HCS and TxHmL Waiver Programs: How to Adjust a Previously Adjusted Claim
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The TexMedConnect User Guide contains instructions for adjusting a previously submitted claim with dates of service on May 1, 2022 or later, but the guide does not contain instructions for adjusting a previously adjusted claim. The user guide will be updated to include these instructions. In the meantime, follow these steps for adjusting a previously adjusted claim in TexMedConnect:
Click Adjustments under the CSI section in the navigation panel. Then choose one of the following options:
Enter the claim number, and click the Lookup button.
If you don’t know the claim number, you can search using the date of service and client information. Enter the required information, and click the Search button.
The search results will appear. If you see more than one claim number with the same date of service, you will be able to adjust only the claim with the most recent effective date. To determine which claim is the most recent, click on the hyperlink for each claim in the list and compare the effective dates. Then click the claim number that has the most recent effective date to begin adjusting that claim.
Select the appropriate claim type from the drop-down menu, and click the Adjust Claim button.
For each tab (Client, Provider, Claim, and Details), verify that all the required fields are filled out. The required fields are tagged with a red dot.
Client Tab: Confirm that the patient account number and referral number fields are filled out correctly.
Provider Tab: Confirm that the ID Qual and Other ID fields are already filled out; reselect the information if they are not.
Claim Tab: Follow these steps to enter the diagnosis code:
Select a claim file indicator code from the drop-down menu. (Always select Medicaid for professional claims.)
Select a place of service from the drop-down menu.
Use the Qualifier field to indicate that the diagnosis code is an ICD-10 code. Note: Filling in an invalid diagnosis code may result in an error message and prevent you from submitting the claim in TexMedConnect.
In the Add New Diagnosis field, enter the diagnosis code.
Click on the magnifying glass icon to verify that the correct information populates.
Details Tab: The system will automatically generate negative units for each row that was successfully adjusted from the original claim; a positive line will show the original (preadjustment) amount. The Unit, Unit Rate, and Line-Item Total fields will be autopopulated and read-only. The Other Insurance (OI) and Applied Income (AI)/Co-Pay fields on the negative rows will always autopopulate with “0.” You should not modify these fields. Delete the positive line item and any extra lines, leaving only the negative line item that needs to be adjusted. Then create new positive lines by clicking Add New Detail Row to rebill a corrected amount. If you want to only return funds and not rebill, leave the negative line item as is and proceed to finish.
Click the Other Insurance/Finish tab, click the Save to Batch button, check the “We Agree” box, and then click the Finish button in the lower-right corner. All adjustments must be submitted as batches.
In the navigation panel under CSI, go to the Pending Batch and click Continue.
After you have submitted the batch, you can view it under “Batch History” in the navigation panel under CSI. Click on the Batch ID, and then click Accepted to view the Claims Details page.
For all Home and Community-based Services (HCS) and Texas Home Living (TxHmL) inquiries about forms or claims, contact the Texas Medicaid & Healthcare Partnership Long-Term Care (LTC) Help Desk at 800-626-4117 option 1, option 7 (HCS, TxHmL).
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