NHICan EDS company

TDHconnect 3.0

08/27/03

08/27/03

Table of Contents

TDHconnect 3.0 Hardware and Software Requirements ...................................................................................................... 1

Functions of TDHconnect 3.0 ................................................................................................................................................ 1

Support .................................................................................................................................................................................. 2

Installation.............................................................................................................................................................................. 4

Software Updates (Service Packs)........................................................................................................................................ 8

TDHconnect Log On............................................................................................................................................................ 10

Set Up Communications...................................................................................................................................................... 11

Set Up Reference Files ....................................................................................................................................................... 14

TDHconnect System Maintenance...................................................................................................................................... 20

System Totals Window ........................................................................................................................................................ 30

Medicaid Eligibility ............................................................................................................................................................... 34

Medicaid Claims .................................................................................................................................................................. 41

Medicaid Claim Status Inquiry (CSI).................................................................................................................................... 61

Medicaid Electronic Remittance and Status (ER&S)........................................................................................................... 66

Medicaid Appeals ................................................................................................................................................................ 68

TDHconnect Log On Error Messages ................................................................................................................................. 78

Terminology......................................................................................................................................................................... 80

Shortcut Keys ...................................................................................................................................................................... 81

Function Keys ...................................................................................................................................................................... 81

TDHconnect Order Form ..................................................................................................................................................... 83

National Heritage Insurance Company Electronic Remittance and Status (ER&S) Agreement Instructions ..................... 85

National Heritage Insurance Company Electronic Remittance and Status (ER&S) Request Agreement .......................... 86

Request for Electronic Funds Transfer................................................................................................................................ 87

Claim Status Inquiry Authorization ...................................................................................................................................... 89

Texas Medicaid TDHconnect 3.0 Workshop Evaluation ..................................................................................................... 91

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TDHconnect 3.0 Hardware and Software RequirementsMINIMUM PC REQUIREMENTS

PC with a Pentium II (2) class processor, 400 Mhz128 MB of RAM100MB hard disk space for installation, plus 3 times the size of the databaseCD-ROM drive for installation800 x 600 VGA (monitor resolution), 256 colorsMicrosoft Windows 95 or later operating system or Microsoft Windows NT operating system version 4.0 withService Pack 6 or later. Note: Windows XP is not supported at this time.9600 bps modemAdobe Acrobat Reader 4.05 or higher (4.05 is included on the installation CD)Microsoft Internet Explorer (I.E.) 4.01 with Service Pack 2 (Microsoft Internet Explorer 5.0 will be included on theTDHconnect installation CD.)

Important:• Providers in rotary dial areas cannot use TDHconnect 3.0.• TDHconnect does not work with T1 or cable modem transmission lines. It does work with a standard telephone line

or the slower port of a DSL connection that a telephone could connect to.• A basic knowledge of Windows is required.• The section titled “Log On” provides basic information on how to log in after TDHconnect 3.0 software installation.

Functions of TDHconnect 3.0With TDHconnect 3.0 you can:� Administer billing for Family Planning, Long Term Care, Medicaid, and CSHCN clients (see HIPAA table below)� Support the submission of Blue Cross and Medicare claims� Access the same database simultaneously for up to ten concurrent users per database

HIPAA Compliant Transaction TypesEligibility Request 270Eligibility Response 271Professional Claims 837PInstitutional Claims 837IDental Claims 837DClaim Status Inquiry 276Claim Status Inquiry Response 277Electronic Remittance and Status Report 835

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SupportIn no event will NHIC be liable to you for damages, including any loss of profits, lost savings, or other incidentalor consequential damages arising out of your use, inability to use, or interpretation of these instructions.

DocumentationIn addition to the instructions contained in this manual, the installation and setup instructions are also contained in thebooklet “TDHconnect 3.0 Service Quick Start Guide” shipped with the software. The guide is also available inTDHconnect (after installation) by clicking Help → Online Manuals → Quick Start Guide.

Technical AssistanceThe Electronic Data Interchange (EDI) Technical Helpdesk provides technical assistance only by troubleshootingTDHconnect 3.0 and Texas Medicaid Network (TexMedNet) system problems. Contact your system administrator forassistance with modem, hardware, or phone line issues.

To reach the EDI Technical Helpdesk, select one of the following methods available Monday through Friday, 8 a.m. to5:30 p.m. Central Standard Time:� Fax 512-514-4230 or 512-514-4228 (Expect a response within 24 hours)� E-mail nhictexmed@eds.com� For Medicaid, CSHCN and Family Planning technical issues, call 888-863-3638 (or in Austin, call 512-514-4150)� For Long Term Care technical issues, call 800-626-4117 (Select option 2) (or in Austin, call 512-335-4729)(Providers in rotary dial areas cannot use TDHconnect 3.0)

Training AssistanceThe EDI Technical Helpdesk does NOT provide training. Call your NHIC Provider Relations training specialist or attendone of the training workshops provided by NHIC Provider Relations.� For training specialist contact information, call NHIC Customer Service at 800-925-9126 (select option 5) or visit our

website at www.eds-nhic.com.� For CSHCN Customer Service, call 800-568-2413.� For Long Term Care (LTC), call NHIC LTC Helpdesk at 800-626-4117 (in Austin dial 512-335-4729).� For Medicaid and Family Planning information, call NHIC Customer Service at 800-925-9126 (select option 5).� For workshop and other information, visit www.eds-nhic.com� For other Medicaid customer service numbers, refer to the 2003 Texas Medicaid Provider Procedures Manual,

Telephone and Addresses Guide, pages v through x.

Claim AssistanceFollowing is contact information for questions regarding electronic or paper claims:� For Medicaid, Family Planning, and CSHCN claims assistance, call NHIC Customer Service at 800-925-9126 (Select

option 5 to speak to a Customer Service Representative) or refer to the NHIC web page, www.eds-nhic.com, and linkto Medicaid workshop schedules and FAQs.

� For Long Term Care (LTC), call NHIC LTC Operations at 800-626-4117 (in Austin, call 335-4729), select option 1, orrefer to the NHIC web page, www.eds-nhic.com, and link to the LTC home page.

� For other customer service numbers, refer to the 2003 Texas Medicaid Provider Procedures Manual, Telephone andAddresses Guide, pages v through x.

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TDHconnect 3.0 Online Help (after installation)The help topics provide instructions for using TDHconnect 3.0. To access help from the menu, click Help, and then clickContents and Index or click the help book icon on the toolbar. Press F1 to open related help topics for each window.Contents, Index, Search, and Favorites tabs appear on the left side of your browser window to access help topics. Theright side displays the selected help information and instructional steps.Important: To run TDHconnect 3.0 help, Internet Explorer 4.01 Service Pack 2 or higher must be installed on your PC.� The Contents tab contains a multi-tiered list of help topics in TDHconnect 3.0 help.� The Index tab contains an index for TDHconnect 3.0 help. Information is organized alphabetically.� The Search tab works like most Internet search engines. In the "Type in the keyword to find" field, type the word or

words you want to find, and then click List Topics. The help system returns a list of the help topics that contain theword you typed.

� The Favorites tab allows you to mark the address of a help topic you use regularly. Open the help topic and clickAdd in the Favorites tab. The current topic is added to the tab as a link.

Display the TDHconnect 3.0 User ManualAdobe Acrobat Reader 4.01 with Service Pack 2 or higher is required in order to open, display, and print the onlineTDHconnect 3.0 User Manual. When using a printed copy, remember that the flow of information is intended for onlineviewing, not hard copy reading.

Print the TDHconnect 3.0 User Manual1. On the main menu, click Help → Online Manuals → User Manual.2. On the Acrobat Reader main menu, select File and click Print.3. Select the printer and printer settings.4. Click OK.

NHIC Web SitePublications and forms can be downloaded from the www.eds-nhic.com site, by clicking either “TDH-NHIC 2003Publications” or “Downloadable Forms and Manuals”. Publications include the 2003 Texas Medicaid ProviderProcedures Manual and bulletins.

TexMedNetTexMedNet is available through either an Internet Service Provider (ISP) or through a dial-up connection. The simplestmethod of connecting to TexMedNet is through www.texmednet.com. For instructions on establishing a dial-upconnection, see the section “Software Updates (Service Packs)” in this manual.

To access file libraries in TexMedNet:� From the TexMedNet home page, click File Libraries. The “Enter Network Password” window displays.� Enter the user ID in the User Name field. For most users it will begin with "P." The default ID is “guest” (in lower

case).� Enter the Password in the password field. For most users the password will be “temp1” (in lower case). The default

password is “state” (in lower case).

Some of the libraries are:� “03manual” Contains 2003 manuals such as the 2003 Texas Medicaid Provider Procedures Manual.� “BNPG” Contains banner pages.� “Bulletin” Contains bulletins.� “Feesched” Contains fee schedules.� “TDHUPDT” Contains service packs (software updates).

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InstallationHelpful Hints� If installing TDHconnect on a local area network (LAN):

� The system administrator must install TDHconnect 3.0 on each PC and install the databases in a common LANlocation.

� The system administrator must map the individual PCs to the database location on the LAN.� Since there is only one database (located on the server), only one Compass 21 user ID and password is needed.� The most current TDHconnect service pack must be installed on each PC that has TDHconnect 3.0.� If you need to submit CSI requests or download the Electronic Remittance and Status report, you need to obtain

the appropriate form from www.eds-nhic.com or from the EDI Technical Helpdesk. On the TDHconnect mainmenu (Systems Totals window), select Communications, then click System Settings. Verify you have aproduction user ID in the Compass21 and/or CMS user ID fields.

� TDHconnect 3.0 does not support modem pools.� Administrative rights are required when installing to a network.

� "How to" documents explaining how to transmit transactions are located atwww.eds-nhic.com under the Electronic Data Interchange link.

� To learn more about current TDHconnect 3.0 issues, visit www.eds-nhic.com. Click the Electronic Data Interchangelink or the Long Term Care link for more information. Copyright (©) 2001-2003 Electronic Data Systems Corporation.All rights reserved. Acrobat (®) Reader (©) 1987-1999 Adobe Systems Incorporated. All rights reserved. InternetExplorer (©) 1995-1999 Microsoft Corp. All rights reserved.

Before installing TDHconnect 3.0, carefully read and follow the sequence of installation tasks listed below.If the installation sequence is interrupted TDHconnect 3.0 will not install correctly.

Pre-Installation Steps1. Determine that the computer(s) meet the hardware and software requirements, previously mentioned.

2. Verify that Internet Explorer (IE) 4.01 Service Pack (SP) 2 or higher is installed. To determine the version of InternetExplorer installed on your system, start Internet Explorer and select “About Internet Explorer”. Internet Explorer (IE)5.0 is included in the TDHconnect 3.0 Installation CD-ROM. If an earlier version of Internet Explorer is installed,uninstall it and install Internet Explorer 5.0 from the CD-ROM. If no version of Internet Explorer is installed, theninstall Internet Explorer 5.0 from the CD-ROM.

