Appendix XXXI, HEART Case Record Assignment Procedures

5-2025

The Texas Health and Human Services (HHS) Enterprise Administrative Report and Tracking System (HEART) is an online database used by Program Support Unit (PSU) staff. HEART is a repository of current and historic case records for STAR+PLUS Home and Community Based Services (HCBS) program and Medically Dependent Children Program (MDCP) individuals, applicants, and members where PSU staff document case management processes.

Designated PSU staff create, update, and assign case records in HEART daily from the following sources, if a case action is required:

  • Texas Medicaid & Healthcare Partnership (TMHP) Long Term Care Online Portal (LTCOP);
  • MCOHub;
  • reports;
  • emails;
  • regular mail;
  • faxes;
  • phone calls; or
  • other reliable sources.

Managed care organizations (MCOs) submit documents to the PSU by the TMHP LTCOP and the MCOHub. Designated PSU staff must retrieve and upload these documents to the Manage Documents tab of the HEART case record within one business day of submission by the MCO.

Examples:

  • An MCO submits an individual service plan (ISP) to the TMHP LTCOP on Wednesday, June 12, 2024. PSU staff must upload the ISP to the Manage Documents tab of the HEART case record on Thursday, June 13, 2024.
  • An MCO posts Form H2067-MC, Managed Care Programs Communication, to the MCOHub on Friday, June 21, 2024. PSU staff must upload the form to the Manage Documents tab of the HEART case record on Monday, June 24, 2024.
  • An MCO posts Form H3676, Managed Care Pre-Enrollment Assessment Authorization, Section B, to the MCOHub on Monday, Nov. 11, 2024. Texas HHS offices are closed for the Veteran’s Day federal holiday on Monday, Nov. 11, 2024.  PSU staff must upload the form to the Manage Documents tab of the HEART case record on Tuesday, Nov. 12, 2024.

Designated PSU staff must date stamp, upload, and document the HEART case record of information or data received from one the following sources, by one business day from receipt of:

  • emails;
  • regular mail;
  • faxes;
  • phone calls; and
  • other reliable sources.

Examples:

  • PSU staff receive an email from a Medicaid for the Elderly and People with Disabilities (MEPD) specialist on Monday, July 15, 2024. PSU staff must upload a copy of the email to the Manage Documents tab of the HEART case record by Tuesday, July 16, 2024.
  • PSU staff receive a request to appeal a medical necessity (MN) denial by voicemail, on Saturday, June 29, 2024. PSU staff must document the request in the Narrative Data Entry field of the HEART case record on Monday, July 1, 2024.
  • PSU staff receive an email from an MCO on Monday, Sept. 2, 2024. PSU offices are closed for the Labor Day federal holiday on Monday, Sept. 2, 2024. The designated PSU staff must upload a copy of the email to the Manage Documents tab of the HEART case record on Tuesday, Sept. 3, 2024.

Reports

Reports unrelated to interest list releases (ILRs) are received with an established due date. Designated PSU staff must ensure HEART case records for these reports are created, if case action is required, to allow processing by the established due date.

Searching for a HEART Case record

Designated PSU staff must search HEART to determine if a document should be uploaded to a current case record or if a new case record needs to be created. Designated PSU staff must select the Assignment tab on HEART’s Home Page and chose Search Assignment to search for a case record using one or more of the following options:

  • Tracking Number – field for the unique identifier assigned to each case record when it is first created.
  • Staff Assigned To – a drop down alphabetical list of all staff who have ever received a HEART assignment.
  • Client First Name – field for the individual, applicant or member’s first name.
  • Client Last Name – field for the individual, applicant or member’s last name.
  • Status – a drop down list providing case statuses.
  • Program Type – a drop down list providing all Texas Health and Human Services Commission (HHSC) programs utilizing HEART.
  • PCN – field for the individual, applicant, or member’s Medicaid identification (ID) number, Social Security Number (SSN) or Interest List ID number.
  • Waiver Type – a drop down list providing a list of Medicaid waiver Programs.
  • Issue Type – a drop down list of HEART case record issue types.
  • Urgent – a drop down list noting the urgency of the HEART case record.

Note: Designated PSU staff must exhaust all possible search options before creating a new HEART case record.

