Revision 20-5; Effective October 9, 2020

 

This appendix outlines the screenshots Program Support Unit (PSU) staff upload to the Texas Health and Human Services (HHS) Enterprise Administrative Report and Tracking System (HEART) case record.

PSU staff must use the HEART Naming Conventions below when uploading documents to the HEART case record. Refer to Appendix XXXIV, STAR+PLUS TxMedCentral Naming Conventions, for TxMedCentral naming convention instructions.

When there is more than one of the same form, or screenshot, uploaded, then add a sequence number after the naming convention. For example, the first Form H1746-A sent or received would be uploaded as 1746, the second form sent or received would be uploaded as 1746_2, 1746_3, etc.

All screenshots, forms, documents and emails marked as “Yes,” in the “Required” column, must be included in the HEART case record. Screenshots, forms, documents and emails marked with an “*” in the “Required” column must be included in the HEART case record if used by PSU staff in the HEART transaction.

Interest List Release (ILR)
Item HEART Naming Convention Required
TIERS Individual - Medicaid History Screenshot TIERS ME Yes
TIERS Individual - Managed Care Screenshot TIERS MC Yes
TIERS LTSS Eligibility Periods Details Screenshot TIERS LTSS Yes
SASO Authorizing Agent Screenshot SASO AA Yes
SASO Enrollment Screenshot SASO EN Yes
SASO Service Plan Screenshot SASO SP Yes
SASO Service Authorization Screenshot SASO SA Yes
SASO Level of Service Screenshot SASO LS Yes
SASO Diagnosis Screenshot SASO DG Yes
SASO Medical Necessity Screenshot SASO MN Yes
CARE Screenshot CARE *
CSIL Closure Screenshot CSIL CLOSURE Yes
Form 2442 (English) 2442 *
Form 2442-S (Spanish) 2442-S *
Form 2606 2606 *
Form 2606-S 2606-S *
Form H1200 1200 Yes
Form H1700-1 (if received through TMHP LTCOP) LTCOP ISP Yes
Form H1700-1 (if received through TxMedCentral) Use TxMedCentral Naming Convention Yes
Form H1700-2 Use TxMedCentral Naming Convention Yes
Form H1746-A (form alone or with fax confirmation page) 1746 *
Form H1746-A Fax Confirmation (if confirmation page only) 1746 CONF Yes
Form H2053-B 2053B *
Form H2065-D Generated in TMHP LTCOP (English and Spanish) 2065 Yes
Form H2065-D Generated Manually (English and Spanish) Use TxMedCentral Naming Convention Yes
Form H2065-D Screenshot of Upload to TxMedCentral 2065 TXMED Yes
Form H2067-MC Use TxMedCentral Naming Convention Yes
Form H2067-MC Screenshot of Upload to TxMedCentral 2067 TXMED Yes
Form H3675 3675 *
Form H3676-A Use TxMedCentral Naming Convention Yes
Form H3676-A Upload to TxMedCentral 3676A TXMED Yes
Form H3676-B Use TxMedCentral Naming Convention Yes
Emails for PSU QA Process QA EMAIL *
Emails to and from CCSE CCSE EMAIL *
Emails to and from ERS ERS EMAIL Yes
Emails to and from ILM Unit ILM EMAIL *
Emails to and from MCCO MCCO EMAIL *
MEPD Communication Tool MEPD EMAIL *

 

Upgrades
Item HEART Naming Convention Required
TIERS Individual - Medicaid History Screenshot TIERS ME Yes
TIERS Individual - Managed Care Screenshot TIERS MC Yes
TIERS LTSS Eligibility Periods Details Screenshot TIERS LTSS Yes
SASO Authorizing Agent Screenshot SASO AA Yes
SASO Enrollment Screenshot SASO EN Yes
SASO Service Plan Screenshot SASO SP Yes
SASO Service Authorization Screenshot SASO SA Yes
SASO Level of Service Screenshot SASO LS Yes
SASO Diagnosis Screenshot SASO DG Yes
SASO Medical Necessity Screenshot SASO MN Yes
CARE Screenshot CARE *
Form 2606 2606 *
Form 2606-S 2606-S *
Form H1200 1200 Yes
Form H1700-1 (if received through TMHP LTCOP) LTCOP ISP Yes
Form H1700-1 (if received through TxMedCentral) Use TxMedCentral Naming Convention Yes
Form H1700-2 Use TxMedCentral Naming Convention Yes
Form H1746-A (form alone or with fax confirmation page) 1746 *
Form H1746-A Fax Confirmation (if confirmation page only) 1746 CONF Yes
Form H2065-D Generated in TMHP LTCOP (English and Spanish) 2065 Yes
Form H2065-D Generated Manually (English and Spanish) Use TxMedCentral Naming Convention Yes
Form H2065-D Screenshot of Upload to TxMedCentral 2065 TXMED Yes
Form H2067-MC Use TxMedCentral Naming Convention Yes
Form H2067-MC Screenshot of Upload to TxMedCentral 2067 TXMED Yes
Emails for PSU QA Process QA EMAIL *
MEPD Communication Tool MEPD EMAIL *

