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)

ItemHEART Naming ConventionRequired
TIERS Individual - Medicaid History ScreenshotTIERS MEYes
TIERS Individual - Managed Care ScreenshotTIERS MCYes
SASO Enrollment ScreenshotSASO ENYes
SASO Service Authorization ScreenshotSASO SAYes
CSIL Closure ScreenshotCSIL CLOSUREYes
Form 2442 (English)2442*
Form 2442-S (Spanish)2442-S*
Form 2442 Screenshot of Upload to TxMedCentralUse TxMedCentral Naming Convention*
Form 26022602*
Form 2604 (if received through TMHP LTCOP)LTCOP ISPYes
Form 2604 (if received through TxMedCentral)Use TxMedCentral Naming ConventionYes
Form 26062606*
Form 2606-S2606-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 H1826H1826*
Form H2053-B2053B*
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 TxMedCentral2065 TXMED*
Form H2067-MCUse TxMedCentral Naming ConventionYes
Form H2067-MC Screenshot of Upload to TxMedCentral2067 TXMEDYes
Form H3676-AUse TxMedCentral Naming ConventionYes
Form H3676-A Upload to TxMedCentral3676A TXMEDYes
Form H3676-BUse TxMedCentral Naming ConventionYes
Emails for PSU QA ProcessQA EMAIL*
Emails to and from CCSECCSE EMAIL*
Emails to and from CRUCRU EMAIL*
Emails to and from ERSERS EMAIL*
Emails to and from IDD UnitIDD EMAIL*
Emails to and from ILM UnitILM EMAIL*
Emails to and from MCCOMCCO EMAIL*
Emails to and from PSORTPSORT EMAIL*
MEPD Communication ToolMEPD EMAIL*

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

Money Follows the Person (MFP)

ItemHEART Naming ConventionRequired
TIERS Individual - Medicaid History ScreenshotTIERS MEYes
TIERS Individual- Managed Care ScreenshotTIERS MCYes
SASO Enrollment ScreenshotSASO ENYes
SASO Service Authorization ScreenshotSASO SAYes
CSIL Closure ScreenshotCSIL CLOSUREYes
Form 2604 (if received through TMHP LTCOP)LTCOP ISPYes
Form 2604 (if received through TxMedCentral)Use TxMedCentral Naming ConventionYes
Form 26062606*
Form 2606-S2606-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 ReleaseH1826*
Form H2053-B2053B*
Form H2065-D Generated in TMHP LTC Online Portal (English and Spanish)2065Yes
Form H2065-D Generated Manually (English and Spanish)Use TxMedCentral Naming ConventionYes
Form H2065-D Screenshot of Upload to TxMedCentral2065 TXMEDYes
Form H2067-MCUse TxMedCentral Naming ConventionYes
Form H2067-MC Screenshot of Upload to TxMedCentral2067 TXMEDYes
Emails for PSU QA ProcessQA EMAIL*
Emails to and from CCSECCSE EMAIL*
Emails to and from CRUCRU EMAIL*
Emails to and from ERSERS EMAIL*
Emails to and from IDD UnitIDD EMAIL*
Emails to and from ILM UnitILM EMAIL*
Emails to and from MCCOMCCO EMAIL*
Emails to and from PSORTPSORT EMAIL*
MEPD Communication ToolMEPD EMAIL*

Annual Reassessment

ItemHEART Naming ConventionRequired
TIERS Individual - Medicaid History ScreenshotTIERS MEYes
TIERS Individual - Managed Care ScreenshotTIERS MCYes
Form 2604 (if received through TMHP LTCOP)LTCOP ISPYes
Form 2604 (if received through TxMedCentral)Use TxMedCentral Naming ConventionYes
Form 26062606*
Form 2606-S2606-S*
H1826, Case Information ReleaseH1826*
Form H2065-D Generated in TMHP LTCOP (English and Spanish)2065Yes
Form H2065-D Generated Manually (English and Spanish)Use TxMedCentral Naming ConventionYes
Form H2065-D Screenshot of Upload to TxMedCentral2065 TXMEDYes
Form H2067-MCUse TxMedCentral Naming Convention*
Form H2067-MC Screenshot of Upload to TxMedCentral2067 TXMED*
Emails for PSU QA ProcessQA EMAIL*
Emails to and from IDD UnitIDD EMAIL*
Emails to and from MCCOMCCO EMAIL*
Emails to and from PSORTPSORT EMAIL*

Transition to Adult Programs (MDCP Age-Out)