To uninstall a program, go to the Start menu (in lower left corner of screen) and click Settings, then Control Panel.Double-click Add/Remove Programs. In the Install/Uninstall tab, click the program to be removed and then click theAdd/Remove button.

To install a program, go to the Start menu (in lower left corner of screen) and click Settings, then Control Panel.Double-click Add/Remove Programs and in the Install/Uninstall tab click Install. Insert the CD-ROM containing theprogram to be installed and click Next.

3. If Acrobat Reader 3.0 is installed, it must be uninstalled. (See above to uninstall a program or contact your systemadministrator for assistance. If you do not have a system administrator, please contact the appropriate technicalassistance group.)

4. Create and save an external backup of TDHconnect 3.0 onto tape, CD-ROM, or a separate machine if available.

5. Purge old records from TDHconnect if this has not been done. From the TDHconnect Explorer, click the plus sign(+) next to System and the double-click Database Utilities. Select the Purge tab and select the program to bepurged. In the Age in days box, enter or select the number of days. Only records older than the number of daysdefined in this box will be purged. Click Purge to purge the records for the selected programs.

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6. Compress the database by clicking the plus sign (+) next to System (on the left side of the screen) and then double-click Database Utilities. Select the Compress tab and select the program to be purged. Only one database at atime can be compressed. Click Compress.

7. Close all open applications on the desktop.

Installation StepsImportant: Administrative rights are required when installing TDHconnect 3.0 in a Windows network environment.

1. Close all open programs on your desktop.

2. On the Start menu, select Settings, and then click Control Panel.

3. Double-click Add/Remove Programs.

4. In the Install/Uninstall tab, click Install.

5. Insert the installation CD into your CD-ROM drive. Click Next.

6. Click Browse.

7. In the Look in field, select the location of your CD-ROM drive.

8. Select "Setup.exe" from the list of files, and then click Open.

9. Click Finish. The TDHconnect 3.0 installation window opens.

10. Read the TDHconnect Welcome screen, and click Next, and Next again to confirm that you are about to installTDHconnect.

11. When the Choose Destination Location window opens, click Next to install the default installation location, or clickBrowse to select a new location.

12. In the Start Copying Files window, click Next.

13. When the Acrobat Reader 4.05 Setup window opens, click Next. If you have Acrobat Reader 4.05 or higher alreadyinstalled on your system, click Cancel, then Yes, and skip to step 16.

14. When the Choose Destination Location Window opens, click Next to install to the default location, or click Browse toselect a new location. A message appears: “Copying program files…”.

15. When the Information window displays “Thank you for choosing Acrobat Reader!”, click OK.

16. The following message appears: “Do you wish to backup your databases” This will overwrite databases that are inthe Backup folder.” Click Yes to backup the existing databases, or No to avoid backing up the databases.

17. The Setup Complete window opens. Select either “Yes, I want to restart my computer now.” or “No, I will restart mycomputer later”, and click Finish to close the window.NOTE: TDHconnect 3.0 will not finish installing until after you have restarted your computer.

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Set Up the Dialing Properties in a Windows Operating SystemImportant: This setup does not apply to Windows 2000. For all providers, before you can send requests and retrieveresponses, you must set up your dialing properties and communications settings in TDHconnect 3.0.

1. From the Start menu, select Settings, then click Control Panel.

2. Double-click the Modems icon. If you have more than one modem installed or listed in the Modems Propertiesdialog box, select the modem that was setup during installation.

3. On the Modem Properties dialog box, click Dial Properties.

4. If you must dial a number to access an outside line, proceed to steps 5 and 6. (If not, skip to step 7.)

5. In the "To access outside lines for local calls, dial" field, type 9. (You may substitute another number instead of 9if your service requires it.)Important: If using Windows 95 and 10-digit dialing is required, also enter your area code.

6. In the "To access outside lines for long distance calls, dial" field, type 9. (You may substitute another numberinstead of 9 if your service requires it.)

7. In the Dialing Properties window, click Apply, then click OK.

8. In the Modem Properties window, click Close. Exit the Control Panel window.

Finish Installation1. If TDHconnect 3.0 is still open, exit the program.

2. If other applications are added after installing TDHconnect 3.0, the system administrator (or appropriate technicalassistance group) should test TDHconnect 3.0 to ensure that the other applications did not disable it.

Important: After installation, download the most recent Service Pack (see next section) to get critical software updates!Check with www.eds-nhic.com or www.texmednet.com for the most recent Service Pack release.

Data ConversionEDS/NHIC is not liable for any data lost during the conversion process. It is your responsibility to take the appropriatesteps to back up and save your data before beginning the data conversion process.

Installation converts eligibility, claims, claim status inquiry and electronic remittance and status reports data toTDHconnect 3.0 automatically. All acute care completed claims are converted with the status of Incomplete. As a result,you have to open all converted claims and save them. If the claim passes TDHconnect 3.0 edits, the claim saves asComplete; however, the word “Complete” should not be confused with a claim being processed and finalized by NHIC,rather, a completed claim is stored on your hard drive and is ready to be submitted to NHIC.

Note to providers who file eyeglass appeals: If you convert data from TDHconnect 2.0 to TDHconnect 3.0, any rejectedeyeglass appeals that were stored in TDHconnect 2.0 will have to be manually re-entered in TDHconnect 3.0 beforeresubmitting the eyeglass appeal.

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Convert Existing Appeals to TDHconnect 3.0The Data Conversion process converts appeals information. If the data conversion process stalls or stops duringprocessing and does not complete correctly, it is possible that your old database might be corrupted or you might loseold data.

1. Back up and save your TDHconnect 2.0 data prior to conversion.

2. Exit all versions of TDHconnect, including TDHconnect 3.0.

3. From the Start menu, select Programs, then TDHconnect.

4. Click ConvertAppeals.

5. The TDHconnect Appeals Conversion window opens. Click the type of appeals to be converted, such as “ConvertMedicaid Appeals” for Medicaid appeals. The totals in the windows change to reflect the conversion changes.

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Software Updates (Service Packs)The TexMedNet Web site contains information such as bulletins, banner pages, the Provider Procedures Manual(s), aswell as TDHconnect updates (service packs). There are two ways to connect to the Texas Medicaid Network(TexMedNet) Web site (formerly known as TexMedNet BBS):1) through an internet service provider (ISP) or 2) through Windows Dial-up Networking.

Important: Administrative rights are required when installing updates to TDHconnect 3.0 in a Windows NT or Windows2000 environment.

Staying current with the most recent service pack for TDHconnect software is very important as the updates may containcritical changes which affect billing. Routinely check the web sites as described below to see if new service packs havebeen released and if so, be sure to download and install them. Service packs are comprehensive, so that the mostrecent service pack contains the changes made in prior service packs and service releases.

The two main methods of downloading service packs are through a web site or through a dial-up connection.Downloading from a web site incurs the cost of having an Internet service provider whereas the dial-up connection incurslong distance telephone charges.

NOTE: It is not necessary to be connected to the TexMedNet web site or to have an Internet service provider to submitclaims, eligibility requests, appeals, or claim status inquiries through TDHconnect.

Connect to TexMedNet (choose one of the following, although the first option is recommended):Downloading through an Internet Service Provider (ISP)� Open Internet Explorer. (If not connected, first connect to your ISP.)� In the address line, type www.texmednet.com. The TexMedNet Web site should open and display

"Welcome to TexMedNet!".� Follow the instructions “Log on to TexMedNet” listed below.

Downloading through a dial-up connection� Create a dial-up Connection profile called "TexMedNet." (See the "Access TexMedNet" topics in the

TDHconnect 3.0 User Manual.) Remember to use 512-514-4899 as the phone number, bbsguest as theuser ID, and state as the password.

� Dial the TexMedNet dial-up connection profile previously created.� When the connection has been established, open Internet Explorer.� Type 209.99.78.2 in the address line. The TexMedNet Web site should open and display "Welcome to

TexMedNet!"

Log on to TexMedNet� From the TexMedNet home page, click File Libraries. The “Enter Network Password” window displays.� Type the user ID in the User Name field. For most users it will begin with "P." The default ID is “guest” (in lower

case).� Type the password in the Password field. For most users the password will be “temp1”. The default password is

“state” (in lower case).� Click OK. The area of the Web site you selected will appear.

Download the most current TDHconnect 3.0 Service Pack1. Click once on the TDHUPDT library in the lower left-hand pane.

2. Click once on the filename of the readme file for the Service Pack (e.g. TDHSP1.TXT) from the list of files in theright-hand pane. This readme file contains important and helpful information on the following topics:• Information on the improvements included in the service pack.

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• Downloading a TDHconnect 3.0 Service Pack• Installing a TDHconnect 3.0 Service Pack• To read this file online, use the PAGE DOWN and PAGE UP keys. Print the file by clicking Print on the File

menu in the Windows-based editor or viewer.

3. Click once on the filename of the Service Pack (e.g. TDHSP1.EXE) from the list of files in the right-hand pane. Youwill be prompted to: "Run this program from its current location" or "Save this program to disk".

4. Select "Save this program to disk", and then click OK. A dialog box will open.

5. Download the file to the desktop by clicking on the black arrow to the right of "Save in" for the drop down menu. Clickonce on Desktop from the drop down menu, and then click Save. The file downloads to the desktop.

6. After the file downloads, click Close and exit TexMedNet.Note: The download can also be made from the Downloads and Updates <./downloads.html>sections of theTDHconnect Online Helpdesk.

Install the TDHconnect 3.0 Service Pack1. From the desktop, double click on the icon added by the completed download (The file can be moved to a location on

a LAN to share with other TDHconnect 3.0 users.)

2. A message box opens with the following message: "This will install TDHconnect 3.0 Service Pack #. Do you want tocontinue?" Click Yes to install the TDHconnect 3.0 Service Pack.

3. The TDHconnect Service Update Installation Utility window appears then the TDHconnect 3.0 Service Pack wizardopens.

4. Several informational messages appear. Click Next with each message.

5. A message box opens with the following message "Do you wish to backup your databases? This will overwritedatabases that are in the Backup folder." Click "Yes" if you want to backup your databases before installing anydatabase updates. Click "No" if you want to continue with the installation with out making backups.

6. Several additional informational messages appear. This process may take several minutes as database updates arebeing made.

7. Installation of the TDHconnect 3.0 Service Pack is complete. To view the readme file, check the box then clickFinish. The readme document opens.

8. After reading the document, close it by clicking the X in the upper right hand corner, then uncheck the box and clickFinish.

9. When prompted to restart the computer, choose Yes, I want to Restart my computer, then click Finish.

10. The next time TDHconnect is opened, the version of the service pack will be displayed along with the name“TDHconnect 3.0”.

Alternative Method of Downloading: Using the eds-nhic web siteThis is the simplest way to download service packs but requires an Internet Service Provider and may be slower thanconnecting to TexMedNet described below. To download from the eds-nhic web site:� Open Internet Explorer.� In the address line, type www.eds-nhic.com.� Click “Electronic Data Interchange”, click “Downloads and Updates” and follow the online instructions.

