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ALL rights reserved. CPT is a registered trademark of American Medical Association. You acknowledge that AMA holds all copyright, trademark and other rights in CPT. License to use CPT for any use not authorized herein must be obtained through the American Medical Association, Intellectual Property Services, 515 N. State Street, Chicago, Illinois, 60610.The AMA does not directly or indirectly practice medicine or dispense medical services. The responsibility for the content of this product is with THHS, and no endorsement by the AMA is intended or implied. The AMA disclaims responsibility for any consequences or liability attributable to or related to any use, non-use, or interpretation of information contained or not contained in this product. All rights reserved. CDT is a trademark of the ADA. You agree to take all necessary steps to ensure that your employees and agents abide by the terms of this agreement. You acknowledge that the ADA holds all copyright, trademark and other rights in CDT. You shall not remove, alter, or obscure any ADA copyright notices or other proprietary rights included in the materials. License to use CDT for any use not authorized herein must be obtained through the American Dental Association, 211 East Chicago Avenue, Chicago IL 60611. Applications are available at the American Dental Association web site,. No fee schedules, basic unit, relative values or related listings are included in CDT. The ADA does not directly or indirectly practice medicine or dispense dental services. The sole responsibility for the software, including any CDT and other content contained therein, is with TMHP or the CMS; and no endorsement by the ADA is intended or implied. This Agreement will terminate upon notice to you if you violate the terms of the Agreement. The ADA is a third party beneficiary to this Agreement. Any questions pertaining to the license or use of the CDT should be addressed to the ADA. End Users do not act for or on behalf of the CMS.
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CMS DISCLAIMS RESPONSIBILITY FOR ANY LIABILITY ATTRIBUTABLE TO END USER USE OF THE CDT.If you do not agree to the terms and conditions, you may not access or use the software. Instead, you must exit from this computer screen. Release notes and archives of previous editions are also available. This may be extended in special circumstances. Requests for exceptions to the enrollment process, risk category, and provider types that require additional state approval may extend the length of the application process. Providers cannot enroll in Texas Medicaid if their license or certification is due to expire within 30 days of application. A current license or certification must be submitted, if applicable. Providers can view and confirm their revalidation date and enrollment information on the Provider Information Management System (PIMS). Most providers have an enrollment period of 5 years. Some providers have shorter enrollment periods, which are based on risk categories and other considerations. Providers that are unable to revalidate using PEP must download and submit the appropriate paper enrollment application. To avoid application processing delays, providers should update the following information before submitting a revalidation application: Providers must allow 30 business days from the date on which TMHP receives the form for the changes to take effect before they can complete a revalidation application. Their claims will not be paid, and their prior authorization requests will be denied. They will not be eligible to participate as a network provider in Medicaid MCOs. An NPI is a 10-digit number assigned randomly by the NPPES. An NPI must be obtained before a provider can enroll as a Texas Medicaid provider. Providers may have more than one taxonomy code. (Taxonomy codes can be obtained from the Washington Publishing Company website at www.wpc-edi.com ).
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Providers will be supplied a list of taxonomy codes to choose from that correspond to the services rendered by the type of provider they wish to enroll as. Only the code will be displayed. Due to copyright laws, TMHP is unable to publish the taxonomy description. Therefore, providers must verify the taxonomy code associated with their provider type and specialty before beginning the online attestation process. Providers who opt out can enroll in the CSHCN Services Program and in THSteps at a future date using the online PEP tool. The messages can be viewed on the secured access portion of the website. Providers may opt out of email communication and receive messages or deficiency letters by mail. Performing providers can complete their portion of a group application by logging into the online PEP tool with their unique user name and password. Providers are able to edit submitted applications to correct identified deficiencies. Providers may download the Texas Medicaid Provider Enrollment Application at www.tmhp.com or request a paper application form by contacting TMHP directly at 1-800-925-9126. Enrollment applications are updated periodically. When an application has been updated, the older version will no longer be accepted and will not be available on the website. It is recommended that the provider check the website regularly for updates and notifications. Providers can choose from one of the following on each application they submit (only one per application is allowed). An individual may also enroll as an employee, using the federal tax identification number of the employer. Certain provider types must enroll as individuals, including dieticians, licensed vocational nurses, occupational therapists, registered nurses, and speech-language pathologist. The enrollment is under the name and federal tax identification number of the legal entity.
