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HCS & TxHmL Forms and Claims Migration ProjectJuly 2021
1
Agenda
• Product Overview
• Product Go-no-go Criteria
• Product Readiness
• Operational Readiness
• Ways to Prepare for the Transition
July 2021 2
Purpose of Project
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Modernization
A phased approach to replace legacy technology systems with an ecosystem that better reflects the Texas Medicaid business model today and is more adaptable for future needs.
Result will be more efficient, system-driven processes, and data capabilities that better support business objectives.
Standardization
HCS and TxHmL processing will be done in the same systems used by other HHSC Long Term Services and Support (LTSS) programs.
3July 2021
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Name Purpose Who?
LTCOP HCS TxHmL Forms Data Entry & Workflow All
TMC Claim Submission Portal LIDDA, Provider
EDI Electronic Data Interchange (Claims) LIDDA, Provider
CMS Claims Adjudication None (Back Office)
CSIL Interest List Management LIDDA, State Employee
CARE Current Case Management All
Provider Provider Registration & Management State Employee
Slots Slot Assignment & Management State Employee
SSAS Service Authorization Management None (Back Office)
SAS-O Service Authorization Management Portal State Employee
TMHP Systems HHSC Systems
LTCOP CMS
TMC SSAS
CARE
CSIL
Slots
Provider
SAS-O
EDI
Participating Systems
July 2021
What’s Moving Out of ID-CARE
Waiver Interest ListsCommunity Services Interest Lists
(CSILs)
Service Authorization Functionality
Integrated LTC Online Portal & HHSC Service Authorization System (SAS)
Claims Processing Texas Medicaid & Healthcare Partnership (TMHP) Claims Management System (CMS)
ID-C
ARE
Functions moving out of ID-CARE into standardized HHSC systems
5July 2021
1185 Permanency Plan Status Report
249 PPR Approval Status (Inquiry)
309 Permanency Plan Review
686 Critical Incident Update
286 Critical Incidents Data Inquiry
C97 WS/C Authority Review Notations
410 Add Case to ID / Demographics
325 Register individual: CARE-ID
360 Death/Separation of individual: Add/Change/Delete
What’s Staying in ID-CARE
ID-C
ARE
Some reports will still be available through the existing Filezilla folder(s)6
July 2021
What’s Staying in ID-CARE
Project Schedule
Dates What is happening?
May 2021 to Present
Testing: • User Acceptance Tests with business scenarios• Complete end-to-end scenarios• CARE form and service authorization data conversion and
validation• EDI Claims submission by Providers, LIDDAs and FMSAs
Provider, FMSAs & LIDDAs Account Setup: • TMHP Long Term Care Portal Accounts and Userids (Form
Submission)• TMHP TexMedConnect (Claim Submission)• TMHP EDI Accounts (Claims Submission)
After UAT Completes Establish a new Release Date
7July 2021
Go/No-go Criteria
• Go = Release the Product
• If UAT is 100% complete* with all:
• Critical and High Defects are closed
• Critical Enhancements are closed
• No-Go = Postpone the Product Release
• If UAT is less than 100% complete with:
• Critical and High Defects open or in progress
• Critical Enhancements open or in progress
• This situation indicates a lack of complete product readiness as defined by the go-no-go criteria.
• This option requires Project Sponsorship approval and acceptance of the risk
July 2021 8* Complete UAT is defined as all Scenarios in a Passed status.
Go-no-go Status
• On 6/28/2021:
• Project Sponsors recommended to Executive Management a postponement of the release from the planned August 2, 2021; date due to incomplete User Acceptance Test.
• A new target UAT completion date was set for 7/23/2021 (with checkpoints for status updates to be provided to project sponsors on 7/9 and 7/16).
July 2021 9
Go-no-go Status (cont.)
• On 7/2 Notifications were posted at:
• TMHP.com, GovDelivery and ID CARE
• HHSC HCS, TxHmL and LIDDA webpages
• As of the 7/9 checkpoint:
• UAT remained incomplete
• As of the 7/16 checkpoint:
• UAT remained incomplete
July 2021 10
Next Steps
• Continue postponement of the Release.
• Continue with UAT:
• UAT Test Team to continue performing UAT scenarios that are listed as ‘In Progress’.
