How to find your R&S Reports

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How to find your R&S Reports

1) Go to www.tmhp.com and click providers in the header.

2) Click Go to TexMedConnect in the upper right corner.

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4) Click R&S in the left navigation column the the TexMedConnect screen.

5) Click the appropriate NPI for the R&S Report you want to access.

6) Select Program 100.

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R&S Report Sections

R&S Reports include the following sections:

• Banner Pages: Banner messages are used to inform providers of new policies and procedures.

• Claims – Paid or Denied: Claims in the “Claims - Paid or Denied” section were finalized

during the week before the preparation of the R&S Report. Claims are sorted by claim status,

claim type, and by order of client names. The reported status of each claim will not change

unless further action is initiated by the provider, HHSC, or TMHP.

• Adjustment to Claims: Adjustments are listed by claim type, client name, and the client’s

Medicaid identification number.

• Financial Transactions: The “Financial Transaction” section of the R&S Report describes

any amounts that are added or taken out of the weekly payment. All accounts receivable, IRS

levies, payouts, refunds, reissues, and voids appear here.

• Claims Payment Summary: The “Claims Payment Summary” section summarizes all

payments, adjustments, and financial transactions that are listed on the R&S Report. The

section has two categories: one for amounts “Affecting Payment This Cycle” and one for

“Amount Affecting 1099 Earnings.”

• Claims in Process: The “Claims in Process” section can list up to five explanation of pending

status (EOPS) codes per claim. The claims listed in this section are in process and cannot

be appealed for any reason until they appear in either the “Claims Paid or Denied,” or

“Adjustments Paid and Denied” sections of the R&S Report. TMHP is listing the pending

status of these claims for informational purposes only.

• EOB: Explanation of Benefits - This page will list the EOB codes found in your R&S Report

and give a description of the code.

Sample EOB Codes for MTP (Claim Type 060)

EOB

Descritpion

01171

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

01172

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

01173

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

01174

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

WHEN THE MTP SYSTEM BECOMES AVAILABLE.

01175

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

SER-VICE.

01176

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

MTP CLAIM DATE OF SERVICE.

01177

THE AMOUNT/NUMBER OF UNITS BILLED ON THE MTP CLAIM HAS BEEN REDUCED TO EQUAL THE

AMOUNT/NUM-BER OF UNITS AUTHORIZED BY MTP FOR THIS SERVICE.

01178

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

01180

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

UNITS OR THE BILLED UNITS.

01181

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

01182

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

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Sample R&S Report - ITP

Dear Provider,

The services below have been processed for payment. John DOE

123456 SouTh airPorT roaD corPuS chriSTi TX 79510-4569 Payment Date: XX/XX/XXXX r&S no.: XXXXXXXXXXXXXX aPi: XXXXXXXXXXXXX Taxonomy: XXXXXXXXX TPi-Location: XXXXXXXXX-XX aiS no.: XXXXXXXXX For questions about claims, call: 1-800-925-9126

TMhP, Medical Transportation 12345 riata Trace

austin TX 78729-4569

cLaiM no. DaTe oF Service cLienT naMe

MiLeS BiLLeD MiLeS PaiD aMT. PaiD

eoB DeScriPTion XXXXXXXXXXXXXXXXXXXXXXXX XX/XX/XXXX XXXXXXXXXXXXXXXXXXXXXX XXX.X XXX.X $XXX,XXX,XXX.XX XXXXX XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX. XXXXX XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX. XXXXX XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX. XXXXX XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX. XXXXX XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX. XXXXXXXXXXXXXXXXXXXXXXXX XX/XX/XXXX XXXXXXXXXXXXXXXXXXXXXX XXX.X XXX.X $XXX,XXX,XXX.XX XXXXX XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX. XXXXX XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX. XXXXX XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX. XXXXX XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX. XXXXX XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX.

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

iF you neeD To aPPeaL any cLaiM in ThiS LeTTer, you May aPPeaL onLine For FaSTer ProceSSing. you May aLSo MaKe a coPy oF ThiS rePorT anD circLe The cLaiM you wanT To aPPeaL. MaiL The MarKeD coPy wiTh a ShorT DeScriPTion oF The aPPeaL. your aPPeaL MuST Be receiveD wiThin 120 DayS FroM The DaTe oF ThiS LeTTer. For inForMaTion regarDing The onLine ProceSS, caLL (ToLL Free) 1-888-863-3638.

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Sample R&S Report - ITP

Page 2 of X The payment amount has been adjusted as listed below:

SySTeM PayouTS

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

eoB DeScriPTion

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

XXXXX XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX.

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

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

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

aDJuSTMenTS

DaTe oF Service cLienT naMe

aDJuSTMenT cLaiM no. aDJuSTeD aMT. PaiD

eoB DeScriPTion XX/XX/XXXX XXXXXXXXXXXXXXXXXXXXXX XXXXXXXXXXXXXXXXXXXXXXXX $XXX,XXX,XXX.XX XXX.X XXXXX XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX. XXXXX XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX. XXXXX XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX. XXXXX XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX. XXXXX XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX. XX/XX/XXXX XXXXXXXXXXXXXXXXXXXXXX XXXXXXXXXXXXXXXXXXXXXXXX $XXX,XXX,XXX.XX XXX.X XXXXX XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX. XXXXX XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX. XXXXX XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX. XXXXX XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX. XXXXX XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX. ToTaL aDJuSTMenTS: $XXX,XXX,XXX.XX

iF you neeD To aPPeaL any cLaiM in ThiS LeTTer, you May aPPeaL onLine For FaSTer ProceSSing. you May aLSo MaKe a coPy oF ThiS rePorT anD circLe The cLaiM you wanT To aPPeaL. MaiL The MarKeD coPy wiTh a ShorT DeScriPTion oF The aPPeaL. your aPPeaL MuST Be receiveD wiThin 120 DayS FroM The DaTe oF ThiS LeTTer. For inForMaTion regarDing The onLine ProceSS, caLL (ToLL Free) 1-888-863-3638.

