Preenrollment Site Visit Required for HCS and TxHmL Providers ...
A TMHP site visit coordinator will reach out through email or phone to schedule a visit. If the TMHP site visit coordinator is unable to reach the provider, then TMHP will conduct an unannounced site visit. If providers have questions, contact the TMHP LTC Help Desk at 800-626-4117 (select option 1 and then option 7). Return to top.
Preenrollment Site Visit Required for HCS and TxHmL Providers That
Home and Community-based Services and Texas Home Living waiver program providers that enrolled through the Texas Medicaid and Healthcare Partnership Provider Enrollment and Management System will be subject to a preenrollment site visit from TMHP. Read the full alert.
PDF Provider Enrollment Frequently Asked Questions
TMHP has Provider Relations representatives that can assist with your revalidation needs. You can access a TMHP provider relations representative by calling the TMHP Contact Center at 1-800-925-9126 or the TMHP-CSHCN Services Program Contact Center at 1-800-568-2413 Monday through Friday from 7 a.m. to 7 p.m.
Pre-enrollment Site Visit Required for HCS and TxHmL Providers That
The pre-enrollment site visit is required for enrollment in Texas Medicaid. The HCS program site visits will be conducted at the locations listed on the enrollment application, including the business office and any locations where clients receive residential assistance services. A TMHP site visit coordinator will reach out through email or ...
Practice Location Information
This section will house your existing Surety Bond information. *Note, this will be blank for new enrollments and un-editable by the provider and TMHP Provider Enrollment. Section: Site Visit. If your screen risk category is a Moderate or High, you will require a Site Visit before your enrollment can be finalized.
TMHP
TMHP is an online portal for Texas Medicaid and other health care programs, providing eligibility checks, claim submissions, and training resources.
Medicaid Providers are Subject to Post-Enrollment Site Visits
As part of Federal Regulation (Code of Federal Regulations 455.432), Texas Medicaid & Healthcare Partnerships (TMHP) may conduct a scheduled or unscheduled post-enrollment site visit for providers who are designated as "moderate" or "high" risk. The purpose of a post-enrollment site visit is to verify that providers are in compliance ...
LTC-only Billing Medicaid Provider Enrollment
Texas Medicaid must comply with 42 CFR §455.460, which requires states to collect an applicable application fee from a prospective or re-enrolling provider. ... HHSC CCS also leverages site visits performed by TMHP contract monitoring staff. A pre-enrollment site visit is required for unlicensed entities. I have already paid an application fee ...
Medicaid and CHIP Enrollment and Revalidation
TMHP How to Apply for Enrollment page. (link is external) , then visit the 'Determine your Application Type' section. TMHP provider enrollment representative at 800-925-9126, Option 3. Submit general questions via email. (link sends email) Providers that want to participate in state health-care programs must enroll in Texas Medicaid.
TMHP Learning
The LTC Online Portal User Guides for HCS and TxHmL Waiver Programs contain information on how to submit, monitor, and manage assessments and forms. User Guides include: LTC HCS and TxHmL Waiver Programs Provider User Guide HCS or TxHmL Pre-enrollment Item-by-Item Guide 8578 Intellectual Disability/Related Condition Assessment Item-by-Item Guide 3608 HCS Individual Plan of Care Item-by-Item ...
Long-Term Care (LTC) User Guide for Preadmission ...
This training has been designed to give you the most up-to-date information as of the publication date. It is your responsibility to regularly review the current Texas Medicaid Provider Procedures Manual (TMPPM) and all updated information as it is published on the Texas Medicaid & Healthcare Partnership (TMHP) website at www.tmhp.com. This User Guide is designed to assist Nursing ...
PDF Affordable Care Act (ACA) Screening Requirements
ACA Screening Requirements. Under the Afordable Care Act of 2010 (ACA), providers must fulfill certain requirements to enroll in Medicaid. Upon initial enrollment, revalidation, update to existing enrollment record, and reenrollment, all participating providers are screened based on their categorical risk level, which may require a site visit ...
Prior Authorization (PA) on the Portal : TMHP Learning
The PA on the Portal CBT contains an explanation of the PA process and three simulations that demonstrate how to navigate the PA on the Portal tool. The first simulation demonstrates how to submit a prior authorization request. This includes completing an eligibility pre-check, identifying essential/critical fields, and locating where to attach documents. The second simulation demonstrates how ...
Provider Alert! UPDATE: Provider Enrollment and ...
PEMS access is tied to the National Provider Identifier (NPI) or Atypical Provider Identifier (API) associated with the TMHP user account. Ensure that the NPI has all the current and correct information. After a TMHP user account is created, follow these best practices for account management: Assign at least two administrators.
Long-Term Care (LTC) User Guide for Online Portal ...
This User Guide is designed as a resource for LTC Providers. The guide covers program general information, the procedures for successfully navigating the LTC Online Portal, and various resources that providers may access to assist in the performance of their duties.
