FYI: SHARS Electronic Remittance Advice Agreements

Heidi BickhamMedicaid

Changing Vendors? As part of the change process from one vendor to another, TMHP now sends an informational email out to LEAs – letting them know a change in 3rd party authorization has occurred. ERAs are only submitted to TMHP and HHSC when districts change vendors.  No action is required by districts – it is merely a courtesy email.

IF, however, you receive this email and have not changed vendors, it it best to reach out to TMHP to ask for clarification.

Below is an example of the ERA form letter sent by TMHP.

SHARS Electronic Remittance Advice Agreements

This message is a reminder from the HHSC Provider Finance Department (PFD) regarding Electronic Remittance Advice (ERA) Agreements. An ERA must be submitted by an enrolled Medicaid provider, or by a third party that is authorized by the respective local educational agency (LEA). The information regarding ERA submissions can be found on the Texas Medicaid & Healthcare Partnership (TMHP) website.

If an LEA believes an ERA was submitted by a third party that was not authorized by them, the LEA should:

  • Contact TMHP at 1-800-925-9125 (Option 4) and let the agent know that you believe the wrong individual/entity may be receiving your Remittance and Status (R&S) reports or ERAs.
    • TMHP will research who is set up to receive the R&S/ERAs.
    • If TMHP is unable to determine who is set up to receive the R&S/ERAs or confirms the incorrect entity has been receiving the R&S/ERAs, an escalation to TMHP’s Health Insurance Portability and Accountability Act (HIPAA) team will be made to determine whether there has been a HIPAA incident. The HIPAA team will follow standard processes for escalation if they determine there has been an incident.
  • Contact the HHSC Office of Inspector General (OIG) Fraud Hotline at 1-800-436-6184. The provider may also fill out a fraud form on the OIG website.

For questions regarding this notice, please contact the HHSC SHARS staff at (512) 730-7400 or email us.

 

As always, if you have any questions, please do not hesitate to reach out to your Onward Financial Manager for assistance.