How to find your R&S Reports - TMHP

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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 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) How to find your R&S Reports-ITP 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
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