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TDHconnect Log OnImportant: Each user must have a unique TDHconnect user ID and password. Additional user IDs can be created inTDHconnect using the security function.1. Double-click the TDHconnect 3.0 icon on your desktop.2. In the User ID field, type the word "admin" in lowercase letters, and then press the TAB key.3. In the Password field, type the word "password" in lowercase letters. This password field is always case sensitive.4. Click OK.

� When logging on, error messages may be displayed such as:• “admin is currently logged on to TDHconnect”, or• “TDHconnect is already running. Please open Task Manager and End Task for the Shell and Hints tasks

that are running.”To resolve these errors, see the section “TDHconnect Log On Error Messages” on page 79 of this manual.

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Set Up CommunicationsSet Up Communications – System SettingsImportant: An ECMS production user ID and password must be requested from the EDI Technical Helpdesk. Afterlogging in, the System Totals screen is displayed. This is the main screen in TDHconnect. From the main menu, selectCommunications, and then click System Settings.

� In the User ID field in the Compass 21 section, enter the Compass21 User ID (not the logon ID) that the EDITechnical Helpdesk issued, in lower case. In the Password field to the right, enter the Compass21 password thatthe EDI Technical Helpdesk issued in lower case. Also enter the Organization Name, or if the name has a lastname and a first name, enter those.

� In the ECMS field, type the ECMS telephone number (866) 627-0015.

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Set Up Communications – System Settings (continued)� Next, click the Contact Information tab.� Enter the last name, first name and phone number of a contact person at the company.� Click Apply, and then click OK.

Set Up Communications - Modem� From the TDHconnect 3.0 main menu, select Communications, and then click Modems.

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Set Up Communications – Modem (continued)� In the Connect using drop-down menu, select the modem name.� In the From location drop-down menu, select the location, such as “new location”.� Click OK.

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Set Up Reference FilesThe client and provider reference files are not required to file claims and appeals. However, they are recommended andcan be time saving when filling out forms and can reduce the chance of keying errors.

The tree view on the left side of the Systems Totals screen that contains yellow folders is referred to as the TDHconnectexplorer. To expand a folder within the tree click on the + sign and to close the folder click on the – sign.

Reference Files – Add ClientsNote: New clients can also be added through eligibility or MESAV responses.� Click the + sign next to Reference Files and then double-click Client.� The existing clients are displayed.� To add clients manually, click Add.

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� Fields with bold headings are required.� Click the Client Status box located next to the appropriate program name.� Click the program in the Launch Program for Client menu (this example chose Medicaid).

� The tabs for a Medicaid client are Client Detail, Associated Provider, Authorization, Diagnosis, Other Insurance, andMiscellaneous.

� Although the fields in these tabs may be manually completed at this time, a faster method is to only enter theAccount No. and the Medicaid No. at this time and use the Eligibility request to fill out the other fields (see theEligibility section). The Account No. is a 1 to 20 character alphanumeric field assigned by the provider (not NHIC) totrack the client. The Medicaid No. is the 9-digit client/Medicaid No.

� After entering this data, click OK.

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Reference Files – Add Clients (continued)

� The screen automatically returns to the client setup screen.� Enter another client or click cancel to close.

Reference Files – Add a Provider� To add a provider record to the database double click on Provider.� Click Add.

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Reference Files – Add a Provider (continued)

� Complete the provider information fields. Fields with bold headings are required.� Click the provider status box next to the appropriate program.� Click the program in the "Launch Program for Provider" menu to continue to the next screen. This example shows

Medicaid selected.

Enter the nine-digit Texas Provider Number (TPI), which is required. The other fields are optional.� Click OK.

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Reference Files – Reference Codes� Double-click Reference Codes to view procedure codes, diagnostic codes, billing codes, EOB codes, etc. These

codes are included with TDHconnect.� To view more than the first 50 entries, use the Filter function. The Autofind Column window displays the code that

was selected in the Codes window. Enter a code in the Autofind Text window, and as the code is entered, theDescription window above lists entries matching the Autofind Text.

� To see different types of codes, scroll up or down the Codes window and select the desired code (e.g. Procedures,Diagnosis, EOB, EOPS, etc).

� When in claims or appeals, and the cursor is in a code field, the F2 key can be pressed to access these codes whichcan be used to auto-populate the forms.

� Modifiers and billed amounts can be added to procedure codes and used later to auto-populate claim forms. To addmodifiers or billed amounts to procedure codes, click the procedure code (using Filter if necessary to locate it) thenclick the modifier field or billed amount field and enter the desired data. Repeat for each modifier or billed amount tobe added. When finished, click OK.

� To exit click Cancel.

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Reference Files – (Retrieve Other) Download Reference Codes� Although TDHconnect includes reference codes, these codes change and need to be periodically downloaded. Be

sure to compress the database (see the database functions in the System section) after downloading codes. Todownload Compass 21 (C21) reference codes:

� From the System Totals screen click the Retrieve Other tab.� Scroll down to the C21 Reference Codes.� Click the appropriate boxes for codes to be downloaded.� Click the Download button.� After the download is complete, go to the System database functions and compress the database.

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TDHconnect System MaintenanceSystem – System FunctionsTo view system functions click the + sign next to System. This opens the system folder.

System – Database UtilitiesThe maintenance features of backing up files, purging files and compressing the database are important to keepingTDHconnect to a reasonable file size. After sending and receiving requests, the database becomes larger and responsetime may eventually become slower. These database utilities help maintain the response time.� Double-click Database Utilities to display the Database Utilities window.

System – Database Utilities – Compress� Click Compress to compress the database into a smaller area of the hard drive. To improve the performance of the

computer, this feature should be used once per month and after purging data.

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System – Database Utilities – Purge� The Purge tab is used to purge old data from TDHconnect.� Scroll through the menu, click on data to be deleted, and click the Purge button.� In the Age in days box, enter how old (in days) the data must be to be deleted. Any data that is as old or older

than the number of days entered will be deleted.� Finally, click the Purge button to delete the data.Note: It's a good idea to do a back-up before purging data, and to do a Compress after purging.

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System – Database Utilities – MapperNote: Mapper is used mainly when multiple users are sharing one TDHconnect database, although any TDHconnectuser can change the location of the database. The system can support only up to 10 concurrent users. When shared,the database is located on a server and TDHconnect is installed on the computers connected to the server. Thedatabase is shared but TDHconnect itself is not.

To set up concurrent users:� First, create a folder on the server where the TDHconnect database is to be stored (and shared).� After installing TDHconnect 3.0 on the computers that access the server (accepting the default database location),

the Mapper function can be used to locate the TDHconnect database on the server.� Another option is to point to the database on the server during installation of TDHconnect on each computer.

Important: Administrative rights are required when installing TDHconnect 3.0 in a Windows NT or Windows 2000environment.

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System – Database Utilities – Back-up� In the Back-up tab, click the Select box for the type of data to be backed-up (e.g. Medicaid), then click the Back-up

button. Note: Be careful not to accidentally click the Restore button because it will write over the existing databasewith the backed-up database copy and any changes that occurred since the previous back-up will be lost.

� A back-up copy of the databases chosen is placed in the TDHconnect backup folder. This also overwrites theprevious backup.

� To back-up the data to a different drive (in case of hard disk failure) contact your system administrator or computersupport.

System – Password Admin� To change the password of the user currently logged in, click Password Admin under System. Enter the current

password, enter the new password again to confirm, then click OK. Note: If the password is changed and forgotten,NHIC’s EDI technical support team will be unable to assist in getting into TDHconnect.

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System – Scheduling� The scheduler is used to schedule future events such as sending requests to NHIC, getting responses from NHIC

and completing database maintenance.

System – Scheduling - Options� The Options tab is used to allow, or not allow, events to be scheduled. Note: The PC must be on and the user must

be logged into TDHconnect at the time the event is scheduled! Be sure to schedule events at least 15 minutes apart.

System – Scheduling – Send Requests� To schedule to send a batch of requests to NHIC, click the Send Requests tab and then click the Add button.� Click the down arrow beside the Type window to select an event.� Click the down arrow beside the When window to select a date.� Then enter the hour, minute, second, and AM or PM in the window below the date.� Select an Interval. If Irregular is selected, enter the number of days in the window to the right.� The Age box is not used to send requests.

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System – Scheduling– Get Responses� Click the Get Responses tab to schedule the retrieval of batch responses. If "send requests" have been scheduled

then consider scheduling retrieving them the following day.� The windows are similar to the Send Requests tab.� Click Apply and then OK to schedule.

System – Scheduling– Database� The Database tab serves to back up, compress, or purge files from the database. These are valuable functions of

the Scheduler. Compressing the database is recommended after downloading codes.� Select one of the purge requests, then enter how old (in days) the files are that should be deleted in the Age window.

(Refer to page 20 for complete purge instructions.)� Click Apply and then OK to schedule.

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System – Scheduling – History� The History tab displays any scheduled events that occurred as successful or unsuccessful and should be used to

verify scheduled events.� If the event was unsuccessful, submit the request or response retrieval in the Program Summary window or go to

Database Utilities for database maintenance.

System –Security Administration� Security Administration is used to set up new TDHconnect users.� TDHconnect is set up with a default user called Admin.� Click the Add User button to bring up the Security Wizard.

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System - Security Administration – Wizard Step 1� Follow the Security Wizard step-by-step instructions to add a user.� An orange square indicates the step in process.� Fields with bold titles are required fields.� The word "password" should be used as the password. New users will be asked to change their password the first

time they login.� Click Next to advance to the next step.

System - Security Administration – Wizard Step 2� In step two, choose the program that the new user will need access to by double clicking the program name in the

Program Options menu. The program is moved to the Selections box.� To deselect a program, double click on it in the Selections Box and it will be returned to the Program Options menu.� This example indicates that four programs were selected.� Click Next to continue.

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System - Security Administration – Wizard Step 3� Select the options that the new user will have access to use.� Click the + sign by the user ID to see available programs and click the + sign next to a program (such as Medicaid) to

see the options.� Click any + sign to expand options such as claims, CSI, etc.� Double-click any green ✔ to remove that program. The removal is indicated by a red X. To reverse this action and

restore a program, double-click a red X and it becomes a green ✔ .� Click Next when done.

System - Security Administration – Wizard Step 4� Step four summarizes the functions that the user can complete.� To change a selection click Back, otherwise click Finish to add the user.

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System – TexMedNet� There are two ways to enter TexMedNet: 1) Dial-Up Connection or 2) Internet Explorer.� If an active Internet Explorer has not been established, a Dial-Up Connection window will be displayed after the

user has double-clicked on TexMedNet.� Create a dial-up connection by entering bbsguest in the User name field and state in the password field. Click

Save password to avoid having to complete these steps in the future.

� If an active Internet Explorer has been established, a User Information window will be displayed after the user hasdouble clicked on TexMedNet.

� Enter guest in the User ID field and state in the password field, then click OK.

