© 2005 Texas True Choice. All rights reserved. 1 TEXAS TRUE CHOICE, INC. May 2006 TEXAS TRUE CHOICE, INC. May 2006.

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Presentation transcript:

© 2005 Texas True Choice. All rights reserved. 1 TEXAS TRUE CHOICE, INC. May 2006 TEXAS TRUE CHOICE, INC. May 2006

© 2005 Texas True Choice. All rights reserved. 2 Texas True Choice (TTC) Incorporated in the State of Texas, November, 1996 Corporate headquarters located in Plano, Texas; regional offices in San Antonio & Houston, Texas Acquired San Antonio based Ethix Southwest in June 2000 Rural CHIP Program 2004

© 2005 Texas True Choice. All rights reserved. 3 Multiple Lines of Business Commercial ASO (Self-Funded) Fully Insured CHIP Student Accident

© 2005 Texas True Choice. All rights reserved. 4 Organizational Structure Number of Payors Number of Employer Groups – 6,000+ Number of Members (CHIP) – 76,500 Number of Members (Commercial)

© 2005 Texas True Choice. All rights reserved. 5 TTC Operational Overview

© 2005 Texas True Choice. All rights reserved. 6 How does TTC Operate? Purpose of a PPO Network: Contract with Hospitals, physicians, ancillary providers, and sell access and cost containment savings to various entities. Reprice Claims Credential Providers

© 2005 Texas True Choice. All rights reserved. 7 Operations TTC Does not Conduct Take Risk - Insurance Pay Claims Utilization Management Benefits / Coverage

© 2005 Texas True Choice. All rights reserved. 8 TTC Organization Components Data Management / IT Re-Pricing Provider Relations / Contracting Credentialing

© 2005 Texas True Choice. All rights reserved. 9 Data Management / Information Technology Demographic data on providers Fee schedule information on all providers Reporting EDI Transactions Scanning

© 2005 Texas True Choice. All rights reserved. 10 Claims Re-Pricing All paper claims – Hospitals, Providers, and Ancillary providers. Safety Net – Not all claims can be priced electronically Audit Function

© 2005 Texas True Choice. All rights reserved. 11 PR Contracting / Network Development Recruit / contract with (rates/language) with hospitals, facilities, and various types of providers. Answer questions about fee schedules, participation in network, and changes in demographic information. (Tax ID, address, etc.)

© 2005 Texas True Choice. All rights reserved. 12 Credentialing NCQA Qualifications –Licensure –Malpractice History –Education –Violations / Sanctions Primary Source Verification Re-credential every three years Physician Advisory Committee