Claims that are not filed in accordance with CPT and HCPCS guidelines may be denied, including claims for services that were prior authorized or authorized based on documentation of medical necessity. A list of DSHS Regional Health Service offices and contact information is provided in Chapter 1, “TMHP and HHSC Contact Information.”ĥ.1.3 CPT and HCPCS Claims Auditing GuidelinesĬlaims must be filed in accordance with Current Procedural Terminology (CPT) and Healthcare Common Procedure Coding System (HCPCS) guidelines as defined in the American Medical Association (AMA) and Centers for Medicare & Medicaid Services (CMS) coding manuals. Special equipment that is not listed as a possible benefit in the child’s health insurance plan, such as porch lifts or stair lifts, positioning equipment, or bath aids.ĬSHCN Services Program case managers assist clients and their families with obtaining FSS.Home modifications, such as ramps, roll-in showers, or wider doorways.Vehicle modifications, such as wheelchair lifts and related modifications such as wheelchair tie-downs, a raised roof, and hand controls.Specialized childcare costs above and beyond the cost for typical childcare and related to the child’s disability or medical condition.Respite care to allow caretakers a short break from caring for their child.FSS can also help a client be more independent and able to take part in family life and community activities. Texas Medicaid & Healthcare Partnership Attn: (Department) 12357-B Riata Trace Parkway, Suite 100 Austin, TX 78727ĥ.1.2 Claims Processed by the CSHCN Services Programįamily Support Services (FSS) can help families care for clients with special health-care needs. Texas Medicaid & Healthcare Partnership Attn: CSHCN Services Program Appeals 12357-B Riata Trace Parkway, Suite 100 Austin, TX 78727Īll other correspondence sent by mail must be directed to a specific department or individual at the following address: Texas Medicaid & Healthcare Partnership Attn: CSHCN Services Program Claims PO Box 200855 Austin, TX 78720-0855Ĭlaim corrections and appeals sent by mail to TMHP must be addressed to: Refer to: Chapter 41, “TMHP Electronic Data Interchange (EDI).”Ī listing of the providers and services that are paid by TMHP can be found in Chapter 3, “Client Benefits and Eligibility” of this manual.Īll claims sent by mail to TMHP for the first time must be addressed to: Providers that file paper claims are encouraged to switch to electronic submission. Electronic filing is the most efficient and effective way to submit claims. Providers can submit claims to TMHP through TexMedConnect or a third party vendor. There are two ways to submit claims to C21. C21 is an advanced Medicaid Management Information System (MMIS) that incorporates the latest claims processing methods and offers access to data and flexibility for future program changes. Claims Filing, Third-Party Resources, and ReimbursementĬOMPASS21 (C21) is the claims and encounters processing system currently used by the Texas Medicaid & Healthcare Partnership (TMHP) to process Children with Special Health Care Needs (CSHCN) Services Program claims.
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