TX HHS Form 8612. TAS/MHM Payment Exception Request

The TX HHS Form 8612, TAS/MHM Payment Exception Request, is a document used to request reimbursement for Transition Assistance Services (TAS) and/or Pre-Enrollment Minor Home Modifications (MHMs) that have been previously approved by the Texas Health and Human Services Commission (HHSC). This form helps providers obtain payment for services or modifications that were authorized but not yet reimbursed.

To complete this form, providers must include specific information such as a copy of Form 8604 or Form 8611 signed by an HHSC representative, copies of invoices detailing authorized expenditures, proof of payment, and assessment documents completed in accordance with MHM procurement requirements. The form should only be used when requesting reimbursement for services or modifications that were previously approved via Form 8604 or Form 8611.

The TX HHS Form 8612 is an essential tool for providers seeking to obtain payment for authorized TAS/MHM services or modifications. By following the instructions outlined in this form, providers can ensure a smooth and efficient reimbursement process with the Texas Health and Human Services Commission (HHSC).