TMHP Telephone and Address Guide

Transcription

1 TMHP Telephone and Address Guide TMHP Telephone and Fax Communication x Primary Care Case Management (PCCM) Telephone Communication x Integrated Care Management (ICM) Communication xi Prior Authorization Request Telephone and Fax Communication xi Prior Authorization Status Telephone Communication xi Written Communication With TMHP xii Other TMHP Information xiii TMHP Center xiii Automated Inquiry System (AIS) xiii TMHP Provider Relations xiv TMHP Electronic Data Interchange (EDI) Help Desk xiv State of Texas Access Reform (STAR) Program xiv

2 TMHP Telephone and Fax Communication TMHP Center (general information) Automated Inquiry System (AIS) Telephone/Fax Number or Provider Enrollment Fax Comprehensive Care Program (CCP) (CCP prior authorization status and general CCP and Home Health Services information) Children with Special Health Care Needs (CSHCN) Services Program AIS CSHCN Services Program Fax Comprehensive Care Inpatient Psychiatric (CCIP) Unit (prior authorization and general information) Home Health Services (includes durable medical equipment [DME]): Option 1 TMHP in-home care customer service Option 2 DME supplier with completed Title XIX form Option 3 Registered nurse (RN) with completed plan of care (POC) Health Insurance Premium Payment (HIPP) Long Term Care (LTC) Operations LTC Nursing Facilities Telephone Appeals TMHP Electronic Data Interchange (EDI) Help Desk TMHP EDI Help Desk Fax Texas Health Steps (THSteps) Dental Inquiries THSteps Medical Inquiries Third Party Resources (TPR) (Option 2) TPR Fax Medicaid Audit/Cost Reports Medicaid Audit Fax Family Planning (Tubal Ligation/Vasectomy Consent Forms) Fax Hysterectomy Acknowledgment Statements Fax Primary Care Case Management (PCCM) Telephone Communication Telephone Number PCCM Case Management Nurse Helpline (clients only) PCCM Client Helpline PCCM Prenatal Care PCCM Provider Helpline PCCM Utilization Management Helpline x

3 Integrated Care Management (ICM) Communication Acute care inpatient authorizations All other acute care services requiring authorization Long Term Services and Supports (LTSS) (These services require approval and coordination from the member s Evercare Service Coordinator. LTSS providers should continue to use Department of Aging and Disability Services [DADS] authorization forms, as authorizations will continue to be displayed in Medicaid Eligibility Service Authorization Verification [MESAV].) /Telephone icm_inpatient_authorizations@uhc.com or (fax) icm_authorization@uhc.com or (fax) (For questions regarding LTSS ICM authorizations) Prior Authorization Request Telephone and Fax Communication Telephone/Fax Number Ambulance Authorization (includes out-of-state transfers) Ambulance Authorization Fax Home Health Services Fax CCP Fax CCIP CCIP Fax Outpatient Psychiatric Fax TMHP Special Medical Prior Authorization Fax (including transplants) PCCM Utilization Management Helpline: Option 1: Inpatient authorization request or notification of admission Option 2: Outpatient authorization request PCCM Utilization Management Fax Radiology Services Prior Authorization Radiology Services Prior Authorization Fax Prior Authorization Status Telephone Communication Home Health Services (including DME): Option 1 TMHP in-home care customer service Option 2 DME supplier with completed Title XIX form Option 3 RN with completed POC Telephone Number CCP PCCM Utilization Management Helpline: Option 1 1: Inpatient authorization status Option 2 1: Outpatient authorization status xi

4 Written Communication With TMHP All CMS-1500 forms (excluding ambulance, radiology/laboratory, immunization services, rural health, and mental health rehabilitation) sent to TMHP for the first time, as well as claims being resubmitted because they were initially denied as incomplete claims, must be sent to the following address: Claims PO Box Austin, TX The post office box addresses must be used for the specific items listed in the following table: Correspondence Appeals/adjustments of claims (except zero paid/zero allowed on Remittance & Status [R&S] Reports) Electronically rejected claims past the 95-day filing deadline and within 120 days of electronic rejection report All first-time claims Ambulance/CCP requests (prior authorization and appeals) CSHCN Services Program claims Dental prior authorization requests Home Health Services prior authorizations Medicaid audit correspondence Medical necessity forms 3652, 3618, and 3619, and purpose code E information Medically Needy Clearinghouse (MNC) or Spend Down Unit correspondence Provider Enrollment correspondence Address Appeals/Adjustments PO Box Austin, TX Claims PO Box Austin, TX Comprehensive Care Program (CCP) PO Box Austin, TX CSHCN Services Program Claims PO Box Austin, TX Dental Prior Authorization PO Box Austin, TX Home Health Services PO Box Austin, TX Medicaid Audit PO Box Austin, TX Long Term Care Nursing Facilities PO Box Austin, TX Medically Needy Clearinghouse PO Box Austin, TX Provider Enrollment PO Box Austin, TX xii