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System Totals Window

System Totals Window – Program Summary TabThe Program Summary tab displays programs (Medicaid, Long Term Care, etc.), request types (eligibility, claims, etc.)and request status (number of completed, submitted, accepted, or rejected requests).

Status for Batch Requests:� Completed: A request (eligibility, claim, appeal, or claim status inquiry) was entered into TDHconnect and passed all

the local edits, but it has not been submitted to NHIC. Completed requests convert to submitted status after beingsent to NHIC in a batch.

� Incomplete (displayed in claims section only): The request was entered into TDHconnect but did not pass all thelocal edits and is not ready to submit to NHIC. Incomplete requests convert to completed status after completion.

� Submitted: The request has been transmitted to NHIC for processing (see the Send Requests section later).Submitted requests convert to Processed after the response has been downloaded from NHIC.

� Processed (displayed in later sections): Twenty-four hours after submitting a request, download the request to see ifit was accepted or rejected.

� Accepted: Electronically submitted requests that have passed the acceptance edits at NHIC, have been assignedan ICN (a unique claim number) and will be further processed in the NHIC system. Note: An accepted claim doesnot guarantee payment, only that it is accepted for further processing and will be paid or denied after it finishesprocessing. To see the status of accepted claims, check the Remittance and Status reports or run a Claim StatusInquiry. An agreement must be signed with NHIC to perform claim status inquiries. Call Electronic Data Interchange(EDI) at NHIC (888-863-3638) and also see the Claim Status Inquiry Authorization toward the end of this manual.

� Rejected: Electronically submitted requests that received a response indicating the request has been sent back forerrors. The request may be corrected and resubmitted. Note: Rejected claims do not receive an ICN and will notappear on the Remittance and Status Report, nor can they be seen on a Claim Status Inquiry. It is criticallyimportant to download all submitted claims and appeals to see if any rejected and work them immediately.

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Diagram of Batch versus Interactive Transmission

A common error has been to click the “OK” button in claims or appeals and assume that the transaction has been sent toNHIC. Another common error has been to submit the claim or appeal to NHIC but not retrieve the response the next dayto see if the claim or appeal was accepted or rejected. If all four steps of a batch transmission are not performed,any claims or appeals that were rejected may be missed, causing possible loss of reimbursement.

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System Totals Window – Send Requests� The Send Requests tab allows the user to send “batches” or groups of appeals, claims, claim status inquiries, or

eligibility requests.� To send batches to NHIC click the Send box for the appropriate program and click Submit.� When the transmission to NHIC ends correctly, click the Program Summary tab and the sent requests will change

from “completed” to “submitted” status.

System Totals Window - Retrieve Responses� Approximately 24 hours after submitting requests to NHIC responses will be available. To view responses click the

Retrieve Responses tab. Click the appropriate download box to retrieve the responses and click Download.� If unable to retrieve a response 48 hours after submitting a request, call Electronic Data Interchange (EDI) at 888-

863-3638 for technical help.� To verify that responses were successfully downloaded click on the Program Summary tab. The status should be

changed from "submitted" to either "accepted" or "rejected.”

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System Totals Window – Retrieve Responses (continued)Important: "Rejected" claims are not kept by NHIC and are not included in Remittance & Status (R&S) reports or claimsstatus inquiries. If the rejection is within the original 95-day deadline (one year for out of state) from the date of service,then correct and resubmit the rejected claim. If beyond the original 95-day filing deadline, the next deadline is 180 daysfrom the date of the rejection. In this case, the rejection report would need to be printed (to prove timely filing) and sentalong with a paper claim to NHIC.

System Totals Window – Retrieve Other� The Retrieve Other tab is used to electronically download R&S reports and reference codes.� Electronic R&S (ER&S) reports are available weekly at 6:00 A.M. each Monday.� To retrieve Electronic R&S reports, click the Download box on the ER&S row, then click the Download button.

Note: An ER&S agreement must be on file with NHIC in order to download ER&S reports.� To retrieve reference codes, click the appropriate Download boxes in the Download column, then click the Download

button.� The Process ER&S button is used only if there is an error downloading the ER&S.

Note: The Electronic R&S report cannot be seen from the Retrieve Other tab. To generate and view the Electronic R&Sreport after it has been downloaded, see the section “Medicaid Electronic Remittance and Status (ER&S)” discussedlater in this manual.

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Medicaid EligibilityThe purpose of eligibility requests is to verify that the client has Texas Medicaid eligibility. An eligibility request will returnvery helpful information, such as if the client is in an HMO, has other insurance, no longer has Medicaid eligibility, etc.Refer to the 2003 Texas Medicaid Provider Procedures Manual, Section One, for related policy information.

Changes due to HIPAAUnder HIPAA, the electronic eligibility request is standard 270, and the electronic eligibility response is standard 271.What has changed:� The last name and the suffix are now in separate fields on eligibility requests and responses, so separate the suffix

field even if the paper 3087 shows the suffix appended to the last name.� On the eligibility response, authorization information will no longer be available, so Customer Service may be

contacted at (800) 925-9126.� TPR (Third Party Resources) relationship to the insured will no longer be available on the eligibility response.

Medicaid Eligibility – Beginning the Request� Click the + sign next to Medicaid to expand the folder.� Double-click Eligibility to display the Medicaid Eligibility Request/Response Summary window.

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� Click File, and then click New to start a new eligibility request.

� To complete the Request information, enter the Provider ID (TPI) or click the magnifying glass to select the ProviderID. Enter the Start and End Dates. The Start and End dates can be up to three months’ span. The End date can beas recent as the current date. The date span can go back as far as three years.

� Enter any of the listed field combinations: Medicaid number; SSN and Last Name; SSN and date of birth; or lastname, first name, and date of birth. Suffix is not contained in the last name field, but has its own field.Note: Enter the minimum amount of information in this section, preferably Medicaid number only, because ANYincorrect information will cause the request to fail.

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Medicaid Eligibility – Submitting and Retrieving RequestsThere are two ways to submit eligibility requests: interactive and batch. An interactive request is fast and done onlinewhile you wait, however it can only be done for one client at a time. A batch of requests takes 24 hours (usuallyovernight) but may include one or many eligibility requests.

Submit/Retrieve Interactive RequestsTo submit and retrieve an interactive eligibility request, click the interactive button and within a few minutes the requestwill be either accepted or rejected and the eligibility response will be displayed.

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Submit/Retrieve Batch Requests

NOTE: Clicking the OK button does not send the request to NHIC; it stores therequest in “Completed” status on YOUR database only. You must do all four steps listedbelow to send and retrieve batch requests.

Submitting and retrieving a batch of eligibility requests involves four steps:

1. Fill out eligibility requests and click the 2. Go to the System Totals window; click the Send RequestsOK button on each request. Requests are stored in tab ➜ Send box for Medicaid Eligibility ➜ Submit button.“Completed” status on your database. Cancel out Requests are changed to “Submitted” status and are sent toof Eligibility. NHIC.

3. Go to System Totals window 24 hours later, click the 4. Double click Eligibility under the Medicaid folderRetrieve Responses tab ➜ Download box for Eligibility (left side of window), then double click the response➜ Download button. Requests are now changed to just downloaded to view it.“Processed” status.

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Medicaid Eligibility – ResponseThe response displays client eligibility. Any tabs with shaded labels have no information to display. In this example, theclient has Medicaid eligibility no Medicare, is not a lock-in client, has Managed Care, has benefit limits, but has no otherinsurance.NOTE: HIPAA compliant eligibility responses no longer display authorization information or Relationship to theInsured on the Other Insurance tab.NOTE ALSO: Click the “Patient” icon in the upper right corner of the screen to send client information to the ClientReference file, which allows the magnifying glass icons to be used later to populate client information in forms.

� When the Eligibility Save Patient Wizard comes up, click the fields to be sent to the client reference file, or clickSelect All, then click Finish. A message will state that the patient was updated.

� �

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Medicaid Eligibility – Response (continued)� Click the Managed Care tab to see the HMO or Texas Health Network (THN) information.

� Click the Benefit Limits tab for the latest eyeglass, hearing aid, THSteps Dental and THSteps Medical claims.

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Medicaid Eligibility – Response (continued)� Click the Other Insurance tab for information on other insurers for the client. To update the client’s other insurance,

contact Third Party Resources at (800) 846-7307. See also section 1.5.3 “Third Party Resources” on pages 1-17and 1-18 of the 2003 Texas Medicaid Provider Procedures Manual.

Medicaid Eligibility – Printing ReportsSix types of eligibility reports may be printed from the Medicaid Eligibility Request/Response Summary.� Transmission Summary – Click a batch eligibility response (has Transmit Type “B” and a Transmission ID). Click

Reports and Transmission Summary to display the report. The number of accepted or rejected responses is listed.Click Print for a paper copy.

� Transmission Detail – Click an accepted batch eligibility response (has Transmit Type “B” and a Transmission ID).Click Reports and Transmission Detail. A list of eligibility responses in that batch is displayed. Click Print for apaper copy.

� Information Request – Double-click the completed row near the top of the window. At least one completed eligibilityrequest is required. Click a completed but not submitted request. Click Reports and then Information Request. Adetailed display of the request is given, but no response information is available since this request has not yet beensubmitted to NHIC and retrieved. Click Print for a paper copy.

� Information Response – Click an accepted response, either batch or interactive, until the response is displayed. Toprint the response, click Reports, Information Response, and Print.

� Interactive Summary – Click Reports and Interactive Summary. Enter a range of beginning and ending transmitdates and click OK. A report of eligibility responses is displayed. Click Print for a paper copy.

� Batch Report – Click either an interactive or a batch response, click Reports and Batch Report. The report willIMMEDIATELY start printing a detailed list of ALL eligibility responses from the row you selected.

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Medicaid ClaimsNote: Refer to the 2003 Texas Medicaid Provider Procedures Manual, Section 4, for related policy information.

Changes due to HIPAAUnder HIPAA, the electronic claim request is standard 837. Professional and eyeglass claims are standard 837P, dentalclaims are 837D, and inpatient and outpatient claims are 837I. Numerous changes have occurred to the main tabs(screens) for patient, provider, claim, diagnosis, details, and other insurance, and some tabs now have sub-tabs. A claimresponse for an accepted claim may also be used (via the “save as appeal” button) to generate an appeal.

Important: If a claim denies with zero allowed, zero paid amounts (see R&S below), follow up with a new claim insteadof an appeal, within 180 days of the R&S date. If your new claim has the same provider number, client/Medicaidnumber, date of service, and billed amount, then the new claim can be submitted on TDHconnect. If one of these fieldshas changed, then the new claim must be filed as a paper claim.

If a claim rejects (not denies, but rejects) and the claim is beyond the 95 day filing deadline, the rejected claims reportmay be printed and sent to NHIC along with a new paper claim if within 180 days of the rejection. See claim reports atthe end of this section.

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Begin claims by double-clicking Claims to display the Medicaid Claim Request/Response Summary window.

To start a new claim, either click the one of the five icons in the top left corner of the screen under the menu bar, or clickFile → New on the menu bar and then the type of claim: professional, eyeglass, dental, inpatient, or outpatient.