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For any group enrollment application other than as a THSteps medical checkup provider group, there must also be at least one enrolling performing provider. THSteps providers are only enrolled at the group level. The most appropriate taxonomy codes should be selected for any performing providers that will be enrolled according to their specific performing provider type and specialty. This type of enrollment applies to an individual health care professional who is licensed or certified in Texas, and who is seeking enrollment under a group. The enrollment is under the federal tax identification number of the group, and payment is made to the group. If a health-care professional is required to enroll as an individual, as explained above, but the person is an employee and payment is to be made to the employer, the health-care professional does not enroll as a performing provider. Instead, the health-care professional enrolls as an individual provider under the federal tax identification number of their employer. Although individuals working for or with the entity may be licensed or certified in their individual capacity, the enrollment is based on the licensure or certification of the entity or the supervising licensed practitioner who is assuming responsibility for the facility’s operation. For this reason, facility enrollment does not require enrollment of performing providers. However, certain provider types must enroll as facilities, including the following: For example, enrolled hospital providers will be issued a hospital provider identifier that is specific to hospital services and a separate HASC provider identifier that is specific to ambulatory surgical services unless the provider is subject to restricted reimbursement.
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However, a health-care professional who is already enrolled with Texas Medicaid as an individual with his or her own practice, and who wishes to bill for services provided in connection with a group, must submit a separate enrollment application and be approved as a performing provider with the group. Similarly, a health-care professional who is enrolled as a performing provider with one group, but who wishes to bill for services provided in connection with another group, must submit a separate enrollment application and be approved as a performing provider with the other group. The provider is authorized to use the provider identifier only to bill for services provided as indicated in the approved enrollment application. It is a program violation for a provider to use a provider identifier for any purpose other than billing for the types of services, and under the type of enrollment, for which that provider identifier was issued.The enrollment requirement includes providers who order or refer for supplies or services for dually eligible clients (i.e., clients who are enrolled in both Medicare and Medicaid), as the client’s claims would be considered Medicaid claims. A current billing provider’s active TPI will be deactivated if the provider enrolls as an ordering or referring-only provider. Although ordering or referring-only providers do not submit claims to TMHP for rendered services, the ordering or referring-only provider’s NPI is required on claims that are submitted by the billing providers that render the services or provide the supplies or services. Providers who are out of network for CHIP MCOs do not need to enroll as ordering or referring-only providers.An intern or resident’s licensed supervising physician must be reported as the ordering or referring provider on claims that are generated from the order or referral of the intern or resident.
The NPI of the supervising physician must be listed on orders or referrals written by the interns or residents they supervise. The licensed supervising physician must be enrolled in Texas Medicaid as a billing provider or as an ordering or referring-only provider. Providers that are enrolled in Texas Medicaid and have fulfilled the ACA requirements through their Texas Medicaid enrollment are considered ACA-compliant for all programs in which they are enrolled. Upon completion of the PEP online application, providers will be notified whether they are required to pay an application fee. The amount of the application fee is subject to change every calendar year. Proof of payment must be submitted with the application. Providers who are enrolled in Medicare must provide documentation that specifies whether or not they have completed the ACA rescreening process with Medicare. No other form will be accepted. The use of this form designates HHSC as the sole obligee of the bond. Bonds for longer or shorter terms are not acceptable. The effective date stated on the bond must be. A continuous bond remains in full force and effect from term to term unless the bond is canceled. To avoid losing Medicaid enrollment status, providers must submit proof of continuation to TMHP Provider Enrollment before the expiration date of the bond currently on file. The completed proof of continuation document must include the bond number, original signatures of the authorized corporate representative of the DME or ambulance provider (principal), the attorney-in-fact of the surety company, date of the original bond, and new “good through” date. Providers may submit a copy of the proof of continuation (scan, fax, photocopy) pending the submission of the original document. A copy of the bond must be included with their application to the Department of State Health Services (DSHS) to renew their emergency services provider license.
