TX HHS Form 8612. TAS/MHM Payment Exception Request

The TX HHS Form 8612, TAS/MHM Payment Exception Request, is a crucial document for healthcare providers in Texas. It helps resolve payment issues by requesting 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 is typically used when an applicant's enrollment into a Home and Community-based Services (HCS) program has not occurred, or when there are discrepancies in payment.

To successfully submit a request for reimbursement, providers must include specific information in their packet. These requirements include: a copy of Form 8604 signed by an HHSC representative authorizing reimbursement; copies of invoices detailing authorized expenditures; proof of payment; and assessment documents completed in accordance with MHM procurement requirements. Additionally, the form specifies that HCS providers may request reimbursement from HHSC no sooner than 30 days after the applicant's approved enrollment date.

The TX HHS Form 8612 should be submitted to the Program Enrollment/Utilization Review Unit via mail or fax. Providers are advised not to fax more than 25 pages without prior approval. Key points to note include:

• Required information: signed Form 8604, invoices, proof of payment, and assessment documents
• Conditions: HCS providers may request reimbursement no sooner than 30 days after the applicant's approved enrollment date
• Responsibilities: submit packet to Program Enrollment/Utilization Review Unit via mail or fax