The HIPAA transactions for Professional and Eyeglass claims are now transaction 837P (professional), Dental claims aretransaction 837D (dental), and Inpatient or Outpatient claims are transaction 837I (institutional).

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Medicaid Claims – Filing Professional Medicaid Claims� To start a new professional claim (HIPAA transaction 837P), either click the New Professional Claim icon

under File, or click File → New → Professional.

Medicaid Claims – Professional Claim - Patient Tab� Either click one of the magnifying glass icons to autopopulate the fields in the client database, or enter the fields

manually. Required fields are the 1–20 character account number assigned by the provider, the nine-digit Medicaidnumber, the last name (without the suffix because the suffix now has its own field), first name, sex, date of birth,street address, city, state, and zip code of the client. Other fields are optional.

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Medicaid Claims – Professional Claim – Provider Tab w/Provider Facility Sub-Tab� Click the Provider tab.� Either click one of the magnifying glass icons to autopopulate the fields in the provider database, or enter the fields

manually. Required for all professional claims are the nine-digit billing provider ID (TPI), the last/organization name,provider address, city, state, zip code, .

� If services were provided in a place other than the patient’s home or the provider’s facility (such as a hospital,birthing center, or nursing facility), click the Provider Facility sub-tab and enter information on the Provider Facilitysection of the Provider tab. Required fields are the provider facility’s provider ID, name, ID type (employer ID orsocial security number), other ID (corresponding to ID type), service location, address, city, state, and zip code.

Medicaid Claims – Professional Claim – Provider Tab w/Referring and Other Provider Sub-Tab� If required by the type of claim to enter a referring or primary care physician, click the Referring and Other Provider

sub-tab and enter the 6–13 character referring provider ID as a 9 digit TPI, 6-digit Medicare number, or a UPIN. Alsoenter the last name and first name of the referring provider, ID type (employer ID or social security number), andother ID (corresponding to ID type). Other fields are optional.

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Medicaid Claims – Professional Claim – Claim TabIf ambulance, THSteps Medical, or authorization number is necessary, click the Claim tab and enter the necessary data.

Note for THSteps Medical providers: After clicking the THSteps indicator field on the Claim tab, select an appropriateCondition Code:� NU (Not Used) indicates the patient had a normal screening, an abnormal screen without treatment, an abnormal

screen initiated treatment, was referred to another health agency, or to family planning.� S2 (Under Treatment) indicates that the client’s screen was abnormal, but the condition is under treatment.� ST (New Services Requested) indicates new services requested, such as when the client was referred to the Primary

Care Physician or to a specialist.

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Medicaid Claims – Professional Claim - Diagnosis Tab� Click the Diagnosis tab.� Enter the HCPCS or CPT code to the highest level of specificity. If uncertain of the code, press F2 while the cursor is

in the Code column to bring up diagnosis codes in the reference files.� Enter the description in that column. More than one diagnosis code may be entered. Note: A diagnosis code is

required for professional claims.� For THSteps CCP Pharmacies, the following note is found in section 40.4.8.5 of the 2003 Texas Medicaid

Provider Procedures Manual: “Pharmacies using their VP TPI should obtain prior authorization for prescriptionmedications not paid through the Vendor Drug Program. If a claim is submitted without a diagnosis, then aprovider must attach documentation establishing medical necessity and a signed prescription from a physician(MD or DO). Electronic claims must have diagnosis code V7999 for the claim to be accepted.” Instead, use theHIPAA compliant diagnosis code for THSteps CCP Pharmacies is V7285 (Other Specified Examination).

� For Independent Laboratory providers, section 25.4.12 of the 2003 Texas Medicaid Provider ProceduresManual states the following: “Independent laboratories and pathologists do not have to supply Medicaid with adiagnosis except when billing the following procedures…”. If the procedure being billed by independentlaboratory providers is not one of the procedures listed in that section requiring a diagnosis code by policy, theymay use diagnosis code V726 (Laboratory Examination) for the claim to be accepted.

� For Radiology providers, if no other diagnosis code is available, use V725 (Radiological Examination, NotElsewhere Classified).

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Medicaid Claims – Professional Claim – Details Tab� Click the Details tab and enter the date of service in MM/DD/YYYY format.� Tab to the POS column and use the drop-down box to select place of service (POS).� Click the Procedure Code ID field and use the drop-down box to select the type of procedure code (HCPCS; HIEC;

National Drug Code in 4-4-2 format or 5-3-2 format or 5-4-1 format or 5-4-2 format; or Mutually Defined).� Enter the procedure code. If needed, press F2 to bring up procedure codes in the reference files for assistance. Type

of Service (TOS) is automatically inserted by C21 based on procedure code entered.� Genetic providers must use the Remarks Code field (after the procedure code field) to enter the five-character local

procedure code that identifies the DNA test or laboratory enzyme test performed. See Medicaid Bulletin no. 174.� Enter any needed modifier codes.� If needed, enter anesthesia (Ane) minutes.� Enter the diagnosis reference to refer to the most important diagnosis code entered on the Diagnosis tab.� Enter the quantity and unit price (total charges are calculated).� If the provider is a member of a group, enter the nine-digit performing provider number and name.� Use the scroll bar to gain access to the fields on the right hand side of the window.

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Medicaid Claims – Professional Claim – Other Insurance Tab w/Company Sub-Tab� To list the client's other insurance, click the Other Insurance tab and select the source of payment, such as

Commercial Insurance.� If the other insurance delays and does not reply (110 day rule as per page 4-6 of the 2003 Texas Provider

Procedures Manual), click the Delay box and enter the Bill Date.� If an adjustment reason code is applicable, select an adjustment reason code and enter disposition date and paid

amount.� Enter the other insurance company name, address, city, state, zip code and phone number.� If a verbal denial was received from the other insurer, check the verbal indicator box and enter the date they were

contacted, the contact name, and a comment regarding the conversation. The disposition indicator on the OtherInsurance tab can be used to indicate if the other insurer denied, did not file, paid, or issued no response.

Medicaid Claims – Professional Claim – Other Insurance Tab w/Subscriber Sub-Tab� To enter information about the insured, click the Subscriber tab on the lower right side of the Other Insurance sub-tab

and enter the ID or social security number, last name, first name, group/policy number and group/employer name.

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Medicaid Claims – Submitting and Retrieving RequestsThere are two ways to submit Medicaid claims on TDHconnect, interactive or batch. An interactive claim is accepted orrejected online while you wait, but must be done one claim at a time. A batch of claims takes 24 hours (usuallyovernight) to be accepted or rejected, and can include one or many claims. Note that accepted claims do not guaranteepayment, only that they are accepted for further processing and will later be paid or denied.

Submit/Retrieve Interactive Requests� To submit and retrieve an interactive claim, click the interactive button and within a few minutes your claim will be

either accepted or rejected and the claim response will be displayed.

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Medicaid Claims – Submitting and Retrieving Requests (continued)

Submit/Retrieve Batch Requests

NOTE: Clicking the OK button does not send the claim to NHIC; it stores the claimin “Completed” status on YOUR database only. You must do all four steps listed below tosend and retrieve batch requests.

To submit and retrieve a batch of claims involves four steps:

1. Fill out the claim and click the OK button. Repeat 2. In the System Totals window, click the Sendfor each claim. Claims are stored in “Completed” Requests tab, click Send box for Medicaid claims,status on your database. Cancel out of Claims and and click the Submit button. Requests are changedgo back to the System Totals window. to “Submitted” status and are sent to NHIC.

Note: Only check appropriate boxes.

3. 24 hours later, go to the Systems Totals window, 4. Double click Claims under the Medicaid folderclick Retrieve Responses tab, click Download box (left side of window) and double click the responsefor Claims, and click the Download button. Requests just downloaded to view it.are now changed to “Processed” status.Note: Only check appropriate boxes.

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Medicaid Claims – Eyeglass Claims� After double-clicking Claims under Medicaid, either click the eyeglass icon under File or click File → New →

Eyeglass.� The Patient tab, Provider tab, Diagnosis tab, and Other Insurance tab are identical on the professional (837P) claim

previously covered. The Claim tab and Details tab are described below.

Medicaid Claims – Eyeglass Claim – Claim Tab� For the Claim tab on an eyeglass claim, Eyeglass claims require eyeglass-specific information.

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Medicaid Claims – Eyeglass Claim – Details Tab� Click the Details tab and enter the date of service in MM/DD/YYYY format.� Tab to the POS column and use the drop-down box to select place of service (POS).� Click the Procedure Code ID field and use the drop-down box to select the type of procedure code (HCPCS; HIEC;

National Drug Code in 4-4-2 format or 5-3-2 format or 5-4-1 format or 5-4-2 format; or Mutually Defined).� Enter the procedure code. If needed, press F2 to bring up procedure codes in the reference files for assistance. Type

of Service (TOS) is automatically inserted by C21 based on procedure code entered.� Enter any needed modifier codes.� Enter the diagnosis reference to refer to the most important diagnosis code entered on the Diagnosis tab.� Enter the quantity and unit price (total charges are calculated).� If the provider is a member of a group, enter the nine-digit performing provider number and name.� Use the scroll bar to gain access to the fields on the right hand side of the window.

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Medicaid Claims – Dental Claims� To fill out a dental claim (HIPAA transaction 837D), after double-clicking Claims under Medicaid, either click the

tooth icon in the upper left-hand corner of the screen or click File → New → Dental.� The Patient tab, Provider tab, and Other Insurance tab are identical on the professional (837P) claim previously

covered. The Claim tab and Details tab are described below.

Medicaid Claims – Dental Claims – Claim Tab� Dental claims require dental-specific information on the Claim tab.

Medicaid Claims – Dental Claims – Details Tab� Dental claims require dental-specific information on the Details tab.� Use the scroll bar to access fields on the right hand side of the window.

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Medicaid Claims – Inpatient Claims� To fill out an inpatient claim (HIPAA transaction 837I), after double-clicking Claims under Medicaid, either click the

Inpatient icon under Edit or click File → New → Inpatient.� The Other Insurance tab is identical on the professional (837P) claim previously covered. The Patient tab, Provider

tab, Claim tab, Diagnosis tab, and Details tab are described below.� Medicaid Claims – Inpatient Claims – Patient Tab� Required fields include the provider-defined account no. for the client, in addition to the client’s Medicaid no.,

provider-defined medical record no., last name, first name, sex, date of birth, street address, city, state, and zip code.

Medicaid Claims – Inpatient Claims – Provider Tab w/Billing and Attending Providers Sub-Tab� The Provider tab has two sub-tabs within it. The first is for billing and attending providers.� Required fields include the billing provider’s provider ID, facility name, address, city, state, zip code, tax ID no; and

for the attending provider include the attending provider’s provider ID, last name, first name, ID type (employer ID orsocial security no) and other ID (corresponding to ID type).