The provider applicant is issued a notice of the enrollment determination. The types of conditional enrollment include, among other things. In this case, the provider is sent a notice that includes the deactivation date of the contract. It is the provider’s responsibility, if the provider chooses to seek continued Medicaid participation, to file a complete and correct reenrollment application before the deactivation date of the provider’s current contract. This may avoid a lapse between the provider’s current contract and the new contract, if a new contract is granted. This includes, among other things, reimbursement of only Medicare crossover claims (i.e., claims with respect to “dual eligible” recipients who are covered by both Medicare and Medicaid). If an application is denied, TMHP will send the provider a denial notice that explains the basis for the denial. The notice also explains the provider’s right to make a written request for an informal desk review of the denial decision and the procedures for filing such a request. HHSC will conduct the informal desk review and render a final enrollment determination. HHSC’s final determination is not subject to further administrative review or reconsideration. This date impacts claims filing deadlines. Revalidation notifications that contain the updated revalidation due date are printed the following business day and mailed to the physical address listed on the application. If the applicant is an entity, a principal of the entity must sign the application. Applications must be complete in order to process and issue a provider identifier. Otherwise the enrollment application will be considered incomplete. Providers should retain a copy of the original application for future reference. If the information is not provided within 30 business days, TMHP will terminate the enrollment process. If the provider wants to enroll at a later date, a new enrollment application must be submitted.
Providers are required to review their enrollment application for correctness and completeness before submitting it to TMHP. The application cannot be processed if the application fee is required and is not submitted with the application. If the applicant is an entity, a principal of the entity who has the authority to bind the entity to the requirements of the HHSC Provider Agreement must sign the agreement. “Principal” is defined in the following section. This form is an agreement between HHSC and the provider performing services under the State Plan wherein the provider agrees to certain provisions as a condition of participation. This includes a certification that every person who is required to complete a PIF-2 has done so, and all required PIF-2s are included with the application. If corrections are required on any page within the agreement, a new agreement with an original signature and date is required. If the provider is an entity, the PIF-1 must be completed on behalf of the entity. Failure to provide complete and accurate information as instructed on this form will constitute an incomplete application, which may result in denial of enrollment. Incomplete or inaccurate information on this form constitutes a violation of the rules of Medicaid and may also result in administrative, civil, or criminal liability. This form indicates the individual (by name) who is authorized by the corporation to sign the agreement forms. The secretary of the corporation must sign the Corporate Board of Directors Resolution and have it notarized. If a business is city or government-owned, this form is not required. This information can be obtained from the Texas State Comptroller’s Office website at. Obtain the form from the Office of the Secretary of State of Texas. The name on this form must exactly match the legal name shown on the W-9 form. The form identifies the legal name of the corporation and is proof that the corporation is registered to do business in Texas.
During the enrollment process, TMHP verifies licensure using available resources. If TMHP cannot verify a license at the time of enrollment, it is the providers’ responsibility to provide a copy of the active license to TMHP. Psychologists and facilities must submit a copy of their license since these licenses cannot be verified online. A reminder letter for renewal will be sent to the provider 60 days before the provider’s license expires. The letter must contain the provider’s specific identification information, license number, and licensure period. Not abiding by this license and certification update requirement may impact a provider’s qualification to continued participation in Texas Medicaid. For purposes of this rule, “consultation” means discussion of patient status, care, and management. This agreement must be signed by the CNM or LM and the physician. If a provider’s license has expired, a deactivation letter will be sent to the provider, and all claims filed on and after the expiration date will be denied. Payment will be considered for dates of service on or after the date of license renewal. Claims denied due to an inactive license may be appealed, and payment will be considered for dates of service on or after the date of return to active license status. Payment deadline rules for the fiscal agent arrangement must be met. Therefore, in order to be eligible to enroll in Texas Medicaid, a provider must be a Medicare participating provider. Certain types of providers, however, are not required to meet the Medicare participation requirement, including: The following provider types are eligible to apply for this waiver: The group enrollment application must include the current and valid Medicare number for the group and for each performing provider in the group, as well as a copy of the notice of Medicare enrollment for the group and for each performing provider in the group.
