAIL	*

Annual Reassessment

Item	HEART Naming Convention	Required
TIERS Individual - Medicaid History Screenshot	TIERS ME	Yes
TIERS Individual - Managed Care Screenshot	TIERS MC	Yes
Form 2604 (if received through TMHP LTCOP)	LTCOP ISP	Yes
Form 2604 (if received through TxMedCentral)	Use TxMedCentral Naming Convention	Yes
Form 2606	2606	*
Form 2606-S	2606-S	*
H1826, Case Information Release	H1826	*
Form H2065-D Generated in TMHP LTCOP (English and Spanish)	2065	Yes
Form H2065-D Generated Manually (English and Spanish)	Use TxMedCentral Naming Convention	Yes
Form H2065-D Screenshot of Upload to TxMedCentral	2065 TXMED	Yes
Form H2067-MC	Use TxMedCentral Naming Convention	*
Form H2067-MC Screenshot of Upload to TxMedCentral	2067 TXMED	*
Emails for PSU QA Process	QA EMAIL	*
Emails to and from IDD Unit	IDD EMAIL	*
Emails to and from MCCO	MCCO EMAIL	*
Emails to and from PSORT	PSORT EMAIL	*

Transition to Adult Programs (MDCP Age-Out)

Item	HEART Naming Convention	Required
TIERS Individual - Medicaid History Screenshot	TIERS ME	Yes
TIERS Individual - Managed Care Screenshot	TIERS MC	Yes
Form 2606	2606	*
Form 2606-S	2606-S	*
Form H1200 (Page 1, Section A, You and Your Spouse, and Page 19, Signature Page)	1200	*
Form H1746-A (form alone or with fax confirmation page)	1746	*
Form H1746-A Fax Confirmation (if confirmation page only)	1746 CONF	*
H1826, Case Information Release	H1826	*
Form H2053-B	2053B	*
Form H2065-D Generated in TMHP LTCOP (English and Spanish)	2065	Yes
Form H2065-D Generated Manually (English and Spanish)	Use TxMedCentral Naming Convention	Yes
Form H2065-D Screenshot of Upload to TxMedCentral	2065 TXMED	Yes
Form H2067-MC	Use TxMedCentral Naming Convention	*
Form H2067-MC Screenshot of Upload to TxMedCentral	2067 TXMED	*
Form H2116	2116	*
Emails for PSU QA Process	QA EMAIL	*
Emails to and from CCSE	CCSE EMAIL	*
Emails to and from ERS	ERS EMAIL	*
Emails to and from Higher Needs Coordinator	HN EMAIL	*
Emails to and from IDD Unit	IDD EMAIL	*
Emails to and from ILM Unit	ILM EMAIL	*
Emails to and from MCCO	MCCO EMAIL	*
Emails to and from STAR+PLUS PSU	PSU EMAIL	*
Emails to and from UR	UR EMAIL	*
MEPD Communication Tool	MEPD EMAIL	*

Denials and Terminations

Item	HEART Naming Convention	Required
TIERS Individual - Medicaid History Screenshot	TIERS ME	Yes
CSIL Closure Screenshot	CSIL CLOSURE	*
Form 2128	120 Day NTCE	*
Form 2606	2606	*
Form 2606-S	2606-S	*
Form H1746-A (form alone or with fax confirmation page)	1746	*
Form H1746-A Fax Confirmation (if confirmation page only)	1746 CONF	*
H1826, Case Information Release	H1826	*
Form H2065-D Generated in TMHP LTCOP (English and Spanish)	2065	*
Form H2065-D Generated Manually (English and Spanish)	Use TxMedCentral Naming Convention	*
Form H2065-D Screenshot of Upload to TxMedCentral	2065 TXMED	*
Form H2067-MC	Use TxMedCentral Naming Convention	*
Form H2067-MC Screenshot of Upload to TxMedCentral	2067 TXMED	*
Appendix XXVII, Fair Hearing Options for MDCP Denials – Applicants	MN DENIAL ATCH	*
Appendix XXIV, Fair Hearing and Interest List Options for MDCP Denials – Members	MN DENIAL ATCH	*
Appendix XXIX, Fair Hearing and Interest List Options for Aging Out of MDCP	ATCH D	*
Emails for PSU QA Process	QA EMAIL	*
Emails to and from CRU	CRU	*
Emails to and from ERS	ERS EMAIL	*
Emails to and from IDD Unit	IDD EMAIL	*
Emails to and from ILM Unit	ILM EMAIL	*
Emails to and from MCCO	MCCO EMAIL	*
Emails to and from PSU supervisor for 120-day exception request	EXCEPTION REQ EMAIL	*
MEPD Communication Tool	MEPD EMAIL	*

Note: PSU staff uploads Form H2067-MC or Form H2065-D in the HEART case record, as appropriate.

Fair Hearings

Item	HEART Naming Convention	Required
Form 2606	2606	*
Form 2606-S	2606-S	*
Form 4801	FH COVER LTR	Yes
Form H1746-A (form alone or with fax confirmation page)	1746	*
Form H1746-A Fax Confirmation (if confirmation page only)	1746 CONF	*
H1826	H1826	*
Form H2065-D Generated in TMHP LTCOP (English and Spanish)	2065	Yes
Form H2065-D Generated Manually (English and Spanish)	Use TxMedCentral Naming Convention	Yes
Form H2065-D Screenshot of Upload to TxMedCentral	2065 TXMED	Yes
Form H2067-MC	Use TxMedCentral Naming Convention	Yes
Form H2067-MC Screenshot of Upload to TxMedCentral	2067 TXMED	Yes
Form H4800	4800	*
Form H4800-A	4800A	*
Form H4803	4803	Yes
Form H4806	4806	*
Form H4807	4807	*
Copy of Handbook Section Referenced on Form H2065-D	SKOPH [####]	Yes
Appendix XVII, MDCP Eligibility TAC	ELIGIBILITY TAC	Yes
Appendix XXVII, Fair Hearing Options for MDCP Denials – Applicants	MN DENIAL ATCH	*
Appendix XXIV, Fair Hearing and Interest List Options for MDCP Denials – Members	MN DENIAL ATCH	*
Appendix XXIX, Fair Hearing and Interest List Options for Aging Out of MDCP (English)	ATCH D	*
Notice of Hearing Officer’s Decision	APPEAL DECISION LTR	Yes
HHSC Benefits Portal Screenshot of Hearing Officer's Decision	TIERS APPEAL DECISION	Yes
Emails to and from CRU	CRU EMAIL	*
Emails to and from ERS	ERS EMAIL	*
MEPD Communication Tool	MEPD EMAIL	*

Disenrollment

Item	HEART Naming Convention	Required
TIERS Individual - Medicaid History Screenshot	TIERS ME	Yes
TIERS Individual - Managed Care Screenshot	TIERS MC	Yes
TMHP LTCOP ISP Termination Screenshot	DISENISP	*
Form H1746-A (form alone or with fax confirmation page)	1746	*
Form H1746-A Fax Confirmation (if confirmation page only)	1746 CONF	*
Form H2067-MC	Use TxMedCentral Naming Convention	Yes
Form H2067-MC Screenshot of Upload to TxMedCentral	2067 TXMED	Yes
Medicaid Managed Care Member Disenrollment Form	DISENFORM	Yes
Emails for PSU QA Process	QA EMAIL	*
Emails to and from MCCO	MCCO EMAIL	Yes
MEPD Communication Tool	MEPD EMAIL	*