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Medicaid Claims – Inpatient Claims – Provider Tab w/Billing and Attending Providers Sub-Tab

� The second sub-tab within the Provider tab is for Operating and Other Providers.� Required fields, if applicable, include the operating provider ID, last name, and first name; and if applicable, the other

provider ID, last name, and first name.

Medicaid Claims – Inpatient Claims – Claims-Tab� Click the Claim tab to enter claim data.� Required fields include statement from and to dates, authorization (if needed), patient status, type of bill, admission

date and hour, admission type, admission source, days covered, days non-covered and discharge hour. Include anyapplicable occurrence codes and dates, and any applicable condition codes and dates.

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Medicaid Claims – Inpatient Claims – Diagnosis-Tab

� Click the Diagnosis tab to enter diagnoses.� Required fields include at least one diagnosis code.

Medicaid Claims – Inpatient Claims – Details-Tab w/ Accommodation Details Sub-Tab� The Details tab has three sub-tabs: Accommodation Details, Ancillary Details, and Surgery Details. To enter data for

accommodations, click the Accommodation Details sub-tab.� Required fields for the Accommodation Details sub-tab include revenue codes, days, and daily rate. Non-covered

charges may be used to report specific non-covered amounts.

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Medicaid Claims – Inpatient Claims – Details-Tab w/ Ancillary Details Sub-Tab� Click the Ancillary Details sub-tab of the Details tab to enter Ancillary charges.� Required fields include revenue codes, units, and total charges. Unit prices are required for revenue codes 100-219.

Non-covered charges may be used to report line specific non-covered amounts.

Medicaid Claims – Inpatient Claims – Details-Tab w/ Surgery Details Sub-Tab� Click the Surgery Details sub-tab of the Details tab to enter surgery charges.� Optional fields include surgical code, procedure information (HCPCS or ICD-9 code), and date of service.

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Medicaid Claims – Outpatient Claims� To fill out an outpatient claim (HIPAA transaction 837I), after double-clicking Claims under Medicaid, either click the

Outpatient icon under View in the upper left-hand corner, or click File → New → Outpatient.� The Provider tab is identical on the Inpatient (837I) claim previously covered, and the Other Insurance tab is identical

on the Professional (837P) claim previously covered. The Patient tab, Claim tab, Diagnosis tab, and Details tab aredescribed below.

Medicaid Claims – Outpatient Claims – Patient-Tab� Click the Patient tab.� Required fields include the client’s provider-defined account number, in addition to the client’s Medicaid number, last

name, first name, sex, date of birth, street, city, state, and zip code.

Medicaid Claims – Outpatient Claims – Claim-Tab� Click the Claim tab to enter claim information.� Required fields include the client’s admission date, admission hour, type of bill, discharge date, and discharge hour.

Optional fields include the authorization number, occurrence codes and dates, and condition codes and dates.

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Medicaid Claims – Outpatient Claims – Diagnosis-Tab� Click the Diagnosis tab to enter diagnosis information.� Required fields include at least one diagnosis code.

Medicaid Claims – Outpatient Claims – Details Tab� Click the Details tab.� Required fields include the date of service, diagnosis reference, quantity, and total charges. Procedure code ID is

the type of procedure code such as HCPCS; HIEC; National Drug Code in 4-4-2 format or 5-3-2 format or 5-4-1format or 5-4-2 format; or Mutually Defined.

� Use the scroll bar at the bottom of the screen to access fields on the right hand side of the window.

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Medicaid Claims – Printing ReportsSeven types of claim reports may be printed from the Medicaid Claim Request/Response Summary.� Transmission Summary - Click a batch claim response (has Transmit Type “B” and a Transmission ID). Click

Reports and Transmission Summary to display the report. The number of accepted or rejected claim responses islisted. Click Print for a paper copy.

� Transmission Detail – Click an accepted batch claim response (has Transmit Type “B” and a Transmission ID, andthe No. of Requests is greater than the No. Rejected). Click Reports and Transmission Detail. A list of claimresponses in that batch is displayed. Click Print for a paper copy.

� Interactive Summary - Click Reports and Interactive Summary. Enter a range of beginning and ending transmitdates and click OK. A report of claim responses is displayed. Click Print for a paper copy.

� Error Summary – Click a batch claim response (has Transmit Type “B” and a Transmission ID) and the “No.Rejected” must be greater than zero. Click Reports and Error Summary. A list of rejected claims and errors in thebatch is displayed. Click Print for a paper copy.

� Claim Detail – Double-click an interactive or batch claim response. Click Reports and Claim Detail. A detailed list ofthe claim is displayed. Click Print for a paper copy.

� Completed Claims – Click Reports and Completed Claims. A detailed list of ALL completed claims willIMMEDIATELY start printing.

� Rejected Claims – Click Reports and Rejected Claims. A detailed list of ALL rejected claims will IMMEDIATELYstart printing. This report can be very useful for working rejected claims. Remember that you will not see rejectedclaims on your Remittance and Status Report or on a claim status inquiry.

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Medicaid Claim Status Inquiry (CSI)Important: Before using Claim Status Inquiry, you must fax in a CSI request form, even though Claim StatusInquiry is a built-in function of TDHconnect. See page 89 of this manual for the form. Note: Rejected claims are notdisplayed in CSI, only claims that are in process, paid, or denied.For claims assistance call NHIC Customer Service (800-925-9126). For LTC claims assistance call the LTC HelpDesk (800-626-4117 or in Austin dial 512-335-4729).

Medicaid CSI – New RequestThe purpose of Claim Status Inquiries (CSI) are to retrieve information on the status of claims that were acceptedinto the NHIC system, regardless of whether the claims were submitted on paper or by TDHconnect or electronically.

� To begin a claim status inquiry, double-click CSI to display the Medicaid Claim Status Inquiry Request/ResponseSummary window.

� To see the two types of CSI requests, in the Medicaid CSI Request/Response Summary window, click File → NewRequest.

� Another method is to click either the Provider Patient Request icon or the Claim Request icon in the upperleft, which are described as follows:� Provider Patient Request – This batch request retrieves claim information for a specific client and provider over

a range of up to three months of service dates, and this three month window can go back three years. Althoughthe range of service dates can span only up to three months, several requests could be submitted in a batch tocover a longer range of service dates.

� Claims Request – This request is either interactive or batch and is very useful for finding the status of oneclaim quickly.

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Medicaid CSI – Provider Patient Request� In the Medicaid CSI Request/Response Summary window, click File → New Request → Provider Patient Request

or click its icon .� Use this CSI to find the status of claims for one client over a span of service dates that can be three months.� Required fields are the service Begin and End dates, the 9 digit Provider ID (TPI), the last name of the provider or

the organization name, the client’s Medicaid number, last name, and first name. The service Begin and End datesmay either be keyed or use the down arrow to select a range of dates. A span of up to three months can be used,going back three years. The service end date may be as recent as the current date.

� Click OK to save as a completed batch CSI request to be sent to NHIC later.

NOTE: Clicking the OK button does not send the request to NHIC; it stores therequest in “Completed” status on YOUR database only. You must do all four steps listed onpage 66 under “Submit/Retrieve Batch Requests” to send and retrieve batch requests.

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Medicaid CSI – Claim Request� In the Medicaid Claim Status Inquiry Request/Response Summary window, click File → New Request → Claim

Request or click its icon .� Use this CSI to find specific claims.� Required fields are the 24 digit claim number, nine digit provider ID (TPI), the provider’s last name or organization

name, and the client’s Medicaid number, last name, and first name.� This request may be sent either interactively by clicking Interactive and getting an immediate response, or by clicking

OK to save as a batch request to be sent later. Since this request deals with just one claim, interactive mode isrecommended.

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Medicaid CSI – Submitting and Retrieving RequestsSubmit/Retrieve Interactive Requests� To submit and retrieve an interactive request (Claim Request), fill out the request and click the interactive button.

Your response will be returned online while you wait.

Submit/Retrieve Batch Requests� Submitting and retrieving a CSI batch request (Provider Patient CSI or Claim Request CSI) involves four steps:

1. Fill out the CSI request and click the 2. Go to System Totals window, click the SendOK button. Repeat as needed for each Requests tab, click the Send box forCSI request. Medicaid CSI, and click the Submit button.

3. Go to System Totals window 24 hours later, 4. Double click CSI under the Medicaid folderclick Retrieve Responses tab, click Download (left side of window), and double click the responsebox for CSI, then click the Download button. just downloaded to view it.

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Medicaid CSI – Printing ReportsTwo types of CSI reports may be printed from the Medicaid Claim Status Inquiry Request/Response Summary.� Response Report – Click an accepted CSI response (No. of Requests is greater than the No. Rejected). Click

Reports, Response Report, and then Claim Report. Click Print for a paper copy.� Batch Report – Click either an interactive or a batch response, click Reports and Batch Report. The report will

IMMEDIATELY start printing a detailed list of ALL CSI responses from the row you selected.

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Medicaid Electronic Remittance and Status (ER&S)Note: Refer to the 2003 Texas Medicaid Provider Procedures Manual, Section 4 (pages 4-53 through 4-71),Appendix C (page C-3) and Appendix D (pages D-31 and D-32) for related information and ER&S Agreement forms.See page 86 of this manual for an ER&S Agreement form. EDI (Electronic Data Interchange) can also be called at888-863-3638 for these forms.

� Double-click ER&S to display the Medicaid ER&S Summary List window.� To display a specific ER&S report, double-click the row of the report.

Download an ER&S Report� Before generating a report, go to the TDHconnect System Totals window, click the Retrieve Other tab, click the

Download box on the ER&S row, and then click the Download button. ER&S reports are available to download at6:00 A.M. each Monday. A good practice is to download them weekly.

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Generate an ER&S Report� In the Medicaid ER&S Summary List window, click File, then Generate R&S to generate a report.� The provider ID, start date, end date, and claim status are required. The Start Date is usually a Friday and the end

date is usually the following Monday. Select Display Report to see the report.

Medicaid ER&S – Print Report� Click Print to print the ER&S report.� Use the forward or backward arrows to see other pages.� The down arrow on the size (100%) box reduces or enlarges the image.

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Medicaid AppealsNote: Refer to the 2003 Texas Medicaid Provider Procedures Manual, Section 5, for related policy information.Important: If a claim denies with zero allowed, zero paid amounts (see R&S below), follow up with a new claiminstead of an appeal, within 180 days of the R&S date. See the claims section in this document for details. Also, anappeal cannot be filed on a pending claim. The Electronic R & S Report has section for pending claims, identified as“THE FOLLOWING CLAIMS ARE BEING PROCESSED”. The claim must finalize and once paid, an appeal may be filed.

Changes to Appeals from HIPAA:• ALL required data on the appeal must now be completed, not just the data being changed from the original claim.• Appeals look similar to claims now, with the exception of three fields on the patient tab of the appeal. See next page.• Changes to surgical procedure codes on inpatient claims must be appealed on paper with supporting documentation

for review.• Appeals must include all detail lines on the original claim, in the same order as the original claim. An appeal will

reject if it contains fewer detail lines than the original claim being appealed.• An added detail line must be submitted as a separate new day claim.

