How to find your R&S Reports

Transcription

1 How to find your R&S Reports 1) Go to and click providers in the header. 2) Click Go to TexMedConnect in the upper right corner. 3) Enter your User name and Password. Click OK. Version

2 How to find your R&S Reports-ITP 4) Click R&S in the left navigation column the the TexMedConnect screen. 5) Click the appropriate NPI for the R&S Report you want to access. 6) Select Program ) Choose the appropriate R&S Report from the list by its date. 2 Version

3 R&S Report Sections R&S Reports include the following sections: Banner Pages: Banner messages are used to inform providers of new policies and procedures. Claims Paid or Denied: Claims in the Claims - Paid or Denied section were finalized during the week before the preparation of the R&S Report. Claims are sorted by claim status, claim type, and by order of client names. The reported status of each claim will not change unless further action is initiated by the provider, HHSC, or TMHP. Adjustment to Claims: Adjustments are listed by claim type, client name, and the client s Medicaid identification number. Financial Transactions: The Financial Transaction section of the R&S Report describes any amounts that are added or taken out of the weekly payment. All accounts receivable, IRS levies, payouts, refunds, reissues, and voids appear here. Claims Payment Summary: The Claims Payment Summary section summarizes all payments, adjustments, and financial transactions that are listed on the R&S Report. The section has two categories: one for amounts Affecting Payment This Cycle and one for Amount Affecting 1099 Earnings. Claims in Process: The Claims in Process section can list up to five explanation of pending status (EOPS) codes per claim. The claims listed in this section are in process and cannot be appealed for any reason until they appear in either the Claims Paid or Denied, or Adjustments Paid and Denied sections of the R&S Report. TMHP is listing the pending status of these claims for informational purposes only. EOB: Explanation of Benefits - This page will list the EOB codes found in your R&S Report and give a description of the code. Sample EOB Codes for MTP (Claim Type 060) EOB Descritpion NO MTP AUTHORIZATION EXISTS FOR THE MTP CLAIM DATE OF SERVICE VALID DRIVER S LICENSE FOR THE ITP WAS NOT ON FILE WITH TMHP ON THE MTP CLAIM DATE OF SERVICE VALID AUTOMOBILE INSURANCE FOR THE ITP WAS NOT ON FILE WITH TMHP ON THE MTP CLAIM DATE OF SERVICE THE MTP SYSTEM WAS NOT AVAILABLE AT THE TIME THIS CLAIM WAS RECEIVED. THE CLAIM WILL BE PROCESSED WHEN THE MTP SYSTEM BECOMES AVAILABLE THE MTP AUTHORIZATION SHOWS THE CLIENT HAS NO PROGRAM ELIGIBILITY FOR THE MTP CLAIM DATE OF SER- VICE THE PERSON RECEIVING TRANSPORTATION IS NOT ON THE LIST OF CLIENTS THE ITP IS APPROVED TO DRIVE ON THE MTP CLAIM DATE OF SERVICE THE AMOUNT/NUMBER OF UNITS BILLED ON THE MTP CLAIM HAS BEEN REDUCED TO EQUAL THE AMOUNT/NUM- BER OF UNITS AUTHORIZED BY MTP FOR THIS SERVICE THE MTP CLAIM WITH A LODGING TAXES CLAIM DETAIL HAS NO CLAIM DETAIL PAID FOR A LODGING STAY THE REIMBURSED AMOUNT EQUALS THE LESSER OF THE MTP LEVEL 1 RATE MULTIPLIED BY THE AUTHORIZED UNITS OR THE BILLED UNITS THE AMOUNT BILLED ON THE MTP CLAIM HAS BEEN REDUCED TO MEET THE AUTHORIZED PERCENTAGE RATE NO REIMBURSEMENT IS ALLOWED FOR LODGING TAXES WHEN THERE IS NO ASSOCIATED LODGING STAY. Version

4 TMhP, Medical Transportation riata Trace austin TX John DOE SouTh airport road corpus christi TX Payment Date: XX/XX/XXXX r&s no.: XXXXXXXXXXXXXX api: XXXXXXXXXXXXX Taxonomy: XXXXXXXXX TPi-Location: XXXXXXXXX-XX ais no.: XXXXXXXXX For questions about claims, call: Dear Provider, The services below have been processed for payment. claims PaiD or DenieD claim no. DaTe of Service client name MiLeS BiLLeD MiLeS PaiD amt. PaiD XXXXXXXXXXXXXXXXXXXXXXXX XX/XX/XXXX XXXXXXXXXXXXXXXXXXXXXX XXX.X XXX.X XXXXXXXXXXXXXXXXXXXXXXXX XX/XX/XXXX XXXXXXXXXXXXXXXXXXXXXX XXX.X XXX.X ToTaL claims PaiD: if you need To appeal any claim in ThiS LeTTer, you May appeal online For FaSTer ProceSSing. you May also MaKe a copy of ThiS report and circle The claim you want To appeal. MaiL The MarKeD copy with a ShorT DeScriPTion of The appeal. your appeal MuST Be received within 120 DayS FroM The DaTe of ThiS LeTTer. For information regarding The online ProceSS, call (ToLL Free) Page 1 of X 4 Version