5 Correspondence Other provider correspondence Send all other written communication to TMHP TPR/Tort correspondence Provider Enrollment Contract/Credentialing Address Provider Relations PO Box Austin, TX (Department) B Riata Trace Parkway, Suite 150 Austin, TX Third Party Resources/Tort PO Box Austin, TX PCCM Contracting/Credentialing PO Box Austin, TX Other TMHP Information TMHP Center The TMHP Center is available from 7 a.m. to 7 p.m., Central Time, Monday through Friday. The TMHP Center assists with questions such as: Provider enrollment procedures. Claims filing procedures. Policy information. The TMHP Center is available to assist providers and clients. Please review the telephone and fax communication guides in this section for a list of contact phone and fax numbers. For questions or information about Medicaid eligibility, clients are referred to their caseworker or the local Health and Human Services Commission (HHSC) office. Automated Inquiry System (AIS) AIS provides the following information and services through the use of a touch-tone telephone: claim status, patient eligibility, benefit limitations, Medically Needy case status, Family Planning, current weekly payment amount, and claim appeals. Eligibility and claim status information is available on AIS 23 hours a day, 7 days a week, with scheduled down time between 3 a.m. and 4 a.m., Central Time. All other AIS information is available from 7 a.m. until 7 p.m., Central Time, Monday through Friday. AIS offers 15 transactions per call. For full instructions on the use and benefits of AIS, refer to the Automated Inquiry System (AIS) User s Guide available on or call the TMHP Center at for faxed instructions. xiii

6 1.0.1 TMHP Provider Relations The TMHP Provider Relations Department comprises a staff of Austin- and field-based provider relations representatives whose goal is to serve the health-care community by furnishing a variety of services and activities designed to inform and educate health-care providers about Texas Medicaid activities and claim submission procedures. Provider Relations activities include the following: Provider education through planned events. Provider Relations representatives conduct a planned program of educational workshops, in-services, and training sessions designed to keep all activelyenrolled providers informed of the latest policies, claim processing procedures, and federal and state regulations affecting Texas Medicaid. Problem identification and resolution. A staff of research coordinators is available to assist providers with clarification of Medicaid policies and assist with in-depth problem claim submission issues after initial inquiries are made with the TMHP Center. Coordinators work closely with field-based regional representatives to coordinate the educational needs of the community. Relationship with professional health-care organizations. To ensure that Texas associations that represent health-care professions have up-to-date information about the requirements for participation in Texas Medicaid, the Provider Relations Department maintains a work relationship with these organizations. Also, the Provider Relations Department participates in several events sponsored by Texas health-care associations, such as conventions and conferences. Visit for Provider Relations contact information, or call the TMHP Center at for assistance. TMHP Electronic Data Interchange (EDI) Help Desk The TMHP EDI Help Desk assists Medicaid providers with EDI transactions. The TMHP EDI Help Desk is available at from 7 a.m. to 7 p.m., Central Time, Monday through Friday. TMHP EDI Help Desk activities and responsibilities include, but are not limited to, the following: Enrolling providers for electronic billing. Qualifying vendors for TMHP EDI production through testing. Diagnosing claim transmission problems through research. Consulting with provider billing personnel, billing services, and software vendors regarding TMHP EDI. TMHP EDI Help Desk staff assists with questions about TMHP EDI, TexMedConnect, and electronic transmissions at Providers who employ hardware or software vendors should contact those vendors for the resolution of technical problems. State of Texas Access Reform (STAR) Program STAR, STAR+PLUS, and NorthSTAR Help Line (MAXIMUS) Telephone Refer to: Telephone Communication with HHSC and DSHS on page A-4 for agency telephone numbers. xiv