HHSC and Texas Medicaid & Healthcare Partnership (TMHP) conducting On
HCS program providers should be prepared for 3-person residences and 4-person residences assessments. HCS program providers should notify HH/CC service providers of the ongoing assessment process. HHSC and TMHP staff may reach out directly to schedule an on-site visit or alert you of required follow-up action to achieve full compliance.
Learning Resources: What to Expect from a Site Visit (video)
Having these copies ready to go will speed up your site visit. During the site visit you can expect that we'll tour your facility. We'll interview you according to the checklist. And we'll obtain the required copies. We'll let you know if you've met all the requirements for the site visit. Otherwise, you'll correct any outstanding items and ...
PDF Update on Medicaid Enrollment Revalidation Process for HCS Program
HHSC has categorized HCS waiver providers as a "moderate" risk provider type, which means the Texas Medicaid & Healthcare Partnership (TMHP) must conduct site visits of all HCS practice locations as part of the Medicaid enrollment and revalidation process. P.O. Box 13247 • Austin, Texas 78711-3247 • 512-424-6500 • hhs.texas.gov.
The OIG and Provider Enrollment
After an application has been submitted, processed by Texas Medicaid & Healthcare Partnership (TMHP), and determined to be complete, the application is routed to the OIG for screening. By statute, the OIG has 10 business days to complete screening activities. Based on the outcome of the OIG's review, a recommendation is made regarding whether ...
Provider Enrollment and Management System (PEMS)
A Step-by-Step Guide. These pages will guide you through the process of enrolling as a provider using TMHP's Provider Enrollment and Management System (PEMS) tool. Additional helpful resources are available on the Enrollment Help page and the TMHP YouTube channel. To begin, please select the type of application you will be completing.
Fee Schedules
The Online Fee Lookup provides fee information for Texas Medicaid, including Texas Health Steps (THSteps), the HHSC Family Planning Program and the CSHCN Services Program. Users can also search for fee information for specified procedure codes. The fee information is accurate for the current date or for a specified prior date of service.
PDF Enrollment Revalidation: A Quick Reference
provider accounts, completing a Texas Medicaid program application, and policies that affect enrollment. • For general inquiries, call 800-925-9126. • For account assistance, call the EDI Help Desk at 888-866-3638. Additional resources: • PEMS Instructional Site • TMHP video tutorials and demonstrations. ENROLLMENT REVALIDATION. A QUICK ...
Provider Enrollment and Management System (PEMS) Enrollment Help
Additionally, they offer hands-on assistance with completing and submitting the TMHP enrollment application. If you require further guidance with the enrollment process, please reach out to the TMHP Contact Center at 800-925-9126 or the TMHP-CSHCN Services Program Contact Center at 800-568-2413.
TMHP Provider Enrollment and Management System (PEMS)
Note: Texas Medicaid managed care organizations (MCOs) must provide all medically necessary, Medicaid-covered services to eligible clients. Administrative procedures such as prior authorization, pre-certification, referrals, and claims/encounter data filing may differ from traditional Medicaid (fee-for-service) and from MCO to MCO. Providers should contact the client's specific MCO for details.
COMMENTS
A TMHP site visit coordinator will reach out through email or phone to schedule a visit. If the TMHP site visit coordinator is unable to reach the provider, then TMHP will conduct an unannounced site visit. If providers have questions, contact the TMHP LTC Help Desk at 800-626-4117 (select option 1 and then option 7). Return to top.
Home and Community-based Services and Texas Home Living waiver program providers that enrolled through the Texas Medicaid and Healthcare Partnership Provider Enrollment and Management System will be subject to a preenrollment site visit from TMHP. Read the full alert.
TMHP has Provider Relations representatives that can assist with your revalidation needs. You can access a TMHP provider relations representative by calling the TMHP Contact Center at 1-800-925-9126 or the TMHP-CSHCN Services Program Contact Center at 1-800-568-2413 Monday through Friday from 7 a.m. to 7 p.m.
The pre-enrollment site visit is required for enrollment in Texas Medicaid. The HCS program site visits will be conducted at the locations listed on the enrollment application, including the business office and any locations where clients receive residential assistance services. A TMHP site visit coordinator will reach out through email or ...
This section will house your existing Surety Bond information. *Note, this will be blank for new enrollments and un-editable by the provider and TMHP Provider Enrollment. Section: Site Visit. If your screen risk category is a Moderate or High, you will require a Site Visit before your enrollment can be finalized.
TMHP is an online portal for Texas Medicaid and other health care programs, providing eligibility checks, claim submissions, and training resources.
As part of Federal Regulation (Code of Federal Regulations 455.432), Texas Medicaid & Healthcare Partnerships (TMHP) may conduct a scheduled or unscheduled post-enrollment site visit for providers who are designated as "moderate" or "high" risk. The purpose of a post-enrollment site visit is to verify that providers are in compliance ...