Reminders:• If the appeal requires additional paperwork, as on ambulance claims, the appeal must be sent on paper.• Crossover claims must be submitted on paper, along with a Remittance Advice from Medicare.

Appeals with dates of service prior to 10/16/2003 should contain Medicaid local procedure codes, if applicable.• TDHconnect appeals are only by batch; there are no interactive TDHconnect appeals.

Note to providers who file eyeglass appeals: If you convert data from TDHconnect 2.0 to TDHconnect 3.0, anyrejected eyeglass appeals that were stored in TDHconnect 2.0 will have to be manually re-entered in TDHconnect 3.0before resubmitting the eyeglass appeal.

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Three ways to fill out TDHconnect appeals:

1. Populate an appeal from an accepted TDHconnect claim by clicking the “Save as Appeal” tab at thebottom of an opened claim in the Claims section of TDHconnect. Remember that the claim being appealed must befinalized (paid or denied) before it can be appealed.

2. Populate an appeal from an electronic Remittance and Status Report by clicking the “Create Appeal from ER&S”

icon in Appeals. If you have not signed up to receive electronic Remittance and Status Reports, you may do soby filling out page 88 of this manual and faxing it in to the Electronic Data Interchange department of NHIC.

3. Start from scratch in Appeals and filling out all required fields from a blank TDHconnect appeal by selecting the

appropriate appeal icon from the upper left of the screen .

Appeal Fields� The fields for appeals are the same as for claims of the same type with one exception: the patient tab has three

additional fields not found on claims.� Frequency Code: Select the value of 7 to indicate an appeal, or 8 to void (recoup) the ENTIRE CLAIM. To

recoup only a DETAIL LINE on a claim, fill out the entire appeal and enter the value 0 (zero) for the Unit Pricefield on the Details tab.

� Original ICN: Enter the 15 or 24 digit claim number of the claim being appealed.� Original Medicaid Number: Enter the 9-digit client Medicaid number used on the claim being appealed.

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Medicaid Appeals – Create an Appeal from an Accepted TDHconnect ClaimIn the Claims section of TDHconnect, open an accepted claim and click the Save as Appeal tab at thebottom of the claim.

A message will pop up stating that an incomplete appeal has been generated and saved, to go to Appeals inTDHconnect to complete the appeal, and to verify that the claim is in appealable status before submitting it.

Go to Appeals and double-click the Incomplete Appeals row.

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Then double-click the appropriate appeal from the List of Incomplete Appeals.

� Finally, begin filling out any missing information required on the appeal. The fields for appeals are the same as forclaims of the same type with one exception: the patient tab has three additional fields not found on claims. Forfrequency code, select 7 for an appeal or 8 for a void (recoupment), enter the original ICN as a 15 or 24-digit claimnumber, and the original Medicaid number is filled in for you.

� Remember that bolded fields are required, and other fields may be necessary depending on the type of appeal. ClickOK on the appeal to save it in completed status to be submitted later to NHIC. Appeals are only submitted by batch,not interactively. A batch can contain one or more appeals.

NOTE: Clicking the OK button does not send the appeal to NHIC; it stores theappeal in “Completed” status on YOUR database only. You must do all four steps listed onpage 76 to send and retrieve batch requests.

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Medicaid Appeals – Create an Appeal from an ER&S Report� Get into Appeals by double-clicking “Appeals” on the left side of the System Totals window.

� From the Medicaid Appeal Request/Response Summary window, click File, then From ER&S, or click the

From ER&S icon .

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Medicaid Appeals – Create Appeal from ER&S (continued)

� In the ER&S Search window, enter search criteria to find the claim to be appealed and click Search.

� Click the claim being appealed and click Create.

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Medicaid Appeals – Create Appeal from ER&S (continued)

• Finally, begin filling out any missing information required on the appeal. The fields for appeals are the same as forclaims of the same type with one exception: the patient tab has three additional fields not found on claims. Forfrequency code, select 7 for an appeal or 8 for a void (recoupment). The original ICN and the original Medicaidnumber are filled in for you.

� Remember that bolded fields are required, and other fields may be necessary depending on the type of appeal. ClickOK on the appeal to save it in completed status to be submitted later to NHIC. Appeals are only submitted by batch,not interactively. A batch can contain one or more appeals.

NOTE: Clicking the OK button does not send the appeal to NHIC; it stores theappeal in “Completed” status on YOUR database only. You must do all four steps listed onpage 76 to send and retrieve batch requests.

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Medicaid Appeals – Create an Appeal from a Blank Form� To create a Medicaid professional (837P) appeal from a blank form, double-click Appeals and the Medicaid Appeal

Request/Response Summary window will populate.

� Click File, then New, then one of the following: Professional, Eyeglass, Dental, Inpatient, or Outpatient.

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Medicaid Appeals – Submitting and Retrieving RequestsSubmit/Retrieve Batch RequestsNOTE: Clicking the OK button does not send the appeal to NHIC; it stores theappeal in “Completed” status on YOUR database only. You must do all four steps listedbelow to send and retrieve batch requests.

When through entering data, click OK to save the completed appeal that will be submitted to NHIC later. Appeals areonly submitted by batch, not interactively. A batch can contain one or more appeals. To submit and retrieve a batch ofappeals involves four steps:

1. Fill out the appeal and click the OK button. 2. Go to System Totals, click the Send Requests tab,Repeat for each appeal in the batch. click the Send box for Medicaid Appeals, and click the

Submit button.

3. Go to System Totals window 24 hours later, 4. Double-click Appeals under the Medicaid folderclick the Retrieve Responses tab, click Download (left side of window), and double-click the responsebox for Appeals, click Download button. just downloaded to view it.

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Medicaid Appeals – Printing ReportsSix types of appeals reports may be printed from the Medicaid Appeal Request/Response Summary.� Transmission Summary – Click an appeal response, then click Reports and Transmission Summary to display

the report. The number of accepted or rejected appeals is listed, along with the amount billed. Click Print for a papercopy.

� Transmission Detail – Click an accepted appeal response. Click Reports and Transmission Detail. A list ofappeal responses in that batch is displayed. Click Print for a paper copy.

� Error Summary – Click an appeal response with a processed status and “No. Rejected” greater than zero. ClickReports and Error Summary. A list of rejected appeals and errors in the batch is displayed. Click Print for a papercopy.

� Appeal Detail – Double-click an appeal response. Click Reports and Appeal Detail. A detailed list of the appeal isdisplayed. Click Print for a paper copy.

� Completed Appeals – Click Reports and Completed Appeals. A box will display, stating “There are __ appeals toprint. Do you want to continue?” Click Yes to print a detailed list of ALL completed but not yet submitted appeals.

� Rejected Appeals – Click Reports and Print Rejected Appeals. A box will display, stating “There are __ appeals toprint. Do you want to continue?” Click Yes to print a detailed list of ALL rejected appeals.

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TDHconnect Log On Error MessagesTDHconnect Log On Error Messages – Admin currently logged on� During login, a message may appear, “Admin is currently logged on to TDHconnect” or whatever user ID is used.

Click OK.

� To resolve the message of a user currently logged on, click on Start → Programs → TDHconnect → TDHconnectUtilities.

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TDHconnect Log On Error Messages – Admin currently logged on (continued)� Click the Logoff User tab, in the drop down box select the user ID (in this case, “admin”) by clicking the user name,

then click the Log Off button and OK.

TDHconnect Log On Error Messages– TDHconnect already running� A message that may appear if the TDHconnect icon is clicked more than once to load is, “TDHconnect is already

running….” To resolve this situation, press CTRL + ALT + Delete simultaneously to bring up the Task Manager.Note: Different computers will open up with a different Task Manager option, such as Task List or anApplication tab.

� Within Task Manager, click TDHconnect and then End Task.

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TerminologyAccepted - Electronically submitted requests that have passed the acceptance edits, been assigned an ICN, and will befurther processed in the system. Accepted claims will appear on your Remittance and Status Report.

Batch Submission - One or more transactions grouped together and submitted for processing. You may download aresponse 24 hours after submission.

Completed - Request has been entered into TDHconnect 3.0, passed all the local edits, but has not been submitted.Completed requests convert to Submitted status after being sent in a batch.

Denied - A claim that that has been denied for payment because it did not pass all program edits. A denied claim willappear on your Remittance and Status Report in the Non-Pending Section.

Download - The process of retrieving electronic files from a Bulletin Board System (BBS).

Interactive Submission - Submission of a single electronic transaction that receives a response during one telephone call(modem connection).

Minimize - To lower a program window. To perform this function click on the first box located on the top right hand side ofyour window. The button will contain a “ _” symbol.

Operating System - This is the version of Windows you are currently using, this could include Windows 95, 98, ME, NTand 2000. (XP is not currently supported)

Paid - A claim that has been approved to pay because it passed the program edits. This claim will appear on theRemittance and Status Report.

Pended/Suspended Claim - A claim that has failed a program edit and is pending edit resolution before continuedprocessing. You cannot submit a claim or an adjustment for a claim in the Pending Section of your Remittance andStatus Report.

Processed - Request has been submitted through TDHconnect 3.0 and a response has been downloaded. Processedrequests cannot be resubmitted.

Rejected - Request that has received a response indicating the request has been sent back for errors. The request maybe corrected and resubmitted. Rejected claims will not receive an ICN or appear on the Remittance and Status Report.Providers are still bound to submitting a claim within the original 95-day timeline, but if the rejection is within the 95-daytimeline, they may print the rejection report and submit a new claim with a paper copy of the rejection report within 180days of the rejection.

Submit Error – A submit error is a software level error that resulted in the batch not being transmitted electronically toNHIC. A submit error is usually the result of keying errors on one or more claims but could be the result of severaldifferent reasons. If the error in the claim(s) cannot be located, please contact the EDI helpdesk at 888-863-3638.

Submitted - Request has been transmitted for processing. Submitted requests convert to Processed after the responsehas been Downloaded.

Submitter I.D - This is the 9 character, numeric I.D first issued when starting to electronically bill. This should be placed inthe Compass 21 user I.D field and/or CMS user ID field, located under the System Settings window. You can reach thiswindow by going to Communications and then to System Settings.

Template - A TDHconnect 3.0 window that shows all the data fields needed to submit a claim or MESAV request.Templates allow you to save complete or partial data for future use.

TPI Number - This is the 9 character, numeric Texas Provider Identifier number that is issued to you through Medicaid.

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Shortcut Keys

Press ActionCTRL+T Clear all fields on this windowCTRL+C Copy selected textCTRL+X Cut selected textCTRL+D Delete a record from the databaseCTRL+E Focus on Error WindowCTRL+R Focus on TDHconnect ExplorerCTRL+W Focus on WorkspaceCTRL+O Open a record from a listALT+E Open Edit menuALT+H Open Help menuALT+N Open Navigation menuALT+R Open Reports menuALT+V Open View menuSHIFT+F1 Open What’s This?CTRL+V Paste selected textCTRL+S Save a request

Function Keys

Press ActionF1 Accesses the Help Files for information about the

window. To use this feature, press F1.F2 Accesses the Local Reference Database for the

selected field. To use this feature, place the cursor inthe desired field, press F2.

