Information Letter No. 18-02 -Nursing Facility providers often make two common mistakes that usually result in denial of authorization requests or Health and Human Services Commission (HHSC)
Preadmission Screening and Resident Review (PASRR) NF specialized services or assessments. To avoid this error, DADS has published this letter to help avoid these errors.
The two most common reasons HHSC denies authorization requests for PASRR specialized services and assessments are:
1. NF staff fail to respond to “Pending Denial” status requests for additional information made through the TMHP LTC Online Portal within the required time frames.
2. After receiving a “Pending Denial” status alert, NF staff fail to update the submission status to “Pending State Review” after responding to the request for additional information made through the TMHP LTC Online Portal NFSS Form.
To avoid a “Denied” status:
1. After receiving a “Pending Denial” status alert and request for additional information through the TMHP LTC Online Portal, NF staff must submit the additional information or attachment within 7 calendar days for habilitative therapy assessments and service authorization requests, or within 14 calendar days for durable medical equipment and customized manual wheelchair assessments and service authorization requests.
2. After submitting the requested additional information, the NF staff must update the request status to “Pending State Review” to alert the reviewer of the updated submission.