Texas Medicaid must comply with 42 CFR §455.460, which requires states to collect an applicable application fee from a prospective or re-enrolling provider. ... HHSC CCS also leverages site visits performed by TMHP contract monitoring staff. A pre-enrollment site visit is required for unlicensed entities. I have already paid an application fee ...
TMHP How to Apply for Enrollment page. (link is external) , then visit the 'Determine your Application Type' section. TMHP provider enrollment representative at 800-925-9126, Option 3. Submit general questions via email. (link sends email) Providers that want to participate in state health-care programs must enroll in Texas Medicaid.
The LTC Online Portal User Guides for HCS and TxHmL Waiver Programs contain information on how to submit, monitor, and manage assessments and forms. User Guides include: LTC HCS and TxHmL Waiver Programs Provider User Guide HCS or TxHmL Pre-enrollment Item-by-Item Guide 8578 Intellectual Disability/Related Condition Assessment Item-by-Item Guide 3608 HCS Individual Plan of Care Item-by-Item ...
This training has been designed to give you the most up-to-date information as of the publication date. It is your responsibility to regularly review the current Texas Medicaid Provider Procedures Manual (TMPPM) and all updated information as it is published on the Texas Medicaid & Healthcare Partnership (TMHP) website at www.tmhp.com. This User Guide is designed to assist Nursing ...
ACA Screening Requirements. Under the Afordable Care Act of 2010 (ACA), providers must fulfill certain requirements to enroll in Medicaid. Upon initial enrollment, revalidation, update to existing enrollment record, and reenrollment, all participating providers are screened based on their categorical risk level, which may require a site visit ...
The PA on the Portal CBT contains an explanation of the PA process and three simulations that demonstrate how to navigate the PA on the Portal tool. The first simulation demonstrates how to submit a prior authorization request. This includes completing an eligibility pre-check, identifying essential/critical fields, and locating where to attach documents. The second simulation demonstrates how ...
PEMS access is tied to the National Provider Identifier (NPI) or Atypical Provider Identifier (API) associated with the TMHP user account. Ensure that the NPI has all the current and correct information. After a TMHP user account is created, follow these best practices for account management: Assign at least two administrators.
This User Guide is designed as a resource for LTC Providers. The guide covers program general information, the procedures for successfully navigating the LTC Online Portal, and various resources that providers may access to assist in the performance of their duties.
HCS program providers should be prepared for 3-person residences and 4-person residences assessments. HCS program providers should notify HH/CC service providers of the ongoing assessment process. HHSC and TMHP staff may reach out directly to schedule an on-site visit or alert you of required follow-up action to achieve full compliance.
Having these copies ready to go will speed up your site visit. During the site visit you can expect that we'll tour your facility. We'll interview you according to the checklist. And we'll obtain the required copies. We'll let you know if you've met all the requirements for the site visit. Otherwise, you'll correct any outstanding items and ...
HHSC has categorized HCS waiver providers as a "moderate" risk provider type, which means the Texas Medicaid & Healthcare Partnership (TMHP) must conduct site visits of all HCS practice locations as part of the Medicaid enrollment and revalidation process. P.O. Box 13247 • Austin, Texas 78711-3247 • 512-424-6500 • hhs.texas.gov.
After an application has been submitted, processed by Texas Medicaid & Healthcare Partnership (TMHP), and determined to be complete, the application is routed to the OIG for screening. By statute, the OIG has 10 business days to complete screening activities. Based on the outcome of the OIG's review, a recommendation is made regarding whether ...
A Step-by-Step Guide. These pages will guide you through the process of enrolling as a provider using TMHP's Provider Enrollment and Management System (PEMS) tool. Additional helpful resources are available on the Enrollment Help page and the TMHP YouTube channel. To begin, please select the type of application you will be completing.
The Online Fee Lookup provides fee information for Texas Medicaid, including Texas Health Steps (THSteps), the HHSC Family Planning Program and the CSHCN Services Program. Users can also search for fee information for specified procedure codes. The fee information is accurate for the current date or for a specified prior date of service.
provider accounts, completing a Texas Medicaid program application, and policies that affect enrollment. • For general inquiries, call 800-925-9126. • For account assistance, call the EDI Help Desk at 888-866-3638. Additional resources: • PEMS Instructional Site • TMHP video tutorials and demonstrations. ENROLLMENT REVALIDATION. A QUICK ...
Additionally, they offer hands-on assistance with completing and submitting the TMHP enrollment application. If you require further guidance with the enrollment process, please reach out to the TMHP Contact Center at 800-925-9126 or the TMHP-CSHCN Services Program Contact Center at 800-568-2413.
Note: Texas Medicaid managed care organizations (MCOs) must provide all medically necessary, Medicaid-covered services to eligible clients. Administrative procedures such as prior authorization, pre-certification, referrals, and claims/encounter data filing may differ from traditional Medicaid (fee-for-service) and from MCO to MCO. Providers should contact the client's specific MCO for details.