Appendix III, Expedited Payment System | Texas Health and Human Services

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Revision 04-1; Effective June 1, 2004

Purpose

To request expedited payment.
To liquidate expedited payment.

Requesting Expedited Payment

Follow procedures below to request expedited payment through the paper claims process.

Note: Expedited payment is available only to community-based alternative services, family care, and primary home care agencies that offer personal assistance services.

Complete Form 1290 in the usual manner but enter 80% of the pervious month's reimbursement as the expedited payment amount.

Claim Requirements

Mail the expedited payment claim (Form 1290) by the 20th of the service month. (Example: The service month is September; mail the expedited payment claim by September 20th).

Liquidating (Reconciliating) Expedited Payment

After the first of the month after the service month, submit a regular detailed claim, using Form 1290 for each client for the previous month. On Form 1290, indicate the amount of the claim, including the expedited payment. CMS deducts the expedited payment from the claim and pays you the difference. If the claim submitted does not completely reconcile, then CMS takes 100% of the claim. CMS waits until another claim comes in to reduce the difference.

You must reconcile the expedited payment by the 25th of the month. Example: The service month is September; expedited payment claim is submitted September 20th; reconciliation must be done by the 25th of October. If you do not reconcile by the date the ceiling is posted for the next expedited payment (usually after the 25th of the month), you will not receive the next expedited payment.

If your expedited payment is not liquidated by the date the ceiling is posted for the next payment, you WILL NOT receive the next expedited payment.

If your expedited payment claim is rejected, Form 1290 is returned to you. Complete a new Form 1290.

The liquidation of the expedited payment does not begin until the receipt of the regular detailed claim for the month covered by the expedited payment.

Sanctions

Providers who do not comply with the reconciliation requirements will not receive an expedited payment for at least one month. For providers who have continuous problems billing for expedited payment, DHS retains the right to cancel participation in the expedited billing system.