ItemHEART Naming ConventionRequired
TIERS Individual - Medicaid History ScreenshotTIERS MEYes
TIERS Individual - Managed Care ScreenshotTIERS MCYes
Form 26062606*
Form 2606-S2606-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 ReleaseH1826*
Form H2053-B2053B*
Form H2065-D Generated in TMHP LTCOP (English and Spanish)2065Yes
Form H2065-D Generated Manually (English and Spanish)Use TxMedCentral Naming ConventionYes
Form H2065-D Screenshot of Upload to TxMedCentral2065 TXMEDYes
Form H2067-MCUse TxMedCentral Naming Convention*
Form H2067-MC Screenshot of Upload to TxMedCentral2067 TXMED*
Form H21162116*
Emails for PSU QA ProcessQA EMAIL*
Emails to and from CCSECCSE EMAIL*
Emails to and from ERSERS EMAIL*
Emails to and from Higher Needs CoordinatorHN EMAIL*
Emails to and from IDD UnitIDD EMAIL*
Emails to and from ILM UnitILM EMAIL*
Emails to and from MCCOMCCO EMAIL*
Emails to and from STAR+PLUS PSUPSU EMAIL*
Emails to and from URUR EMAIL*
MEPD Communication ToolMEPD EMAIL*

Denials and Terminations

ItemHEART Naming ConventionRequired
TIERS Individual - Medicaid History ScreenshotTIERS MEYes
CSIL Closure ScreenshotCSIL CLOSURE*
Form 2128120 Day NTCE*
Form 26062606*
Form 2606-S2606-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 ReleaseH1826*
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 TxMedCentral2065 TXMED*
Form H2067-MCUse TxMedCentral Naming Convention*
Form H2067-MC Screenshot of Upload to TxMedCentral2067 TXMED*
Appendix XXVII, Fair Hearing Options for MDCP Denials – ApplicantsMN DENIAL ATCH*
Appendix XXIV, Fair Hearing and Interest List Options for MDCP Denials – MembersMN DENIAL ATCH*
Appendix XXIX, Fair Hearing and Interest List Options for Aging Out of MDCP ATCH D*
Emails for PSU QA ProcessQA EMAIL*
Emails to and from CRUCRU*
Emails to and from ERSERS EMAIL*
Emails to and from IDD UnitIDD EMAIL*
Emails to and from ILM UnitILM EMAIL*
Emails to and from MCCOMCCO EMAIL*
Emails to and from PSU supervisor for 120-day exception requestEXCEPTION REQ EMAIL*
MEPD Communication ToolMEPD EMAIL*

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

Fair Hearings

ItemHEART Naming ConventionRequired
Form 26062606*
Form 2606-S2606-S*
Form 4801FH COVER LTRYes
Form H1746-A (form alone or with fax confirmation page)1746*
Form H1746-A Fax Confirmation (if confirmation page only)1746 CONF*
H1826H1826*
Form H2065-D Generated in TMHP LTCOP (English and Spanish)2065Yes
Form H2065-D Generated Manually (English and Spanish)Use TxMedCentral Naming ConventionYes
Form H2065-D Screenshot of Upload to TxMedCentral2065 TXMEDYes
Form H2067-MCUse TxMedCentral Naming ConventionYes
Form H2067-MC Screenshot of Upload to TxMedCentral2067 TXMEDYes
Form H48004800*
Form H4800-A4800A*
Form H48034803Yes
Form H48064806*
Form H48074807*
Copy of Handbook Section Referenced on Form H2065-DSKOPH [####]Yes
Appendix XVII, MDCP Eligibility TACELIGIBILITY TACYes
Appendix XXVII, Fair Hearing Options for MDCP Denials – Applicants MN DENIAL ATCH*
Appendix XXIV, Fair Hearing and Interest List Options for MDCP Denials – MembersMN DENIAL ATCH*
Appendix XXIX, Fair Hearing and Interest List Options for Aging Out of MDCP (English)ATCH D*
Notice of Hearing Officer’s DecisionAPPEAL DECISION LTRYes
HHSC Benefits Portal Screenshot of Hearing Officer's DecisionTIERS APPEAL DECISIONYes
Emails to and from CRUCRU EMAIL*
Emails to and from ERSERS EMAIL*
MEPD Communication ToolMEPD EMAIL*

Disenrollment

ItemHEART Naming ConventionRequired
TIERS Individual - Medicaid History ScreenshotTIERS MEYes
TIERS Individual - Managed Care ScreenshotTIERS MCYes
TMHP LTCOP ISP Termination ScreenshotDISENISP*
Form H1746-A (form alone or with fax confirmation page)1746*
Form H1746-A Fax Confirmation (if confirmation page only)1746 CONF*
Form H2067-MCUse TxMedCentral Naming ConventionYes
Form H2067-MC Screenshot of Upload to TxMedCentral2067 TXMEDYes
Medicaid Managed Care Member Disenrollment FormDISENFORMYes
Emails for PSU QA ProcessQA EMAIL*
Emails to and from MCCOMCCO EMAILYes
MEPD Communication ToolMEPD EMAIL*