How to find your R&S Reports - TMHP

How to find your R&S Reports 

1) Go to www.tmhp.com 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. 

How to find your R&S Reports-ITP 

Version 2011 0805 1


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 100. 

7) Choose the appropriate R&S Report from the list by its date. 

2 Version 2011 0805

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 

01171 NO MTP AUTHORIZATION EXISTS FOR THE MTP CLAIM DATE OF SERVICE. 

01172 VALID DRIVER’S LICENSE FOR THE ITP WAS NOT ON FILE WITH TMHP ON THE MTP CLAIM DATE OF SERVICE . 

01173 VALID AUTOMOBILE INSURANCE FOR THE ITP WAS NOT ON FILE WITH TMHP ON THE MTP CLAIM DATE OF SERVICE. 

01174 THE MTP SYSTEM WAS NOT AVAILABLE AT THE TIME THIS CLAIM WAS RECEIVED. THE CLAIM WILL BE PROCESSED 

WHEN THE MTP SYSTEM BECOMES AVAILABLE. 

01175 THE MTP AUTHORIZATION SHOWS THE CLIENT HAS NO PROGRAM ELIGIBILITY FOR THE MTP CLAIM DATE OF SER- 

VICE. 

01176 THE PERSON RECEIVING TRANSPORTATION IS NOT ON THE LIST OF CLIENTS THE ITP IS APPROVED TO DRIVE ON THE 

MTP CLAIM DATE OF SERVICE. 

01177 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. 

01178 THE MTP CLAIM WITH A LODGING TAXES CLAIM DETAIL HAS NO CLAIM DETAIL PAID FOR A LODGING STAY. 

01180 THE REIMBURSED AMOUNT EQUALS THE LESSER OF THE MTP LEVEL 1 RATE MULTIPLIED BY THE AUTHORIZED 

UNITS OR THE BILLED UNITS. 

01181 THE AMOUNT BILLED ON THE MTP CLAIM HAS BEEN REDUCED TO MEET THE AUTHORIZED PERCENTAGE RATE. 

01182 NO REIMBURSEMENT IS ALLOWED FOR LODGING TAXES WHEN THERE IS NO ASSOCIATED LODGING STAY. 

Version 2011 0805 3


Sample R&S Report - ITP 

TMhP, Medical Transportation 

12345 riata Trace 

austin TX 78729-4569 

JohnaThon S. KenneDy 

123456 SouTh airPorT roaD 

corPuS chriSTi TX 79510-4569 

Dear Provider, 

The services below have been processed for payment. 

cLaiMS PaiD or DenieD 

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: 

1-800-925-9126 

cLaiM no. DaTe oF Service cLienT naMe 

MiLeS BiLLeD MiLeS PaiD aMT. PaiD 

eoB DeScriPTion 

XXXXXXXXXXXXXXXXXXXXXXXX XX/XX/XXXX XXXXXXXXXXXXXXXXXXXXXX 

XXX.X XXX.X $XXX,XXX,XXX.XX 

XXXXX XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX. 





XXXXXXXXXXXXXXXXXXXXXXXX XX/XX/XXXX XXXXXXXXXXXXXXXXXXXXXX 

XXX.X XXX.X $XXX,XXX,XXX.XX 






ToTaL cLaiMS PaiD: $XXX,XXX,XXX.XX 

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) 1-888-863-3638. 

Page 1 of X 

4 Version 2011 0805


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,XXX,XXX.XX XXX.X 






XX/XX/XXXX XXXXXXXXXXXXXXXXXXXXXX 

XXXXXXXXXXXXXXXXXXXXXXXX $XXX,XXX,XXX.XX XXX.X 






SySTeM PayouTS 

ToTaL aDJuSTMenTS: $XXX,XXX,XXX.XX 

PayouT conTroL nuMBer PayouT aMT. reF. cK. no. reF. cK. aMT. 


Page 2 of X 


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) 1-888-863-3638. 

XXXXXXXXXXXXX $XXX,XXX,XXX.XX XXXXXXXX $XXX,XXX,XXX.XX 


XXXXXXXXXXXXX $XXX,XXX,XXX.XX XXXXXXXX $XXX,XXX,XXX.XX 


your payment has been increased for the reason(s) indicated above. 

