HCS billing documentation: what records support an HCS claim in Texas?

What are the HCS billing guidelines?

The HCS billing guidelines are HHSC's HCS Program Billing Requirements, the document that says what an HCS claim must meet and what records must support it. The current version is Revision 25-1, effective January 1, 2025.

Older versions were published as the HCS Program Billing Guidelines, which is why many providers still use that name. The rules are binding: HHSC rules at 26 TAC §263.601 require program providers to prepare and submit claims in line with the Billing Requirements, and the HCS Program Provider Agreement requires compliance too.

This guide covers the documentation side. It is not legal advice, and agencies should confirm current requirements with HHSC.

What must every HCS service claim meet?

Section 3210 lists the rules for each claim. In short, the service must be authorized, planned, actually delivered by a qualified person on the date claimed, counted correctly, and supported by written documentation.

A claim also covers only one individual and one date, and it must be a clean claim submitted to the state Medicaid claims administrator no later than 12 months after the last day of the month the service was provided.

• Authorized by an IPC (Individual Plan of Care, HHSC Form 3608)
• Identified in the individual's person-directed plan (PDP) and delivered according to the implementation plan
• Provided while the individual has a level of care (LOC), and billed at the level of need (LON) authorized by the ID/RC assessment
• Based on billable activity, done by a qualified service provider
• For the date the service was actually provided, with units calculated by the rules
• Supported by written documentation
• Identifies the service provider who delivered the service

What must an HCS written service log include?

A written service log must be written after the service, name the service and the individual, give the day, month, and year, describe the billable activities, carry the signature and title of the person who wrote it, and be made within 14 calendar days.

The log must be completed by the service provider who delivered the service. A supervisor can review it, but cannot write it for someone else.

For daily services, the log describes the activities that show billable work was done. For hourly services, it also gives a detailed description of activities, the location of the service event, and support for the length of the service event.

The log must describe any unusual incident, such as a seizure, illness, or behavioral outburst, and what staff did in response.

Which service delivery logs support RSS, SL, host home, and ISS claims?

HHSC publishes a log for each common service. Form 4119 covers Residential Support Services (RSS) and Supervised Living (SL), Form 4122 covers Host Home/Companion Care, and Form 8615 covers on-site and off-site Individualized Skills and Socialization (ISS).

The billing rules call these example forms. A provider may document a service in any format that meets the written documentation rules, but the content, timing, and signature rules still apply.

RSS, SL, and Host Home/Companion Care are billed by the day, and a claim cannot be for more than one unit per day. Form 4119 and Form 4122 each hold up to seven service events for one individual, one per column, and each must be completed within 14 calendar days. For host home, the rules also allow a written summary log for the calendar week, made within 14 calendar days after that week.

Form 8615 must be completed within 14 calendar days after the ISS activity. If an individual is away on a visit with family or friends, RSS, SL, and host home can still be claimed for up to 14 consecutive days of the visit, with documentation of the individual's name, the visit dates, and the staff member's date and signature.

• Form 4119: Residential Support Services and Supervised Living Service Delivery Log
• Form 4122: Host Home/Companion Care Service Delivery Log
• Form 8615: On-site and Off-site ISS Service Delivery Log
• Form 4118: Respite and In-Home Respite Service Delivery Log
• Form 2124: Supported Home Living transportation log

What extra documentation do HCS nursing claims need?

Nursing claims need more than a service log. The nurse must record which nursing service was provided, the exact start and end time of the service event, and a description of the medical need for the activity.

The nursing record must also describe any unusual incident and what the registered nurse or licensed vocational nurse did about it. If more than one RN or LVN performs an activity at the same time, the individual's implementation plan must include a written justification.

What is not acceptable in an HCS service log?

HHSC does not accept ditto marks, references to other logs, vague statements like "had a good day," "did ok," or "no problem today," text photocopied from other logs, or a medication log as the description of activities.

Each service component needs its own log. Corrections must follow the state rule the Billing Requirements point to (40 TAC §49.305), so agencies should train staff on how to correct an entry.

If an individual was not available to receive RSS, SL, or host home services on a day, the log should explain why.

What happens in an HCS provider fiscal compliance review?

In a provider fiscal compliance review, HHSC staff check the provider's written documentation against its paid claims. HHSC recoups payment for any claim it cannot verify is supported by documentation that meets the Billing Requirements, and it may require corrective action.

HHSC runs a routine review at least once every four years per program provider, covering services from a three-month period for a sample of individuals. HHSC can also run a special review after it spots a billing anomaly or gets billing information from another source, covering any period, any number of individuals, and any service.

For an on-site routine review, HHSC calls at least 14 calendar days ahead. The review team can widen the time period, and it does not accept any documentation created during the review. Records have to exist before HHSC asks for them.

After the first pass, the team lists unverified claims and lets the provider refute them with more documentation. Once the post refute conference starts, no new documentation is accepted. These reviews are separate from the HHSC certification survey, which checks the certification standards in 26 TAC Chapter 565.

Does Sereniq submit HCS claims or connect to TMHP or EVV?

No. Sereniq does not submit claims, and it does not integrate with TMHP, TexMedConnect, EVV, or HHAeXchange. Sereniq is the documentation system of record that produces and keeps the records your billing team relies on.

DSPs write notes on their phones, and Sereniq turns them into the Form 4119 or Form 4122 service delivery log, printed by week or calendar month. Sereniq also keeps the MAR (printed as Form 3092), the daily census, and the individual binder. Census shows who was present each day; Sereniq does not calculate billable days.

For ISS, Sereniq prints the Form 8615 log and builds monthly statements and invoices to the agencies that place individuals in the program. Those are not Medicaid claims.

On EVV: the Billing Requirements list the services that need EVV, and they are in-home services for individuals in their own home or family home. RSS, SL, and host home/companion care are not on that list.