 

Money Follows the Person (MFP)
Item HEART Naming Convention Required
TIERS Individual- Medicaid History Screenshot TIERS ME Yes
TIERS Individual- Managed Care Screenshot TIERS MC Yes
TIERS LTSS Eligibility Periods Details Screenshot TIERS LTSS Yes
SASO Authorizing Agent Screenshot SASO AA Yes
SASO Enrollment Screenshot SASO EN Yes
SASO Service Plan Screenshot SASO SP Yes
SASO Service Authorization Screenshot SASO SA Yes
SASO Level of Service Screenshot SASO LS Yes
SASO Diagnosis Screenshot SASO DG Yes
SASO Medical Necessity Screenshot SASO MN Yes
CARE Screenshot CARE *
CSIL Closure Screenshot CSIL CLOSURE Yes
Form 2606 2606 *
Form 2606-S 2606-S *
Form H1200 1200 Yes
Form H1700-1 (if received through TMHP LTCOP) LTCOP ISP Yes
Form H1700-1(if received through TxMedCentral) Use TxMedCentral Naming Convention Yes
Form H1700-2 Use TxMedCentral Naming Convention Yes
Form H1746-A (form alone or with fax confirmation page) 1746 *
Form H1746-A Fax Confirmation (if confirmation page only) 1746 CONF Yes
Form H2053-B 2053B *
Form H2065-D Generated in TMHP LTCOP (English and Spanish) 2065 Yes
Form H2065-D Generated Manually (English and Spanish) Use TxMedCentral Naming Convention Yes
Form H2065-D Screenshot of Upload to TxMedCentral 2065 TXMED Yes
Form H2067-MC Use TxMedCentral Naming Convention Yes
Form H2067-MC Screenshot of Upload to TxMedCentral 2067 TXMED Yes
Emails for PSU QA Process QA EMAIL *
Emails to and from CCSE CCSE EMAIL *
Emails to and from ERS ERS EMAIL Yes
Emails to and from ILM Unit ILM EMAIL *
Emails to and from MCCO MCCO EMAIL *
MEPD Communication Tool MEPD EMAIL *

 

Annual Reassessment
Item HEART Naming Convention Required
TIERS Individual - Medicaid History Screenshot TIERS ME Yes
TIERS Individual- Managed Care Screenshot TIERS MC Yes
TIERS LTSS Eligibility Periods Details Screenshot TIERS LTSS Yes
SASO Authorizing Agent Screenshot SASO AA Yes
SASO Enrollment Screenshot SASO EN Yes
SASO Service Plan Screenshot SASO SP Yes
SASO Service Authorization Screenshot SASO SA Yes
SASO Level of Service Screenshot SASO LS Yes
SASO Diagnosis Screenshot SASO DG Yes
SASO Medical Necessity Screenshot SASO MN Yes
CARE Screenshot CARE *
Form 2606 2606 *
Form 2606-S 2606-S *
Form H1700-1 (if received through TMHP LTCOP) LTCOP ISP Yes
Form H1700-1(if received through TxMedCentral) Use TxMedCentral Naming Convention Yes
Form H1700-2 Use TxMedCentral Naming Convention Yes
Form H2065-D Generated in TMHP LTCOP (English and Spanish) 2065 Yes
Form H2065-D Generated Manually (English and Spanish) Use TxMedCentral Naming Convention Yes
Form H2065-D Screenshot of Upload to TxMedCentral 2065 TXMED Yes
Form H2067-MC Use TxMedCentral Naming Convention Yes
Form H2067-MC Screenshot of Upload to TxMedCentral 2065 TXMED Yes
Emails for PSU QA Process QA EMAIL *
Emails to and from MCCO MCCO EMAIL *

 

