Billing Guide

Entering Case Management Claims in TexMedConnect

• Patient Tab

  Account #	You can determine this internal number. You can use the client’s Medicaid number if you choose. This is for your tracking purposes.
  Patient data	Information should auto-populate or should be easily available for you to input.
  Client #	Enter the client’s Medicaid #.

• Provider Tab

  Billing NPI	Enter your group or individual NPI here.
  ID Type	See the drop-down options. Most of you will click on 24 Employer ID or SSN.
  EIN/SSN	Enter your employer ID # if you are a group. Individual providers—enter SSN.
  Skip Facility and Referring Provider Sections. You can save the template here and return later if you choose.

• Claim Tab

  Date of Current Condition	Leave blank.
  Authorization #	Enter the prior authorization number (PAN). This is the number that TMHP issues upon approval of the prior authorization request. There is NO red dot here, but you must enter PAN for CM claims.

• Diagnosis Tab

  Code	Enter the ICD-10 code without periods. For example, enter F909, not F90.9. You can use search: findacode.com
  Description	This should auto-populate.
  Present on Admission	Leave blank.

• General Details Tab

  DOS	Enter the date that you performed the service.
  POS	Use the drop down to find the place that you performed the service.
  Proc ID	Use the drop down and click on HC.
  Proc Code	Enter G9012.
  Remarks	Leave blank.
  Mod1	See the table below and enter appropriate modifier.
  Mod2	See the table below and enter appropriate modifier or none.
  Procedure Code Procedure Description Additional Information G9012 Comprehensive visit (in-person) Modifier U2 and U5 G9012 Comprehensive visit (synchronous audiovisual) Modifier U2, U5 and 95 G9012 Follow-up visit (in-person) Modifier U5 and TS G9012 Follow-up visit (synchronous audiovisual) Modifier U5, TS and 95 G9012 Follow-up visit telephone (audio only) Modifier TS and 93
  Ignore Mod3, Mod4, Ane. Min., OB. Ane Unit
  Diag Ref	Click on the ICD-10 code in drop down.
  Quantity	Enter 1
  Unit Price	You can enter any dollar amount; however, you will be paid that amount if it is below CM rates. Suggest you enter rate as shown in table above.
  Perf NPI	Enter the case manager’s NPI number. This must be the case manager that TMHP authorized services to be provided by. This is also called the performing provider.
  Leave rest blank. Can add another claim here or hit next.

• Other Insurance Tab

  Source of Payment

  Click on NONE in the drop down.

  Skip all other questions.

• Certification, Terms and Conditions

  Click we agree box.

  Submit claim.