ManuaL PayouTS 

ToTaL SySTeM PayouT: $XXX,XXX,XXX.XX 

PayouT conTroL nuMBer PayouT aMT. 


XXXXXXXXXXXXX $XXX,XXX,XXX.XX 




a check has been sent separately as payment for the item(s) listed above. 

ToTaL ManuaL PayouT: $XXX,XXX,XXX.XX 

Version 2011 0805 5



BacKuP wiThhoLDing 

conTroL no. originaL DaTe aMT. wiThheLD 

XXXXXXXXXXXXX XX/XX/XXXX $XXX,XXX,XXX.XX 

XXXXXXXXXXXXX XX/XX/XXXX $XXX,XXX,XXX.XX 

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 $XXX,XXX,XXX.XX $XXX,XXX,XXX.XX $XXX,XXX,XXX.XX 

XXXXXXXXXXXXX $XXX,XXX,XXX.XX $XXX,XXX,XXX.XX $XXX,XXX,XXX.XX 

Due to the levy described below, payment(s) totaling $XXX,XXX,XXX.XX 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 $XXX,XXX,XXX.XX $XXX,XXX,XXX.XX 

XXXXXXXXXXXXXXXXXXXXXXXX $XXX,XXX,XXX.XX $XXX,XXX,XXX.XX 





$XXX,XXX,XXX.XX waS recovereD on ThiS accounT receivaBLe FroM an aFFiLiaTeD ProviDer. 




ToTaL DeDucTionS: $XXX,XXX,XXX.XX 

SuB-owner DeDucTionS 

Deductions listed below are a result of your affiliation with another provider. 

conTroL no. DeDucTeD aMT. 



ToTaL SuB-owner DeDucTionS: $XXX,XXX,XXX.XX 

Page 3 of X 

6 Version 2011 0805


voiDS/SToP PayMenTS 

r&S no. r&S DaTe checK no. aMT. voiDeD/SToPPeD 

XXXXXXXXXXXXX XX/XX/XXXX XXXXXXXX $XXX,XXX,XXX.XX 


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 






SuBToTaL cLaiM SPeciFic $XXX,XXX,XXX.XX 

non-cLaiM SPeciFic 

ToTaL voiDS/SToP PayMenTS: $XXX,XXX,XXX.XX 

r&S no. r&S DaTe checK no. aMT. reiSSueD 


The payment was increased by the amount(s) shown above. 

ToTaL SySTeM reiSSueS: $XXX,XXX,XXX.XX 

conTroL no. aMounT aPPLieD 


XXXXXXXXXXXXXXX $XXX,XXX,XXX.XX 




SuBToTaL non-cLaiM SPeciFic $XXX,XXX,XXX.XX 

ToTaL reFunDeD $XXX,XXX,XXX.XX 

Page 4 of X 


Version 2011 0805 7



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 






SuBToTaL cLaiM SPeciFic $XXX,XXX,XXX.XX 

non-cLaiM SPeciFic 

conTroL no. aMounT aPPLieD 






SuBToTaL non-cLaiM SPeciFic $XXX,XXX,XXX.XX 

cLaiMS in ProceSS 

ToTaL reFunDeD $XXX,XXX,XXX.XX 

cLaiM no. DaTe oF Service 

BiLLeD MiLeS BiLLeD aMT. aLLoweD MiLeS aLLoweD aMT. 

eoPS DeScriPTion 

XXXXXXXXXXXXXXXXXXXXXXXX XX/XX/XXXX 

XXX.X $XXX,XXX,XXX.XX XXX.X $XXX,XXX,XXX.XX 

XXXXX XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX. 





XXXXXXXXXXXXXXXXXXXXXXXX XX/XX/XXXX 

XXX.X $XXX,XXX,XXX.XX XXX.X $XXX,XXX,XXX.XX 






ToTaL cLaiMS in ProceSS: $XXX,XXX,XXX.XX 

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 2011 0805



garniShMenTS 

Deductions listed below are a result of a Texas comptroller request. you can contact the Texas comptroller at 1-800-XXX-XXXX. 

heLD aMounT $XXX,XXX,XXX.XX 

your total payment after all increases, deductions, and adjustments is: $XXX,XXX,XXX.XX 

Banner MeSSageS 

XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX 









Page 6 of X 

Version 2011 0805 9

How to find your R&S Reports - TMHP

Create successful ePaper yourself

Delete template?

Save as template?