Form 3619, Medicare/Skilled Nursing Facility Patient Transaction Notice, can only be submitted electronically by completing Form 3619 on the Texas Medicaid & Healthcare Partnership (TMHP) Long Term Care (LTC) Online Portal. Electronic submission is prescribed by the Texas Administrative Code, 40 TAC §19.2615, which states:

Note: A Form 3618, admitting the person to Full Medicaid, or a Form 3619 (Medicare Coinsurance) must be submitted prior to submission of the MDS LTCMI (to be discussed later).

2023年2月13日 · Superior HealthPlan would like to remind STAR+PLUS Nursing Facility providers that they are subject to all reporting and notification requirements for Resident Transaction Notices (Forms 3618 and 3619).

2025年1月22日 · This User Guide is designed to provide information to LTC Providers regarding the completion and submission of NF Form 3618 - Resident Transaction Notice, Form 3619 - Medicare/Skilled Nursing Facility Patient Transaction Notice, and MDS/LTCMI (Minimum Data Set/Long Term Care Medicaid Information).

Please wait... If this message is not eventually replaced by the proper contents of the document, your PDF viewer may not be able to display this type of document.

IL IL 2010-100 August 12, 2010 2010 August NF IL2010-100.pdf

Hospice providers should only submit Forms 3071/3074. If the person is Medicare for a non-related condition and classified as SNF (Skilled Nursing Facility) by the Hospice provider, Form 3619 is appropriate.

Download Form 3619, Medicare/Skilled Nursing Facility Patient Transaction Notice – Texas Health and Human Services (Texas) form

Form 3619 is for clients who fall under the Medicare Coinsurance category and provides information about the status of a Medicaid applicant or recipient It also provides information to …