• UAT Test Team to continue reporting Issues to TMHP for analysis as either a defect or backlog item (enhancement request).
• Technology team to continue correcting defects and deploying into the UAT environment.
• UAT Test Team to continue retesting scenarios in ‘Failed or Blocked’ status following defect fixes.
July 2021 11
Next Steps (cont.)
• Continue to assess for a new release date.
• Technology team is estimating time needed to add requested enhancements to determine a new release date.
July 2021 12
Operations Readiness
TMHP, HHSC, Providers, LIDDAs & FMSAs
TMHP Operations Readiness
• Operational Green Room
• During the Green Room a team consisting of staff from TMHP and HHSC team provides monitoring and reporting of production usage of the product for at least the first 30 days.
• Current status of readiness for this activity is pending Final State Review and approval dependent upon the go-no-go decision.
• TMHP Internal Staff Training
• Internal Training Materials are in review.
• Delivery to staff requires UAT Completion.
July 2021 14
Provider Readiness by HHSC
• The following Provider Readiness activities by HHSC staff requires UAT Completion:
• Training for LIDDAs for the CSIL system
• Notifications for release updates
• Information Letters
• EVV Training for HCS & TxHmL services
• Finalizing HHSC Handbooks
July 2021 15
Provider Account Setup
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• TMHP security account setup release was on May 17, 2021• TMHP is conducting Provider Outreach emails and phone calls
HHSC Operations Readiness
• HHSC Operational Support areas are also preparing for operations with the following requiring UAT completion:
• State Staff Training
• Documented Processes & Procedures
• CSIL Internal & External User Guides
• Slot Tracking Internal User Guide
• TMHP State Staff User Guide
July 2021 17
Ways to Prepare for the Transition
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Register for TMHPLogon IDs
LTC Online Portal forms system:
• Directions for creating an account are in the:
• Long-Term Care (LTC) Online Portal Basics CBT on the TMHP web Learning Management System (LMS) and
• TMHP LTC Online Portal Security and Permissions Set-up Guide for Providers and LIDDAs on TMHP.com
July 2021 19
Register for TMHPLogon IDs (cont.)
TexMedConnect claims entry:
• A TexMedConnect ID is required to submit claims to the TMHP Claims Management System (CMS) using this free software system.
Electronic Data Interchange (EDI) claims entry:
• EDI connectivity is required to submit claims to the TMHP Claims Management System (CMS) using X12 standard transactions electronically.
July 2021 20
Initiate Electronic Claims
Visit the TMHP EDI web pagehttp://www.tmhp.com/topics/edi
• Get Long Term Care Professional Claim (837P) Companion Guide
• http://www.tmhp.com/Pages/EDI/EDI_companion_guides.aspx
• Complete the Electronic Data Interchange Agreement for Long-Term Care Providers.
• https://www.tmhp.com/sites/default/files/provider-forms/edi/F00021_EDI_Agreement.pdf
Contact the TMHP EDI help desk
1-800-626-4117, Select option 3
• Setup a submitter ID
• Test the file submission
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Become an EDI submitter for batch claims submission.
Use the Learning Aids
Available at TMHP today
• Portal Security Manual explains how to access TMHP systems at: https://www.tmhp.com/sites/default/files/file-library/ltc/Managing-your-LTC-online-portal-account.pdf
• Register for an account on the TMHP Learning Management System (LMS) at: http://learn.tmhp.com/
• Take the Computer Based Training (CBT)
• Portal Basics
• TexMedConnect Claims Entry System
January 2021 22
Use the Learning Aids (cont.)
When announced, download User Guides
• Published on tmhp.com
• Provider User Guide for the LTC Online Portal
• Item by Item Guides for each HCS and TxHmL form
January 2021 23
Stay Current on Data Entry
Keep claim submissions current in ID-CARE.
Submit ID/RC and IPC Renewals in a timely manner.
Complete CARE data entry prior to go-live when announced.
24July 2021
Stay Informed
Sign up for Gov Delivery
Read information published in the LTC Provider Bulletins
View the TMHP website for updates
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https://service.govdelivery.com/accounts/TXHHSC/subscriber/new
http://www.tmhp.com/Pages/LTC/ltc_home.aspx
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HHSC will provide updates as they become available
25July 2021