Creating a New Case Record

PSU staff must complete the following required fields when creating a new case record in HEART:

  • Date Request Entered – field automatically populates with the date the HEART case record is created.
  • Action Type – Inquiry must be selected from a drop-down list for all PSU case actions, unless otherwise directed.
  • Received By – field automatically populates with the name of the person creating the case record.
  • How Received – field to select how the request was received from a drop-down list.
  • Client First Name – field to enter the individual, applicant or member’s first name.
  • Client Last Name – field to enter the individual, applicant or member’s last name.
  • PCN – field to enter the individual, applicant or member’s Medicaid ID number, SSN, or Interest list ID number.
    • The Interest List ID should only be entered if the SSN and Medicaid ID numbers are unavailable.
    • The SSN should only be entered if the Medicaid ID number is unavailable.
    • PSU staff should change this field from the Interest List ID or SSN to the Medicaid ID once it is obtained.
  • Staff Assigned To – field to select the PSU staff who will complete the case action from a drop-down list.
  • Assignee First Name – field automatically populates with the first name of Staff Assigned To.
    • Email of Assignee – field automatically populates with email address of Staff Assigned To.
    • The Email Assignee box will automatically be checked whenever a new HEART case record is created.
  • Assigned staff will receive an email alert after the HEART case record is saved.
  • Date/Time Assigned - field automatically populates with the date and time the HEART assignment is created.
  • Status – field to select the case status from a drop-down list.
  • Due Date – field automatically populates to five business days after the HEART assignment was created.
    • The due date will default to two business days after the HEART assignment was created if the Urgent box is checked.

Designated PSU staff must refer to regional office procedures and the STAR Kids Program Support Unit Operational Procedures Handbook (SKOPH) or the STAR+PLUS Program Support Unit Operational Procedures Handbook (SPOPH) for requirements on additional fields to be completed and assignment due dates when creating new HEART case records.

Designated PSU staff must save a new HEART case record once all required fields are completed. A new case will be assigned a Tracking Number once it has been saved.

Uploading Documents

Designed PSU must label each document uploaded to HEART with a naming convention. The naming convention should be entered and saved in the Narrative Data Entry and Document Name fields of the HEART case record every time a new document is uploaded.

Designated PSU staff must refer to Appendix XVIII, STAR Kids HEART Naming Conventions, or Appendix XXXIII, STAR+PLUS HEART Naming Conventions, for the correct HEART naming convention to use when labeling documents uploaded to the HEART case record.

Designated PSU staff must also refer to regional office procedures and the SKOPH or SPOPH for requirements on assignment due dates when uploading documents to current HEART case records.

Designed PSU staff must complete the following required fields when uploading documents to the Manage Documents tab in the HEART case record:

  • Document Type – field to select the appropriate document type from a drop-down list.
  • Document Name – field to enter the document’s naming convention as noted above.
  • Access Level – None should be selected from a drop-down list for all PSU case actions.
  • Document Path – field for PSU staff to select a document to upload to the case record.
  • Upload – field for PSU staff to select to ensure the document is uploaded to the HEART case record.

Note: The Email Assignee box on the Edit Assignment tab must be checked and the HEART case record saved whenever a new document is uploaded to a current case. Assigned PSU staff will receive an email alert when a new document has been uploaded to the current case record.

Interest List Assignments

Interest List Management (ILM) unit staff create an ILR case record in HEART following an individual’s release from an interest list (IL).

Designated STAR+PLUS HCBS PSU staff must reassign the HEART case record to regional PSU staff within three business days of notification from:

  • ILM Enrollment Broker (EB) 2906 Report, STAR+PLUS HCBS Interest IL: Potentially Eligible for Upgrade;
  • ILM EB 2907 Report, STAR+PLUS HCBS IL: Interested and Packet Received;
  • PSU EB assignment email; or
  • HEART assignment alert.

Designated STAR Kids PSU staff must reassign the HEART case record to regional PSU staff within ten business days of notification from:

  • Medically Dependent Children Program (MDCP) ILR Report; or
  • HEART assignment alert.

Designated STAR+PLUS HCBS program and MDCP PSU staff must create a HEART case record for an unassigned ILR request within three business days of notification.

Relationship Case Record

HEART allows users to create a relationship between case records if more information needs to be added or is related to a current or closed case. PSU staff can create multiple relationships between case records. PSU staff must complete the following activities to create a relationship between cases:

  • follow the steps outlined above on how to create a new HEART case record;
  • find the Tracking Number of the existing or closed case record and copy this number;
  • select the Relationships tab in the newly created HEART case record;
  • paste the copied Tracking Number in the Associated Assignment field of the Relationships tab;
  • choose the option of refer or transfer in the Relationship field;
  • enter a summary of why the relationship assignment is needed in the Brief Summary field; and
  • ensure Save Relation has been selected to complete the relationship.

HEART Case Record Closure

PSU staff must document the HEART case record if the case is closed later than time frames noted throughout the SKOPH or SPOPH. Example of instances which require more documentation include but are not limited to:

  • confirmation that regional PSU staff mailed Form 2442, Notification of Interest List Release Closure, to an individual;
  • confirmation that regional PSU staff mailed Form H2065-D, Notification of Managed Care Program Services, to an applicant or member;
  • confirmation the Community Services Interest List (CSIL) database case record was closed with the proper closure reason;
  • notice Enrollment Resolution Services (ERS) has completed MCO enrollment for initial certification; and
  • verification an MEPD specialist terminated Medicaid financial eligibility .

Appears In

  • STAR Kids Program Support Unit Operational Procedures Handbook
  • STAR+PLUS Program Support Unit Operational Procedures Handbook