Revision 15-2; Effective June 1, 2015

6100 Billing Requirements

Revision 06-1; Effective April 10, 2006

You are entitled to payment for services only if you:

• have prior approval for eligible individuals; and
• bill according to the Department of Aging and Disability (DADS) requirements.

You are liable for monetary exceptions if you:

• do not have prior approval from DADS and/or you do not have the documentation, that indicates services were provided;
• do not have documentation that you billed for services within the established time frames; and
• did not notify the case manager that you were having problems billing because the individual's service authorization was not entered or not entered correctly on the Service Authorization System (SAS).

6110 Rejections/Resubmittals

Revision 06-1; Effective April 10, 2006

If the department rejects a claim because of errors, you must research the errors and return the corrected claim to the Texas Medicaid and Healthcare Partnership (TMHP).

Address any questions about claim rejections or error(s) or both to TMHP. If TMHP is unable to provide assistance, you will be directed to your regional contract manager.

6120 Electronic Billing

Revision 15-2; Effective June 1, 2015

Texas Medicaid and Healthcare Partnership (TMHP) provides electronic software for submitting claims for payment free of charge.

The electronic billing system is:

• designed for data entry;
• designed for transmittal of a claim via modem line; and
• subject to the same system edits as the conventional paper billing.

To obtain information on the electronic billing systems, call TMHP at 1-800-626-4117, press 1, or write to:

Texas Medicaid and Healthcare Partnership
P.O. Box 200105
Austin, Texas 78720-0105

If you bill electronically, you are encouraged to bill twice a month from the:

• 1st to the 15th, and
• 16th to the end of the month.

6130 Status of Claim

Revision 15-2; Effective June 1, 2015

To ask about the status of your reimbursement claim, contact Texas Medicaid and Healthcare Partnership (TMHP). If TMHP is unable to provide assistance, you will be directed to your regional contract manager.

6140 Reimbursement Payments

Revision 06-1; Effective April 10, 2006

Reimbursement payments are made by warrant or direct deposit.

6141 Special Handling

Revision 06-1; Effective April 10, 2006

Special handling of payments is not allowed. Special handling includes sending payments by overnight express mail or making warrants available at DADS.

6142 Direct Deposit

Revision 06-1; Effective April 10, 2006

Reimbursement may be directly deposited to the bank of your choice. Information packets regarding direct deposit may be obtained by calling Claims Correction, Fiscal Management Services, at 512-438-4005.

6200 Record Documentation Requirements

Revision 06-1; Effective April 10, 2006

Documentation requirements can be found under Chapter 49, Contracting for Community Care Services, and Chapter 69, Contract Administration.

6210 Cost Reports

Revision 06-1; Effective April 10, 2006

Contract violation may result in the department withholding all payments until an acceptable cost report is submitted.

More information about cost reporting can be found at 1 Texas Administrative Code, Part 15, §§355.101-111.

6220 Duplication of Records

Revision 06-1; Effective April 10, 2006

The provider may request copies of missing service records from Department of Aging and Disability Services (DADS) staff. The provider reimburses DADS for the actual cost of reproduction. Reproduction cost includes the actual cost of staff time and equipment used and a minimal charge for each page reproduced. This service does not remove the provider's contractual obligation to maintain records.