Performing providers added to this Medicaid-only group also do not require a current Medicare number. Filing claims and receiving payment without having followed this requirement constitutes a program violation and may also result in administrative, civil, or criminal liability. Providers are strongly encouraged to utilize EFT, which allows for more rapid reimbursement. EFT is a method for directly depositing funds into a designated bank account. EFT does not require special software, and providers can enroll immediately. If the bank’s processing software captures and displays the information, both numbers would appear on the banking statement. A voided check or letter on bank letterhead, containing the bank routing and account information, must be attached to the enrollment form. One completed form must be filled out for each billing provider identifier, including an original signature of the provider. Providers will continue to receive paper checks until they begin to receive EFT transactions. The prenotification process is repeated and, once completed, the EFT transaction is deposited to the new bank account. Providers must send all changes to addresses and telephone numbers to: Once a check has been voided, the associated claims may not be payable, and the transaction will be finalized after 24 months. Providers may submit a voided check appeal to TMHP Cash Financial at the following address: EFT ensures that providers receive payments through direct deposit in a bank account of their designation. The TPI will be considered inactive and will not be able to be used to submit claims. Providers will have six months to submit claims and prevent the TPI from being deactivated. If the provider is enrolled in both Medicaid and the CSHCN Services Program, the provider identifiers for both programs will be examined to determine whether claims activity has occurred.
Claims that are submitted for a deactivated TPI after the payment denial code has been applied will be denied. The information on this application must match exactly the information currently on the provider’s file for the payment denial code to be removed. These screenings are a condition of the provider’s enrollment, revalidation, or re-enrollment into state health-care programs. The Texas HHSC-OIG website is found at. If a name matches a name on the exclusion list, it can be verified online with a SSN or EIN. In addition, no Medicaid payments can be made for any items or services directed or prescribed by an excluded provider or other authorized person when the individual or entity furnishing the services either knew or should have known of the exclusion.
Although this version of their machine is advertised as being capable of dialing with mold issues, according to one mold expert that I listened to, I probably should have bought the HealthMate version of the machine because it would probably eliminate the micotoxin particles that some molds produce better. But, so far it has improved my bedroom air considerably. I am happy with it. Reviewed in the United States on September 7, 2018 We bought 3 of these after reading about how good they are. Well, right after the return deadline passed (which wasn’t that long) one starting smelling awful and one of the other ones is making an awful rattling noise. I contacted the company and was told the smell could be a bad air filter (in a brand new machine) and the best they could do was offer me 50 off a replacement filter. I find this to be ridiculous with what we paid for the units and how quickly it had an issue. Regarding the rattling, the company said it sounds like it needs maintenance and they will fix it but I have to pay to ship it to them. If you have one you know how heavy it is. So I will be out of pocket more money. I wanted to just send them back and get my money back since I don’t feel they are worth the money but since it is passed the return window they will not take them back. Extremely disappointed and would not recommend buying them. Please try again later. From the United StatesWell, right after the return deadline passed (which wasn’t that long) one starting smelling awful and one of the other ones is making an awful rattling noise. Extremely disappointed and would not recommend buying them.Please try again later. Helio 3.0 out of 5 stars I bought this filter for my fiance to use. She is an asthmatic, and allergy sufferer. It is dense, and layered and I don't see anything obviously wrong with it. Sleep quality has improved over the Honeywell this unit replaced. It is very power efficient.
