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The following Texas Medicaid and Healthcare Partnership providers will submit claims and forms beginning May 2, 2022:
- Texas Home Living
- Home and Community-based Services
- Local Intellectual and Development Disability Authorities
- Financial management services agencies billing on behalf of Consumer Directed Services employers
Providers, LIDDAs, and FMSAs billing on behalf of CDS employers that will submit claims can submit professional and dental claims using:
- TexMedConnect or X12 837 Professional
- X12 837 Dental claims using Electronic Data Interchange.
Note: Submit claims with dates of service on or after May 1, 2022, using one of the TMHP claim submission systems.
Providers, LIDDAs, and FMSAs submitting claims using TexMedConnect will:
- Select Dental as the claim type for dental procedures
- Professional as the claim type for all other services. Providers:
- Can refer to the Filing A Claim section of the Long-Term Care (LTC) User Guide for TexMedConnect.
- Watch the HCS and TxHmL Claims Submission webinar recording on the TMHP Learning Management System.
- Can refer to the TMHP Account Setup for HCS and TxHmL Waiver Programs Quick Reference Guide for account creation instructions if they still need to set up a TexMedConnect account.
Submit claims that use EDI for dental procedures with 837D dental claims. Submit all other claims with 837P professional claims. Providers can refer to the Long-Term Care 837 Companion Guides under the Companion Guides header of the TMHP EDI web page for more information about 837P and 837D claims.
Providers, LIDDAs, and FMSAs that will use EDI to submit claims must still set up an EDI account. Begin by completing and submitting the EDI Agreement for each provider contract number.
Note: It can take up to 30 days to complete the EDI account setup process. Providers that submit HCS and TxHmL claims using EDI should begin setting up their EDI accounts as soon as possible.
Providers should follow the steps in the Get Started section on the left-hand side of the TMHP EDI web page if they have done both of the following:
Submitted their EDI Agreement.
Are using a third-party claims vendor not on the Approved Vendor List.
Providers can refer to HCS and TxHmL Waiver Programs Frequently Asked Questions (FAQ) or contact the TMHP EDI Help Desk at 888-863-3638 Option 4 for more information.