Note: PSU staff will upload Form 2442 or Form H2065-D in the HEART case record, as appropriate.Welcome to the Chocolatey Community Package Repository! The packages found in this section of the site are provided, maintained, and moderated by the community. TIERS Individual - Managed Care Screenshotįorm 2442 Screenshot of Upload to TxMedCentralįorm 2604 (if received through TMHP LTCOP)įorm 2604 (if received through TxMedCentral)įorm H1200 (, Section A, You and Your Spouse, and, Signature Page)įorm H1746-A (form alone or with fax confirmation page)įorm H1746-A Fax Confirmation (if confirmation page only)įorm H2065-D Generated in TMHP LTCOP (English and Spanish)įorm H2065-D Generated Manually (English and Spanish)įorm H2065-D Screenshot of Upload to TxMedCentralįorm H2067-MC Screenshot of Upload to TxMedCentral TIERS Individual - Medicaid History Screenshot PSU staff will include screenshots, forms, documents and emails marked with an “*” in the “Required” column in the HEART case record if used by PSU staff while completing the case. PSU staff will upload all screenshots, forms, documents and emails marked as “Yes,” in the “Required” column in the HEART case record. For example, PSU staff will name the first Form H1746-A sent or received as 1746_1, the second form sent or received as 1746_2 and the third form sent or received as 1746_3, etc. PSU staff will add a sequence number after the naming convention when more than one of the same form or screenshot is uploaded. Refer to Appendix IX, STAR Kids TxMedCentral Naming Conventions, for TxMedCentral naming convention instructions. PSU staff will use the HEART Naming Conventions below when uploading documents to the HEART case record. This appendix outlines the screenshots Program Support Unit (PSU) staff will upload to the Texas Health and Human Services (HHS) Enterprise Administrative Report and Tracking System (HEART) case record.
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