Using a Kill-A-Watt I measure slightly above 33watts and 35VA on the highest setting. That's pretty low for the amount of air it moves, and not a bad Power Factor at all. That indicates to me the motor is of a relatively high quality. I didn't disassemble the motor to look at it closely, but the shaft is around 6mm if I had to guess. It doesn't seem to get hot at all while in use at the highest speed. The noise level on speed 1 and 2 is very good. The unit doesn't rattle or make noise other than the fan itself. It is actually too quiet for her, she likes a bit more white noise than this thing produces at the lower speed settings. I could feel the barest hint of silicon they obviously used to try to seal the two pieces together, but there wasn't nearly enough. This allowed the fan to draw unfiltered air through bypassing the entire filter. I put some RTV gasket maker around the gap from the inside. I've attached a couple pictures where you can see how much leaked through just from me smoothing out the inside with my finger. I used the leftover silicone from the tube to seal the output (positive pressure) side too even though that fit was much better than the negative pressure side. Using the very non scientific test of a drier sheet held next to the unit before and after, there seems to be more suction from the actual filter area now as well. It's not like they didn't know that gap needed sealing, there was a (very) small amount of silicon residue exactly where I put mine on. They just didn't use nearly enough to be effective. You are paying for premium and getting slapdash at best. Not to mention that since I've now opened and modified the filter, to fix the job they didn't do right in the first place, I've probably voided my warrenty. Disappointing. The Other: While mine arrived in fine condition, I can absolutely see how people have received theirs damaged. The packing material is not good enough.
It comes in a large box (exterior labels identifying the contents for anyone having this left on the porch FYI) with fitted sturdy cardboard end pieces attached at either end of the unit. The whole unit is in a plastic bag. There is no padding or extra protection for the whole center section of the unit, and it is just thin sheet metal. Any large impact to the center of the box definitely will dent the unit. I was originally going to knock the amount of air flow for a unit rated to 750 square feet and blame the motor. I still believe 750 is a gross overestimate of this unit's capabilities. However, after fixing the air leak I now think it is not the motor. Once the air leak was corrected, the noise level on the highest fan setting got louder. It also changed it's sound quite a bit. Before when it could suck air bypassing the filter, it sounded like pretty much any other fan. Now that it is all sealed, there is a noticeable pulsing sound, as if the back pressure on the fan is cycling up and down. You can feel the pulses in the output air on high as well, but not the lower settings. I really believe this unit could benefit from a larger squirrel cage fan attached to this motor. Because the intake area is so large, dust can pass pretty close by and not get sucked in. I would put this under the bad section, but I know the reason is noise. The large 360 (well, 350 maybe) degree input area makes for quiet operation. But, it doesn't seem to draw in air from very far away. While the unit does exhaust a decent amount of air it is very directional. I keep the ceiling fan on the keep more air in the room moving to hopefully get more drawn across the unit. I think it is even a bit underpowered for the 390 I have it in. I would rate this filter at maybe 350 for best results. The label on the underside with power information seems to be pure marketing gibberish. Here's what is says: Voltage: 120v Max. Here's what I've measured on high: Voltage: 120v Watt: 33.2w (35.
1VA with a power factor of.945) Amp.: 0.28 The bottom line: This unit is expensive. For the price I am disappointed in the leaking air, packing material, and seeming overestimate of coverage. I am happy with the filter itself, and the power draw. It seems to be doing a better job than the (undersized!) honeywell it replaced. The construction, while a thin gauge metal, seems pretty solid. The unit is very disassembly friendly for cleaning and fixing of gaskets. I'd consider buying one again, but I would consider some other brands as well. It isn't a slam dunk for another purchase.Please try again later. S'noflake 5.0 out of 5 stars I have a mold problem to deal with and it has reduced it considerably. I am happy with it.Please try again later.I bought this filter for our bedroom about a year ago and since then she has definitely had fewer problems. I know this is not scientific testing, but in her case it seems to have really helped. PROS: 1. Seems to help with respiratory issues. 2. Easy to use - just exterior cleaning required. CONS: 1. Somewhat noisy, even on the lower speeds; but I have come to view it as white noise. 2. Takes up a fair amount of space. BOTTOM LINE: Seems to help people with breathing problems. I would recommend it.Please try again later. amzoo 1.0 out of 5 stars If it is under warranty or not, you must pay the shipping to send it to them. This is a hefty weighty package so that is a hefty expense. Even if the machine is defective, they won't refund the shipping you paid on their defective workmanship during the 5-yr warranty. When I asked about this I was told it is in their return policy. Nothing during purchase process or in my official owner's manual specifies this. And, to review the machine, it came already making fluttery, sputtery, noisy sounds with faint odor coming from filter. A ring soldered inside has a dent in it so that have to turn filter certain way to get thing closed again.