Billing FAQs

What is the difference between 15-minute increments and units billed on the claim?

Billing for PASRR Evaluation (PE) completion is based on the number of hours spent on billable activities, which will be paid in quarter hour increments. The units entered on the claim are hours, not 15-minute increments. To bill 18, 15-minute increments (4.5 hours), enter 4.5 units on the claim, not 18 units.

How do I submit a claim without a Medicaid number?

This would be an automatic rejection without a Medicaid number. During the TMHP training, I thought that I could possibly just put an "N" in the field for the Medicaid number, but that doesn't quite sound right. Can you clarify this issue?

A Medicaid number and Medicaid eligibility are two different things. The Medicaid number is a unique number assigned by the state; Medicaid eligibility is a determination by the state as to the "kind" of Medicaid eligibility (if any) the individual has at a given time. There is no difference in submitting claims for Medicaid-eligible and non-Medicaid individuals. In both cases, the Texas Health and Human Services Commission ( will locate, validate or request the creation of a state-assigned unique identification (ID) for the individual (referred to on the PASSR Level 1 (PL1) and PE as the Medicaid No., even if the individual is not Medicaid eligible).

An "N" can be entered in the Medicaid No. field on the PL1 or PE if the individual's ID is not known. The local authority will need to determine the ID that HHSC used to create the service authorization by looking at the PE on the portal (and can confirm that a service authorization actually was created by pulling a Medicaid Eligibility Service Authorization Verification report on the individual). That ID must be used on the claim, whether or not the individual has Medicaid eligibility. Claims without a valid nine-digit "Medicaid ID" will not be successfully processed at TMHP.

How do I bill each "contact?"

For example, if I complete the evaluation on May 1, 2013 (two hours), have several collateral contacts on May 2, 2013 (45 minutes), the data entry is done on May 3, 2013, and the interdisciplinary meeting is on May 10, 2013 (one hour), am I going to be submitting separate claims for each service?

Billing for PE completion is based on the number of billable hours spent, not on "contacts" made by the LA. For example, if it took 3 hours and 45 minutes to complete all the billable activities associated with the assessment, the LA would enter 3.75 units (hours) on the claim. The LA must enter the date of the assessment in the Service Begin and End Dates fields on the claim in order to be paid, regardless of the date on which the work was done (HHSC creates a one-day service authorization for the date of assessment).

Do I have to roll separate contacts into one claim?

For example, I complete the evaluation on May 1, 2013 (two hours), have several collateral contacts on May 2, 2013 (45 minutes), the data entry is done on May 3, 2013, and the interdisciplinary meeting is on May 10, 2013 (one hour).

The LA can either roll up the time spent on all billable activities associated with the assessment into one line item on the bill, or can bill over multiple days for the number of units (hours) spent each day on the assessment. Using the example above, the LA could:

  • Bill on May 10, 2013 for 3.75 units (hours), or
  • Bill on May 1, 2013, for two units (hours); bill on May 2, 2013, for 0.75 units (hours); and bill on May 10, 2013, for one unit (hour), or
  • Bill on May 2, 2013, for 2.75 units (hours), and bill on May 10, 2013, for one unit (hour).

* Note: In all cases, the Service Begin Date and the Service End Date will be May 1, 2013 (the date of assessment).

Is the "time" stamp going to be required on these contacts like on Type B contacts sent to TMHP?

HHSC has decided to require the use of the Line Item Control Number to enable the LA to bill for multiple activities for one PE on a single claim, rather than rolling them into a daily total number of units (hours) on the claim. For example, the LA completes the evaluation on May 1, 2013, (two hours and performs another billable activity on the same day (45 minutes). Because the LICN is required, the LA will be able to bill for the evaluation and the other billable activity on separate line items on the same claim (one line item for two units [hours] and one line item for 0.75 units [hours]), rather than having to roll them into a single line item on the claim for 2.75 units (hours).

How will the LICN for PE completion differ from the LICN for Targeted Case Management?

LICNs will be created and used in the same way for both PE completion and TCM encounters. LAs will be required to include the time in hour/hour/minute/minute (HHMM) format in the first four characters of the LICN field when submitting SG14/SC80 and 81 details (just like when submitting SG14/12C claim details). Claims submitted without this content will be rejected.

Valid values for the first four characters of the LICN are between 0000 and 2359. For example, midnight is 0000, 9 a.m. is 0900, and 1:45 p.m. is 1345. Characters from five through 30 are alpha-numeric and consistent with the X12 format. This character range is for local use and is not associated with the LICN requirements.

How do I bill units if I have to bill multiple times?

What if I bill one unit one day and another unit the next day? Will it error out due to duplicates?

The LA can either roll up the time spent on all billable activities associated with the assessment into one line item on the bill, or can bill over multiple days for the number of units (hours) spent each day on the assessment. Using the example above, the LA could:

  • Bill on May 10, 2013, for 3.75 units (hours), or
  • Bill on May 1, 2013, for two units (hours); bill on May 2, 2013, for 0.75 units (hours); and bill on May 10, 2013, for one unit (hour), or
  • Bill on May 2, 2013, for 2.75 units (hours), and bill on May 10, 2013, for one unit (hour).

* Note: In all cases, the Service Begin Date and the Service End Date will be May 1, 2013 (the date of assessment).

If I use TexMedConnect to bill, how are claims accepted? What will the system accept?

There is no difference in what the system will accept, whether entering claims directly in TMC or through electronic claim submission. However, the LA will need a TMC submitter ID in order to submit claims using TMC.

How will PASRR billing affect my TCM billings if they are on the same date?

There is no inter-relationship between TCM and PE completion service authorizations in the Service Authorization System. Therefore, one LA can perform a PE on the same date as a TCM encounter and be able to bill for both. However, the same activity cannot be considered as part of both a PE completion and a TCM encounter.

How do I bill when a person indicates a dual diagnosis of an intellectual or developmental disability  and mental illness?

Which authority should respond?

If an individual is dually diagnosed, and the LA completing the assessment is authorized for IDD and MI, the LA will bill the number of units (hours) used for completing the MI and IDD sections of the PE. Separate service authorizations will be created at HHSC for both and the LA can bill for both.

If an individual is dually diagnosed, and the LA completing the evaluation is authorized for only IDD or MI, the LA will bill the number of units (hours) used for completing the section of the evaluation it completed. A service authorization will be created at HHSC for that portion of the PE and the LA can bill for MI or IDD PE completion.

How do I bill for participation in a nursing facility resident's interdisciplinary team?

Participation in the IDT is considered part of the PASRR Level II evaluation and should be included in the billing for completing the evaluation. It can be counted as a billable activity and included within the six-hour cap.

How does the billing system change encounter data?

Will I still be required to send first billed payer (FSB) as the Omnibus Budget Reconciliation Act for the contact?

If the individual is Medicaid eligible at the time of the evaluation, the FSB field must be valued as Medicaid (MCD) and the Medicaid flag field must have a value of "Y" for Yes. If the individual is not Medicaid eligible at the time of the evaluation, the FSB must be valued as "OBR," and that value will be converted to MCD in MBOW once the encounter has passed edits.