F3 Copies a single cell. To use the cell copy feature,place the cursor beneath the cell to be copied, pressF3.

F4 Copies the entire row. To use the line item copyfeature, place the cursor beneath the line to becopied, press F4.

F5 Causes a window to refresh and display all datacreated simultaneously by multiple users ofTDHconnect 3.0. To use this feature, press F5.

F6 Inserts a new row. To use the insert feature, placethe cursor on the desired row beneath which you willcreate a new row, press F6.

F7 Deletes a row. To use this feature, place the cursoron the desired row you want to delete, press F7.

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TDHconnect Order FormTDHconnect is the software owned by HHSC for interfacing into the TexMedNet system. You will be able to useEligibility, Claims Submission, Claim Status Inquiry, Remittance and Status Report, Appeals, TexMedNet Email, andaccess the TexMedNet BBS using this software. The system requirements for TDHconnect are listed on the bottom ofthis page. You should acquire at the least, the minimum PC requirements before ordering TDHconnect. This form shouldbe faxed to 512-514-4228 or 512-514-4230. You should receive your software and User IDs within two weeks of ourreceipt of the form. Installation instructions will be enclosed with your software. TDHconnect includes an online help filecontaining all necessary information for the operation of TDHconnect. However, if you find you need further assistanceusing TDHconnect, workshop-style classes are available. Contact the TDHconnect Workshop Registration line at 512-514-3250 for information regarding TDHconnect workshops.Only one TDHconnect Order Form for your location is necessary. If you have multiple billing Texas Provider Identifiers(TPIs), list all TPIs in the Billing TPI(s) field. Send a separate attachment listing all billing TPIs if there are more thanseven.Organization Name

Billing Texas ProviderIdentifier(s)

Contact NameContact PhoneAddressCity/State/ZIP

TDHconnect 3.0 Hardware and Software Requirements

MINIMUM PC REQUIREMENTSPC with a Pentium II (2) class processor, 400 Mhz128 MB of RAM100MB hard disk space for installation plus 3 times the size of the databaseCD-ROM drive for installation800 x 600 VGA (monitor resolution), 256 colorsMicrosoft Windows 95 or later operating system or Microsoft Windows NT operating system version 4.0 with ServicePack 6 or later. Note: Windows XP is not supported at this time.9600 bps modemAdobe Acrobat Reader 4.05 or higher (4.05 is included on the installation CD)Microsoft Internet Explorer (I.E.) 4.01 with Service Pack 2 (Microsoft Internet Explorer 5.0 will be included on theTDHconnect installation CD.)

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National Heritage Insurance Company Electronic Remittance and Status (ER&S)Agreement InstructionsNHICNational Heritage Insurance Company12545 Riata Vista CircleAustin, Texas 78727-6524

Electronic Remittance and Status ( ER&S) is a computer data file containing information previously only available on a printed paperreport. Providers, or their designated representatives, are able to download the ER&S from the Texas Medicaid Network (TexMedNet)electronic bulletin board. Once downloaded, the provider’s computer system uses the data to quickly reconcile the Medicaid paymentsreceived against the claims submitted. ER&S eliminates data entry processes to enter information from paper R&S reports, and alsoeliminates the time a mailed paper R&S is in the postal system before it reaches the provider.

Providers may enroll in the ER&S service if they currently use electronic claims submission (ECS) to submit claims to the TexasMedicaid Program.

The following items are specific to ER&S:

• Upon receipt of a completed Electronic Remittance and Status (ER&S) Agreement, NHIC sets up the provider to receive theER&S. Or, as designated by the provider, sets up a representative authorized to receive the ER&S on behalf of the provider.

• The ER&S files are available on the electronic bulletin board for downloading by 6 a.m. each Monday.

• ER&S file availability is not restricted by holidays.

To enroll in the ER&S program, complete the attached Electronic Remittance and Status (ER&S) Agreement. The following table is aguide for completing the form:

(A) If the provider(s) has never received an ER&S, complete this section

(B) If the provider(s) wishes to change the TexMedNet production ID to which their ER&S is being sent, complete this section

BLOCK 1 This information is for verification only. Enter the provider’s name, phone number, and physical address as itshould appear on file. Also enter a contact name and phone number if different from the provider. Enter allbilling TPIs belonging to the provider.

BLOCK 2 If a billing service or vendor is to receive the ER&S, complete this block in addition to Block 1

BLOCK 3 Check the first box if the ER&S is to be sent to the provider. Check the second box if the ER&S is to be sent toa billing service or vendor.

Signature Block The Electronic Remittance and Status Request Agreement must be signed and dated.

If you need assistance regarding this service, contact the TexMedNet Help Desk at 888-863-3638.

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National Heritage Insurance Company Electronic Remittance and Status (ER&S)Request AgreementNOTE: If the PROVIDER is downloading the ER&S, fill out BLOCK 1 and BLOCK 3.NOTE: If a Billing Service or Vendor is downloading the ER&S, fill out BLOCK 1, BLOCK 2, and BLOCK 3.

Before your ER&S agreement can be processed, you must choose ONE of the following set-ups (EITHER A OR B):

(A) Set up INITIALLY (first time) using TexMedNet Production ID ______________________________(9 digits)OR

(B) CHANGE TexMedNet Production ID FROM: ________TO: ________________________________(9 digits)The TexMednet Production BBS User Id (Submitter ID), is the electronic mailbox id to be used in downloading ER&S files.

BLOCK 1Provider Name Provider Phone Number Provider FAX Number

Provider Contact Name (If other than provider) Provider Contact Phone Number

Provider’s Physical Address Billing Texas Provider Identifier(s)

BLOCK 2Name of Billing Service or Vendor to Receive ER&S Billing Service or Vendor Phone Number

Billing Service or Vendor Contact Name Billing Service or Vendor Phone Number

Billing Service or Vendor Address Billing Service or Vendor FAX Number

BLOCK 3 NOTE: Indicate LOCATION to receive Remittance and Status (R&S) information (check box 1 OR 2)

BLOCK 3LOCATION1. Electronic R&S sent to provider’s electronic mailbox with no change to the paper R&S destination, OR

2. Electronic R&S sent to business organization’s (identified in block 2 of this form) electronic mailbox, withno change to the paper R&S destination.

I (we) request R&S information in the format indicated above in Block 3. If I (we) want to receive Electronic R&S information, I (we)accept responsibility for interpretation of the data. I (we) ensure our system has been sufficiently tested to ensure reliableinterpretation of Electronic R&S information. I (we) authorize R&S information be deposited in the electronic mailbox as indicatedabove. I (we) will continue to maintain the confidentiality of records and other information relating to recipients in accordance withapplicable State and Federal laws, rules, and regulations.

Provider Signature ________________________________Title ____________________________________________ Date ______________________Please FAX OR MAIL this form to: EDI Department

NHIC12545 Riata Vista Circle, Second FloorAustin TX 78727-6524888-863-3638Fax: 512-514-4228 or 512-514-4230

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Request for Electronic Funds TransferNHIC

Electronic Funds TransferAuthorization Agreement

Complete all sections below and attach a voided check or a copy of your deposit slip. Enter one provider number per form.

Type of Authorization ______NEW ______CHANGE

Provider Name Nine-Character Billing TPI

Provider Accounting Address Provider Phone No.

Bank Name ABA/Transit No.

Bank Phone No. Account No.

Bank Address Type Account (check one)

❐ Checking

❐ Savings

I (we) hereby authorize National Heritage Insurance Company to present credit entries into the bank account referenced above andthe depository named above to credit the same to such account. I (we) understand that I (we) am responsible for the validity of theinformation on this form. If the company erroneously deposits funds into my (our) account, I (we) authorize the company to initiate thenecessary debit entries, not to exceed the total of the original amount credited for the current pay period.

I (we) agree to comply with all certification requirements of the applicable program regulations, rules, handbooks, bulletins, standards,and guidelines published by HHSC or its health insuring contractor. I (we) understand that payment claims will be from federal andstate funds, and that any falsification, or concealment of a material fact, may be prosecuted under federal and state laws.

I (we) will continue to maintain the confidentiality of records and other information relating to clients in accordance with applicable stateand federal laws, rules, and regulations.

Provider Signature Date

Title Internet ID (if applicable)

Contact Name Contact Phone #

Print Provider Name

Please return this form to: Provider EnrollmentNHICPO Box 200795Austin, TX 78720-0795

BSL*Input By ____________________________ Date _____________________

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Claim Status Inquiry AuthorizationIf you plan to submit Claim Status Inquiry requests for additional TPI numbers, please fill out the form below.

1) Enter the Compass 21 User ID*: ______________________________

(*Compass 21 ID is found in TDHC. On the first screen in TDHC named TDHC System Totals, Click at the top of thescreen on Communications, then Click on System Settings. Look under the column named Compass 21 and then inthe field named User ID:)

2) Enter the Compass 21 User ID Password _______________________________

3) Circle A or B: A: Add Claim Status Inquiry Privilege B: Revoke Claim Status Inquiry Privilege

4) Enter the organization information below:

NAME 7 DIGIT TPI BASE NUMBER(first seven digits of provider number)

_____________________________________________________ ________________________

_____________________________________________________ _________________________

_____________________________________________________ _________________________

_____________________________________________________ _________________________

_____________________________________________________ ________________________

4) Enter the requestor information below:

Name: __________________________________

Title:____________________________________

Signature:_______________________________

Telephone number: _________________________

Fax completed form to the NHIC EDI Team at 512-514-4228 or 512-514-4230Updated 10/15/01

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Texas Medicaid TDHconnect 3.0 Workshop EvaluationLocation (City): ________________________________ Date: ________________________________

Presenters: (1) ________________________________ (2) ________________________________

How well do you feel this workshop has fulfilled its objectives? This workshop has helped me to understand:Effective Ineffective

• Reference Files 5 4 3 2 1• Eligibility Inquiries 5 4 3 2 1• Claims Submission 5 4 3 2 1• Claim Status Inquiry 5 4 3 2 1• Electronic R&S Report 5 4 3 2 1• Electronic Appeals 5 4 3 2 1

Comments/Suggestions:

______________________________________________________________________________________

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Overall Program (Evaluate from 1 to 5) Yes No

• Content was informative and helpful to your office 5 4 3 2 1• Information was clearly presented and easily understood 5 4 3 2 1• Seminar met or exceeded your expectations 5 4 3 2 1• Would recommend this seminar to others 5 4 3 2 1

Comments/Suggestions:

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How did you hear about this workshop? ____________________________________________________

Complete the following section only if you would like information or you have a question/problem youneed help resolving:

Name: ___________________________________________ Provider #: ____________________________Provider Name: _________________________________________________________________________Mailing address: ____________________________________ Phone #: _____________________________I need assistance with re-enrollment for Medicaid: _______________________________________________I would like a visit to discuss the following questions/problems:_______________________________________________________________________________________

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