ManuaL PayouTS

PayouT conTroL nuMBer PayouT aMT.

eoB DeScriPTion

XXXXXXXXXXXXX $XXX,XXX,XXX.XX

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

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Sample R&S Report - ITP

DeDucTionS

The payment was reduced by the amount(s) shown below for the reasons listed.

conTroL no. DeDucTeD aMT. orig. aMT.

originaL cLaiM no. Prior BaLance aMT. aPPLieD

eoB DeScriPTion XXXXXXXXXXXXX $XXX,XXX,XXX.XX $XXX,XXX,XXX.XX XXXXXXXXXXXXXXXXXXXXXXXX $XXX,XXX,XXX.XX $XXX,XXX,XXX.XX XXXXX XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX. XXXXXXXXXXXXX $XXX,XXX,XXX.XX $XXX,XXX,XXX.XX XXXXXXXXXXXXXXXXXXXXXXXX $XXX,XXX,XXX.XX $XXX,XXX,XXX.XX XXXXX XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX.

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

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

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

ToTaL DeDucTionS: $XXX,XXX,XXX.XX

irS Levy inForMaTion

conTroL no. PreviouS BaL currenT DeDucTion reMaining BaL.

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

Due to the levy described below, payment(s) totaling $XXX,XXX,XXX.XX were remitted on your behalf to the irS.

SuB-owner DeDucTionS

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

conTroL no. DeDucTeD aMT.

BacKuP wiThhoLDing

conTroL no. originaL DaTe aMT. wiThheLD

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

Backup witholding information:

our records indicate that you have been assessed a penalty by the internal revenue Service (irS) for non-compliance with backup withholding requirements. Therefore, your payment has been lowered and the penalty amount has been remitted to the irS. 28% of your payment amount will be withheld weekly until TMhP receives a w9 or Letter 147c as requested in a B-notice previously sent to you.

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Sample R&S Report - ITP

Page 4 of X caSh reFunDeD To MTP

your refund check #XXXXXXXX dated XX/XX/XXXX was received by TMhP and applied as listed. cLaiM SPeciFic

cLaiM no. ToTaL BiLLeD aMounT aPPLieD

eoB DeScriPTion

SuBToTaL cLaiM SPeciFic $XXX,XXX,XXX.XX

non-cLaiM SPeciFic

conTroL no. aMounT aPPLieD

eoB DeScriPTion

XXXXXXXXXXXXXXX $XXX,XXX,XXX.XX

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

ToTaL reFunDeD $XXX,XXX,XXX.XX

voiDS/SToP PayMenTS

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

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

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

SySTeM reiSSueS

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

XXXXXXXXXXXXX XX/XX/XXXX XXXXXXXX $XXX,XXX,XXX.XX The payment was increased by the amount(s) shown above.

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Sample R&S Report - ITP

cLaiMS in ProceSS

cLaiM no. DaTe oF Service

BiLLeD MiLeS BiLLeD aMT. aLLoweD MiLeS aLLoweD aMT.

eoPS DeScriPTion XXXXXXXXXXXXXXXXXXXXXXXX XX/XX/XXXX XXX.X $XXX,XXX,XXX.XX XXX.X $XXX,XXX,XXX.XX XXXXX XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX. XXXXX XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX. XXXXX XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX. XXXXX XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX. XXXXX XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX. XXXXXXXXXXXXXXXXXXXXXXXX XX/XX/XXXX XXX.X $XXX,XXX,XXX.XX XXX.X $XXX,XXX,XXX.XX XXXXX XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX. XXXXX XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX. XXXXX XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX. XXXXX XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX. XXXXX XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX.

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

The Explanation of Pending Status (EOPS) codes listed is not final claim denails or payment dispositions. The EOPS codes identify the reasons why a claim is in process. Because these claims are currently in process, new information cannot be accepted to modify the cliam until the claim finalizes and appears as finalized on your R&S letter. Please refer to the last section of this letter for the messages that cor-SuB-owner caSh reFunDeD To MTP

your refund check #XXXXXXXX dated XX/XX/XXXX was received by TMhP and applied as listed. cLaiM SPeciFic

cLaiM no. ToTaL BiLLeD aMounT aPPLieD

eoB DeScriPTion

SuBToTaL cLaiM SPeciFic $XXX,XXX,XXX.XX

non-cLaiM SPeciFic

conTroL no. aMounT aPPLieD

eoB DeScriPTion

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

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Sample R&S Report - ITP

Banner MeSSageS XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX

your total payment after all increases, deductions, and adjustments is:

$XXX,XXX,XXX.XX

garniShMenTS

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

heLD aMounT $XXX,XXX,XXX.XX