TMHP - EDI

News

	Updates to 270/271 EDI Transactions Information posted August 3, 2009: Effective August 28, 2009, the 270/271 Health Care Eligibility Benefit Electronic Data Interchange (EDI) responses will return client/policyholder relationship information. For clients who have other insurance on the date of service, the following relationship information will be provided in the 2110C Loop: • The REF-01 segment will contain a 49 qualifier (Family Unit Number). • The REF-02 segment will contain a relationship code. Values for the relationship code are: “C” for child, “M” for spouse, “O” for other, “P” for parent, and “S” for self. Revised companion guides will be available on this website on August 28, 2009. For more information, call the TMHP EDI Contact Center at 1-888-863-3638.
	EDI Testing for MAPS Information posted June 12, 2008: The state of Texas has submitted to the Centers for Medicare & Medicaid Services (CMS) a State Plan amendment pertaining to Medicare Advantage Plans (MAPs). MAPs are managed care organizations that have entered into a Medicare Risk Product Agreement with CMS. They are sometimes called Medicare Advantage Health Plans or MA Health Plans. The amendment initiates a process by which the state will pay a monthly capitated payment to MAPs. In exchange, MAPs will pay health-care service providers for the cost sharing obligations that are attributable to dual-eligible members enrolled in the MAP’s Medicare risk product. The State Agreement will be the only vehicle for recovery of the cost sharing obligations attributable to dual eligible members. The effective date is January 1, 2008. The Health and Human Services Commission (HHSC) is currently contracted with 18 MAPs. Click on the title to view the details.
	Correction to "EDI Testing for MAPs" Article Information posted August 28, 2008: This is a correction to an article that was published on the TMHP website at www.tmhp.com on June 12, 2008, titled “EDI Testing for MAPs”. The contact information for the following Medicare Advantage Plan (MAP) contractors has been corrected: Aetna, Care Improvement Plus, Evercare Health Plan, Humana Health Plan of Texas, and Texas Health Springs. Also, an additional MAP has now contracted with HHSC. Click on the title to view the details.
	NPI Data Submission Errors Cause Higher-Than-Usual Rejection Rate Information posted May 27, 2008: Some providers are experiencing a higher-than-usual rejection rate because of National Provider Identifier (NPI) data submission errors. Many of these errors are because clearinghouses and third-party software programs are submitting incorrect claims information. Click on the title to view the details.
	Revised EDI Companion Guides Now Available Information posted February 26, 2007 - The revised Electronic Data Interchange (EDI) Companion Guides are now available on the EDI page of the TMHP website under the Companion Guides for CMS and C21 link. The EDI Companion Guides include updates related to the enhanced dual strategy approach to submitting electronic claims for the National Provider Identifier (NPI) implementation. For more information, call the TMHP EDI Help Desk at 1-888-863-3638. Click the title to access the file library for these files.