TMHP Telephone and Address Guide

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1 TMHP Telephone and Address Guide TMHP Telephone and Fax Communication x Primary Care Case Management (PCCM) Telephone Communication x Prior Authorization Request Telephone and Fax Communication xi Prior Authorization Status Telephone Communication xi Written Communication with TMHP xi Other TMHP Information xiii TMHP Center xiii Automated Inquiry System (AIS) xiii TMHP Provider Relations xiii TMHP 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 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 Fax Comprehensive Care Inpatient Psychiatric (CCIP) Unit (prior authorization and general information) Home Health Services (includes Durable Medical Equipment [DME]) 1 TMHP In-Home Care Customer Service 2 DME Supplier with completed Title XIX form 3 Registered Nurse (RN) with completed Plan of Care (POC) Health Insurance Premium Payment Systems (HIPPS) Employer 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 Clinical Helpline (clients only) PCCM Client Helpline PCCM Prenatal Care PCCM Provider Helpline PCCM Utilization Management Helpline x

3 Prior Authorization Request Telephone and Fax Communication Telephone/Fax Number Ambulance Authorization (includes out-of-state transfers) Ambulance Authorization Fax Home Health Services Fax Comprehensive Care Program (CCP) Fax Comprehensive Care Inpatient Psychiatric (CCIP) CCIP Fax Outpatient Psychiatric Fax TMHP Special Medical Prior Authorization Fax (including transplants) Primary Care Case Management (PCCM) Utilization Management Option 1 2: Inpatient authorization request or notification of admission Option 2 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 (includes Durable Medical Equipment [DME]) 1 TMHP In-Home Care Customer Service 2 DME Supplier with completed Title XIX form 3 Registered Nurse (RN) with completed Plan of Care (POC) Telephone Number Comprehensive Care Program (CCP) Primary Care Case Management (PCCM) Option 1 1: Inpatient authorization status Option 2 1: Outpatient authorization status 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: PO Box Austin, TX The post office box addresses must be used for the specific items listed in the following table: Appeal/adjust claims (except zero paid/zero allowed on Remittance & Status [R&S] reports) Electronic claims and rejected reports past the 95-day filing deadline All first-time claims Address Appeals/Adjustments PO Box Austin, TX Claims PO Box Austin, TX xi

4 Ambulance/Comprehensive Care Program (CCP) requests (for prior authorization and appeals) Children with Special Health Care Needs (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 Other provider correspondence Send all other written communication to TMHP Third Party Resource (TPR)/Tort correspondence Provider Enrollment Contract/Credentialing Address Comprehensive Care Program (CCP) PO Box Austin, TX CSHCN 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 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 xii

5 Other TMHP Information TMHP Center The TMHP Center is available during the hours of 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 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 6 a.m. until 6 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. 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 healthcare community by furnishing a variety of services and activities designed to inform and educate healthcare providers about Texas Medicaid Program activities and claim submission procedures. Provider Relations activities include the following: Provider education through planned events. Provider representatives conduct a planned program of educational workshops, in-services, and training sessions designed to keep all actively-enrolled providers informed of the latest policies, claim processing procedures, and federal and state regulations affecting the Texas Medicaid Program. 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 healthcare organizations. To ensure that Texas associations that represent healthcare professions have up-to-date information about the requirements for participation in the Medicaid program, the Provider Relations Department maintains a work relationship with these organizations. Also, the Provider Relations Department participates in several events sponsored by Texas healthcare associations, such as conventions and conferences. Please visit for Provider Relations contact information, or call the TMHP Center at for assistance. xiii

6 TMHP EDI Help Desk The TMHP Electronic Data Interchange (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 The TMHP Provider Relations Department assists with questions about demonstration and installation of the TDHconnect software. TMHP EDI Help Desk staff assists with questions about TMHP EDI, TDHconnect software, 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 (Texas Access Alliance [TAA]) Telephone Refer to: Telephone Communication with HHSC and the Department of State Health Services (DSHS) on page A-4 for agency telephone numbers. xiv

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