Transition to Adult Programs (MDCP Age-Out)
Item HEART Naming Convention Required
TIERS Individual - Medicaid History Screenshot TIERS ME Yes
TIERS Individual - Managed Care Screenshot TIERS MC Yes
TIERS LTSS Eligibility Periods Details Screenshot TIERS LTSS Yes
SASO Authorizing Agent Screenshot SASO AA Yes
SASO Enrollment Screenshot SASO EN Yes
SASO Service Plan Screenshot SASO SP Yes
SASO Service Authorization Screenshot SASO SA Yes
SASO Level of Service Screenshot SASO LS Yes
SASO Diagnosis Screenshot SASO DG Yes
SASO Medical Necessity Screenshot SASO MN Yes
CARE Screenshot CARE *
Form 2114 2114 *
Form 2606 2606 *
Form 2606-S 2606-S *
Form H1200 1200 Yes
Form H1700-1 (if received through TMHP LTCOP) LTCOP ISP Yes
Form H1700-1(if received through TxMedCentral) Use TxMedCentral Naming Convention Yes
Form H1700-2 Use TxMedCentral Naming Convention Yes
Form H1746-A (form alone or with fax confirmation page) 1746 *
Form H1746-A Fax Confirmation (if confirmation page only) 1746 CONF Yes
Form H2053-B 2053B *
Form H2065-D Generated in TMHP LTCOP (English and Spanish) 2065 Yes
Form H2065-D Generated Manually (English and Spanish) Use TxMedCentral Naming Convention Yes
Form H2065-D Screenshot of Upload to TxMedCentral 2065 TXMED Yes
Form H2067-MC Use TxMedCentral Naming Convention Yes
Form H2067-MC Screenshot of Upload to TxMedCentral 2067 TXMED Yes
Form H2116 2116 *
Form H3675 3675 *
Form H3676-A Use TxMedCentral Naming Convention Yes
Form H3676-A Upload to TxMedCentral 3676A TXMED Yes
Form H3676-B Use TxMedCentral Naming Convention Yes
Emails for PSU QA Process QA EMAIL *
Emails to and from CCSE CCSE EMAIL *
Emails to and from ERS ERS EMAIL Yes
Emails to and from Higher Needs Coordinator HN EMAIL *
Emails to and from ILM Unit ILM EMAIL *
Emails to and from MCCO MCCO EMAIL *
Emails to and from STAR Kids PSU PSU EMAIL *
Emails to and from UR UR EMAIL *
MEPD Communication Tool MEPD EMAIL *

 

Denials and Terminations
Item HEART Naming Convention Required
TIERS Individual - Medicaid History Screenshot TIERS ME Yes
SASO Authorizing Agent Screenshot SASO AA Yes
SASO Enrollment Screenshot SASO EN Yes
SASO Service Plan Screenshot SASO SP Yes
SASO Service Authorization Screenshot SASO SA Yes
SASO Level of Service Screenshot SASO LS Yes
SASO Diagnosis Screenshot SASO DG Yes
SASO Medical Necessity Screenshot SASO MN Yes
CSIL Closure Screenshot CSIL CLOSURE Yes
Fair Hearing Options for STAR+PLUS HCBS Program Denials MN DENIAL ATCH Yes
Form 2606 2606 *
Form 2606-S 2606-S *
Form H1746-A (form alone or with fax confirmation page) 1746 *
Form H1746-A Fax Confirmation (if confirmation page only) 1746 CONF Yes
Form H2065-D Generated in TMHP LTCOP (English and Spanish) 2065 Yes
Form H2065-D Generated Manually (English and Spanish) Use TxMedCentral Naming Convention Yes
Form H2065-D Screenshot of Upload to TxMedCentral 2065 TXMED Yes
Form H2067-MC Use TxMedCentral Naming Convention Yes
Form H2067-MC Screenshot of Upload to TxMedCentral 2067 TXMED Yes
Emails for PSU QA Process QA EMAIL *
Emails to and from ERS ERS EMAIL Yes
Emails to and from MCCO MCCO EMAIL *
MEPD Communication Tool MEPD EMAIL *

 

Fair Hearings
Item HEART Naming Convention Required
SASO Authorizing Agent Screenshot SASO AA Yes
SASO Enrollment Screenshot SASO EN Yes
SASO Service Plan Screenshot SASO SP Yes
SASO Service Authorization Screenshot SASO SA Yes
SASO Level of Service Screenshot SASO LS Yes
SASO Diagnosis Screenshot SASO DG Yes
SASO Medical Necessity Screenshot SASO MN Yes
Form 2606 2606 *
Form 2606-S 2606-S *
Form H1746-A (form alone or with fax confirmation page) 1746 *
Form H1746-A Fax Confirmation (if confirmation page only) 1746 CONF Yes
Form H2065-D Generated in TMHP LTCOP (English and Spanish) 2065 Yes
Form H2065-D Generated Manually (English and Spanish) Use TxMedCentral Naming Convention Yes
Form H2065-D Screenshot of Upload to TxMedCentral 2065 TXMED Yes
Form H2067-MC Use TxMedCentral Naming Convention Yes
Form H2067-MC Screenshot of Upload to TxMedCentral 2067 TXMED Yes
Form H4800 4800 *
Form 4800-A 4800A *
Form H4800-D 4800D *
Form H4803 4803 Yes
Form H4806 4806 *
Form H4807 4807 *
Copy of TAC §353.1153 for SSI and MN Denials TAC 353.1153 Yes
Copy of TAC §19.2401 for MN Denials TAC 19.2401 Yes
Copy of Section 3632.4 for SSI Denials SPOPH 3632.4 Yes
Copy of Section 3632.5 for MN Denials SPOPH 3632.5 Yes
Fair Hearing Options for STAR+PLUS HCBS Program Denials MN DENIAL ATCH Yes
Notice of Hearing Officer’s Decision APPEAL DECISION LTR Yes
HHSC Benefits Portal Screenshot of Hearing Officer’s Decision TIERS APPEAL DECISION Yes
Emails to and from DER Clerk CLERK EMAIL *
Emails to and from CRU CRU EMAIL *
Emails to and from ERS ERS EMAIL Yes
MEPD Communication Tool MEPD EMAIL *