5 The payment amount has been adjusted as listed below: adjustments DaTe of Service client name adjustment claim no. adjusted amt. PaiD XX/XX/XXXX XXXXXXXXXXXXXXXXXXXXXX XXXXXXXXXXXXXXXXXXXXXXXX XXX.X XX/XX/XXXX XXXXXXXXXXXXXXXXXXXXXX XXXXXXXXXXXXXXXXXXXXXXXX XXX.X ToTaL adjustments: if you need To appeal any claim in ThiS LeTTer, you May appeal online For FaSTer ProceSSing. you May also MaKe a copy of ThiS report and circle The claim you want To appeal. MaiL The MarKeD copy with a ShorT DeScriPTion of The appeal. your appeal MuST Be received within 120 DayS FroM The DaTe of ThiS LeTTer. For information regarding The online ProceSS, call (ToLL Free) SySTeM PayouTS PayouT control number PayouT amt. ref. ck. no. ref. ck. amt. XXXXXXXXXXXXX XXXXXXXX XXXXXXXXXXXXX XXXXXXXX your payment has been increased for the reason(s) indicated above. ToTaL SySTeM PayouT: ManuaL PayouTS PayouT control number PayouT amt. XXXXXXXXXXXXX XXXXXXXXXXXXX a check has been sent separately as payment for the item(s) listed above. ToTaL ManuaL PayouT: Page 2 of X Version

6 BacKuP withholding control no. original DaTe amt. withheld XXXXXXXXXXXXX XX/XX/XXXX XXXXXXXXXXXXX XX/XX/XXXX Backup witholding information: our records indicate that you have been assessed a penalty by the internal revenue Service (irs) for non-compliance with backup withholding requirements. Therefore, your payment has been lowered and the penalty amount has been remitted to the irs. 28% of your payment amount will be withheld weekly until TMhP receives a w9 or Letter 147c as requested in a B-notice previously sent to you. irs Levy information control no. PreviouS BaL current DeDucTion remaining BaL. XXXXXXXXXXXXX XXXXXXXXXXXXX Due to the levy described below, payment(s) totaling were remitted on your behalf to the irs. DeDucTionS The payment was reduced by the amount(s) shown below for the reasons listed. control no. DeDucTeD amt. orig. amt. original claim no. Prior BaLance amt. applied XXXXXXXXXXXXX XXXXXXXXXXXXXXXXXXXXXXXX XXXXXXXXXXXXX XXXXXXXXXXXXXXXXXXXXXXXX was recovered on ThiS account receivable FroM an affiliated ProviDer. XXXXXXXXXXXXX XXXXXXXXXXXXXXXXXXXXXXXX ToTaL DeDucTionS: SuB-owner DeDucTionS Deductions listed below are a result of your affiliation with another provider. control no. XXXXXXXXXXXXX XXXXXXXXXXXXX ToTaL SuB-owner DeDucTionS: DeDucTeD amt. Page 3 of X 6 Version

7 voids/stop PayMenTS r&s no. r&s DaTe check no. amt. voided/stopped XXXXXXXXXXXXX XX/XX/XXXX XXXXXXXX XXXXXXXXXXXXX XX/XX/XXXX XXXXXXXX ToTaL voids/stop PayMenTS: SySTeM reissues r&s no. r&s DaTe check no. amt. reissued XXXXXXXXXXXXX XX/XX/XXXX XXXXXXXX The payment was increased by the amount(s) shown above. ToTaL SySTeM reissues: cash refunded To MTP your refund check #XXXXXXXX dated XX/XX/XXXX was received by TMhP and applied as listed. claim SPeciFic claim no. ToTaL BiLLeD amount applied XXXXXXXXXXXXXXXXXXXXXXXX XXXXXXXXXXXXXXXXXXXXXXXX SuBToTaL claim SPeciFic non-claim SPeciFic control no. amount applied XXXXXXXXXXXXXXX XXXXXXXXXXXXXXX SuBToTaL non-claim SPeciFic ToTaL refunded Page 4 of X Version

8 SuB-owner cash refunded To MTP your refund check #XXXXXXXX dated XX/XX/XXXX was received by TMhP and applied as listed. claim SPeciFic claim no. ToTaL BiLLeD amount applied XXXXXXXXXXXXXXXXXXXXXXXX XXXXXXXXXXXXXXXXXXXXXXXX SuBToTaL claim SPeciFic non-claim SPeciFic control no. amount applied XXXXXXXXXXXXXXX XXXXXXXXXXXXXXX SuBToTaL non-claim SPeciFic ToTaL refunded claims in ProceSS claim no. DaTe of Service BiLLeD MiLeS BiLLeD amt. allowed MiLeS allowed amt. eops DeScriPTion XXXXXXXXXXXXXXXXXXXXXXXX XX/XX/XXXX XXX.X XXX.X XXXXXXXXXXXXXXXXXXXXXXXX XX/XX/XXXX XXX.X XXX.X ToTaL claims in ProceSS: The Explanation of Pending Status (EOPS) codes listed is not final claim denails or payment dispositions. The EOPS codes identify the reasons why a claim is in process. Because these claims are currently in process, new information cannot be accepted to modify the cliam until the claim finalizes and appears as finalized on your R&S letter. Please refer to the last section of this letter for the messages that correspond to the eops codes used on this letter. Page 5 of X 8 Version

9 garnishments Deductions listed below are a result of a Texas comptroller request. you can contact the Texas comptroller at XXX-XXXX. held amount your total payment after all increases, deductions, and adjustments is: Banner MeSSageS Page 6 of X Version