Revision 18-0; Effective September 4, 2018

 

TxMedCentral is a secure Internet bulletin board that the Texas Health and Human Commission (HHSC) and managed care organizations (MCOs) use to share information. TxMedCentral uses specific naming conventions only for the documents listed below. HHSC and MCO staff must follow these naming conventions any time one of the following documents is filed in TxMedCentral.

 

Form H1700-1, STAR+PLUS HCBS Program Individual Service Plan

The following forms may be used, if appropriate, in development of the individual service plan (ISP). Only Form H1700-1, Individual Service Plan (Pg.1), and Form H1700-2, Individual Service Plan (Pg.2), are uploaded to the MCO's ISP folder in TxMedCentral and should not be loaded in any other folder:

  • Form H1700-1 and Form H1700-2;
  • Form H1700-3, Nursing Service Plan;
  • Form H1700-A, Rationale for STAR+PLUS HCBS Program Items/Services;
  • Form H1700-A1, Certification of Completion/Delivery of STAR+PLUS HCBS Program Items/Services;
  • Form H1700-B, Non-STAR+PLUS HCBS Program Services;
  • Form H2060, Needs Assessment Questionnaire and Task/Hour Guide;
  • Form H2060-A, Addendum to Form H2060;
  • Form H2060-B, Needs Assessment Addendum, as applicable; and
  • Form H6516, Community First Choice Assessment.
Two-Digit Plan Identification (ID) Form Number (#) Member ID, Medicaid # or Social Security Number (SSN) Member Last Name (first four letters) Page Number of Form H1700-1 Sequence Number of Form
# # 1700 123456789 ABCD 1 2

This file would be named ##_1700_123456789_ABCD_1_2.doc.

Form H1700-1, completed for non-members, age-outs, and nursing facility (NF) residents transitioning to the STAR+PLUS Home and Community Based Services (HCBS) program, continues to be uploaded to TxMedCentral.

Form H1700-1, completed for members in the community, is submitted to the Texas Medicaid & Healthcare Partnership (TMHP) Long Term Care (LTC) Online Portal.

 

Form H3676, Managed Care Pre-Enrollment Assessment Authorization

Form H3676 is uploaded to the SPW folder and should not be uploaded in any other folder. An "A" or "B" is added to the sequence number to indicate whether Program Support Unit (PSU) or MCO staff uploaded the form.

Two-Digit Plan ID Form # Member ID, Medicaid # or SSN Member Last Name (first four letters) Section Number Sequence Number of Form
# # 3676 123456789 ABCD A or B 2

This file would be named ##_3676_123456789_ABCD_A_2.doc. if uploaded by PSU staff.

This file would be named ##_3676_123456789_ABCD_B_2.doc if uploaded by the MCO staff.

 

Form H2065-D, Notification of Managed Care Program Services

Form H2065-D is uploaded to the SPW folder and should not be uploaded in any other folder.

Two-Digit Plan ID Form # Member ID, Medicaid # or SSN Member Last Name (first four letters) Section Number Sequence Number of Form
# # 2065 123456789 ABCD D 2D or 2A
  • Denials will be coded with a “D” (denial) immediately following the form’s sequence number. This denial file would be named ##_2065_123456789_ABCD_D_2D.doc.
  • Approvals will be coded with an “A” immediately following the sequence number. This approval file would be named ##_2065_123456789_ABCD_D_2A.doc.

If a member has an ISP which is electronically generated, Form H2065-D is available in the "LETTERS" tab of the TMHP LTC Online Portal when the member's ISP is selected. Form H2065-D is uploaded to TxMedCentral only for individuals without electronic ISPs.

MCOs must check the TMHP LTC Online Portal to check for updates and notifications electronically generated by PSU staff.

 

Form H2067-MC, Managed Care Programs Communication

Form H2067-MC is uploaded to the SPW folder and should not be uploaded in any other folder. An "M" or "S" is added to the sequence number to indicate whether the MCO or PSU uploaded the form.

Two-Digit Plan ID Form # Member ID, Medicaid # or SSN Member Last Name (first four letters) Section Number Sequence Number of Form
# # 2067 123456789 ABCD 2M or 2S  

This file would be named ##_2067_123456789_ABCD_2M.doc. if uploaded by the MCO staff.

This file would be named ##_2067_123456789_ABCD_2S.doc. if uploaded by PSU staff.

Additional to the standardized naming convention for Form H2067-MC, a separate naming convention has been developed to address use of Form H2067-MC for NF residents who request transition to the community under the STAR+PLUS Home and Community Based Services (HCBS) program. These individuals are considered expedited cases for application to the STAR+PLUS HCBS program. Both the MCO and PSU staff must be able to readily identify communications specific to these cases.

An "M" or "S" continues to be added to the sequence number to denote, respectively, whether the MCO or PSU staff have uploaded the form. The new naming convention for uploading Form H2067-MC, on both member and non-member cases in a NF, is expanded as follows:

Two-Digit Plan ID Form # Member ID, Medicaid # or SSN Member Last Name (first four letters) Section Number Sequence Number of Form
# # 2067 123456789 ABCD 1M or 1S MFP

Form H2067-MC file uploaded by the MCO would be named ##_2067_123456789_ABCD_1M_MFP.doc. if uploaded by the MCO staff.

Form H2067-MC file uploaded by the MCO staff would be named ##_2067_123456789_ABCD_1S_MFP.doc. if uploaded by PSU staff.

TxMedCentral Folders

The STAR+PLUS MCOs use the following folders for all STAR+PLUS HCBS program related uploads. Each MCO has two folders with three-letter identifiers:

  • ISP — Individual Service Plan, which contains Form H1700-1 and Form H1700-2; and
  • SPW — STAR+PLUS HCBS program, which contains:
    • Form H2065-D;
    • Form H3676; and
    • Form H2067-MC.
Primary Folder: MCO Three-Letter Identifiers Secondary Folder: TxMedCentral Folders by Plan
AMC — Amerigroup MCO AMCISP AMCSPW
EVR — United Healthcare Community Plan MCO EVRISP EVRSPW
MOL — Molina MCO MOLISP MOLSPW
SUP — Superior MCO SUPISP SUPSPW
BRV — Cigna-HealthSpring MCO BRVISP BRVSPW