HCS & TXHML FORMS AND CLAIMS MIGRATION PROJECT - JULY 2021 - TEXAS.GOV
←
→
Page content transcription
If your browser does not render page correctly, please read the page content below
HCS & TxHmL
Forms and Claims
Migration Project
July 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
1
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.
2 Standardization
HCS and TxHmL processing will be done in the same systems used by other
HHSC Long Term Services and Support (LTSS) programs.
July 2021 3
Participating Systems
TMHP Systems HHSC Systems
TMC EDI CSIL Provider SSAS
LTCOP CMS CARE Slots SAS-O
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
4
July 2021What’s Moving Out of ID-CARE
Functions moving out of ID-CARE into standardized
HHSC systems
Service Authorization Integrated LTC Online Portal & HHSC
Functionality Service Authorization System (SAS)
ID-CARE
Community Services Interest Lists
Waiver Interest Lists
(CSILs)
Texas Medicaid & Healthcare
Claims Processing Partnership (TMHP) Claims
Management System (CMS)
July 2021 5What’s Staying in ID-CARE
1185 Permanency Plan Status Report
249 PPR Approval Status (Inquiry)
309 Permanency Plan Review
686 Critical Incident Update
ID-CARE
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
Some reports will still be available through the existing Filezilla folder(s) 6
July 2021Project Schedule
Dates What is happening?
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
May 2021 to Present
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
July 2021 7Go/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 * Complete UAT is defined as all Scenarios in a Passed status. 8Go-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 9Go-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 10Next 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 11Next 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 12Operations 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 14Provider 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 15Provider Account Setup
• TMHP security account setup release was on May 17, 2021
• TMHP is conducting Provider Outreach emails and phone calls
16HHSC 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 17Ways to Prepare for
the Transition
18Register for TMHP
Logon 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 19Register for TMHP
Logon 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 20Initiate Electronic Claims
Become an EDI submitter for batch claims submission.
Visit the TMHP EDI web page Contact the TMHP EDI help desk
http://www.tmhp.com/topics/edi
1-800-626-4117, Select option 3
• Get Long Term Care Professional Claim • Setup a submitter ID
(837P) Companion Guide
• Test the file submission
• 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/fi
les/provider-
forms/edi/F00021_EDI_Agreement.pdf
21Use 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 22Use 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 23Stay 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.
July 2021 24Stay Informed
1 Sign up for Gov Delivery
https://service.govdelivery.com/accounts/TXHHSC/subscriber/new
2 Read information published in the LTC Provider Bulletins
3 View the TMHP website for updates
http://www.tmhp.com/Pages/LTC/ltc_home.aspx
HHSC will provide updates as they become available
July 2021 25Questions?
HCS_TxHml_Form_Migration@hhs.texas.gov
July 2021 26You can also read
