1. TCM SYSTEM What you know and Don’t know? Presented by:
Dion Andres - Sacramento County
Kristina Herrera - Tuolumne County
Noora Azar– DHCS Program - IT
Disclosure: This presentation is not an avenue for solicitation. LGA consortium has no personal financial relationships with commercial interests relevant to this presentation.

2. TCM SYSTEM OVERVIEW The TCM system may be use to:
View encounter rate, target population information and LGA Profile information
Submit claims for TCM encounters
Create and submit invoices for claiming federal reimbursement
Verify Medi-Cal eligibility for individuals to whom TCM services have been provided
Monitor performance by case managers
DHCS TCM staff approve payments
Record receipt of payments by the LGA
Create statistics regarding the overall TCM program
DION - INTRODUCTION OF SPEAKERS: Lynda Lindsay – LGA Coordinator for Lake County; Noora Azar from Department of Health Care Services - IT, and working with TCM Program and managing the TCM system; Dion Andres – LGA Coordinator for Sacramento County. Altogether we have a total of over 36 years experience with TCM.
Here’s the overview of what you can do and how you can use the TCM system. The LGA coordinator submits the Annual participation pre-requisites or APP every year in order to participate to TCM program.
Once the LGA submitted the Annual Participation Pre-requisite or APP to DHCS and the LGA met all the requirements to participate, then DHCS can approve the APP. As long as the LGA has an executed contract with DHCS , your assigned DHCS analyst will load the LGA encounter interim rate, target population information and LGA profile into the TCM system. LGA can create and submit claims and post payment receipt dates into the TCM system. TCM runs a daily sweep of all encounters loaded into the system and veify medi-cal eligibility for those individuals. The LGA can also monitor case managers performance by the number of encounters loaded into the system. Reports like statistics will depend on data entered or loaded into the TCM system. We will cover the details during this presentation. At this time, I will turn it over to Aaron to talk about the System requirements.

3. TCM SYSTEM REQUIREMENTS AND SECURITY
Minimum Browser Requirement
Firefox 3.0
Internet Explorer 11
Chrome 14
Recommended Browser Requirements
Firefox 35
Chrome 40
Minimum Hardware Requirements
64 Megabyte of RAM
233 Megahertz Processor
Noora - TCM deployed a new TCM online system in Feb 26, 2017

4. Encryption and Authentication
The TCM system meets the requirements of the Federal Centers for Medicare and Medicaid Services (CMS) Internet Security Policy issued November 24, 1998 regarding encryption, authentication, identification, security and Health Insurance Portability and Accountability Act (HIPAA)
TCM System Website address is
Noora -

5. LGA REQUIREMENTS To gain access to the TCM system
Each LGA must complete and submit the following required documents:
LGA Profile Request Form
National Provider Identifier Application –
Invoice Signature Authority Form
LGA Coordinator Change of Information Form
Noora - LGA Profile Request Form is completed annually and mail it to your analyst. When you complete your Annual Participation Pre-Requisite (APP) the LGA profile request form is included in the package but need to be mailed separately with blue ink signature to the address identified in the form itself. You can also find the form in the TCM website under tools and template.
National Provider identifier (NPI) Application – HIPAA mandated the adoption of standard unique identifiers for health care providers and health plans to improve the efficiency and effectiveness of the electronic transmission of health information. Thus CMS developed the National Plan and Provider Enumeration System or NPPES to assign these unique identifiers. Each LGA has an NPI as well as each case managers have an NPI. The NPI number that is entered in the TCM for each encounter used the case manager’s NPI number who provided the TCM services. This requirement was effective Nov 26, Encounters entered without an NPI will be assigned the status of Pending. The system will automatically include the LGA NPI when generating an invoice. To apply for NPI go to the website – for individual Case managers, create a log in and follow the instruction given. For Healthcare provider organization create an NPPES ONLY username and password for the NPI for which you are applying then complete the application. Once you obtained your NPI number, complete a TCM LGA NPI submission form, this form is only used for the LGA. the electronic copy to your TCM analyst and submit the original blue ink signed hard copy to your analyst. TCM analyst will then enter the NPI number into the LGA profile in the TCM system.
LGA Invoice Signature Authority Request – LGA needs to provide the names of all individuals authorized to review, approve, and sign on behalf of the county LGA when submitting TCM invoices. Complete and mail the form with blue ink signed hard copies to your analyst. This form is also included in your APP but do not submit electronically with your APP. It can also be found in TCM website under Tools and Templates.
LGA Coordinator Change of Information Form – This form updates information regarding the LGA coordinator information and alternate coordinators. DHCS can submit to Host County or Host County can submit the information to DHCS to update the LGA roster.

6. LGA ADMINISTRATIVE ACCESS
LGA ADMINISTRATOR
Downloads and uploads encounter data
Modifies TCM encounter
Creates, submits and cancel invoices
Enter receipts of payments
Assign TCM system user ID and passwords
Can limit an LGA User Logon by program and subprogram type
Can terminate user’s TCM system access
Responsible in ensuring TCM encounters are correctly entered
DION - Each TCM system user must complete and submit the TCM system user ID request form with the level of access clearly stated to your analyst. – you can find this form in the TCM website under TCM forms. DHCS will assign the LGA administrator ID for access into the TCM system. An LGA designates an LGA administrator and usually but not necessarily the LGA coordinator. Each LGA can have more than one LGA administrator. LGA Administrator must terminate an LGA user’s TCM system access by entering an End Date within the User’s profile in the TCM system’s when no longer needed and the LGA coordinator’s responsibility to notify DHCS when an employee is no longer with LGA for HIPAA compliance.
What can an LGA administrator do in the TCM system:
- Upload encounter data – the specs on how to upload will be discuss later – but TCM user access cannot perform this role in the system. Same thing as downloading data.
As long as an invoice has not been created for those encounters entered, the LGA administrator will be able to modify those encounters, for example, correcting date of birth for clients, entering a client ID for pending encounters etc.
Entering date of payments received
Ability to assign unique ID and passwords to their own TCM users within their LGA – DHCS TCM analyst can help with any questions you may have regarding adding user access.
There are guidelines when requesting User ID and passwords:
LGA user ID has a maximum of 7 characters that consist of the First initial of the User’s first name followed by the consecutive letters of their last name.
Passwords must contain at least 5 to 8 characters
LGA User ID request form must be kept on file for each granted access to the system with the LGA coordinator
The LGA administrator must terminate an LGA user by entering an end date when no longer needed

7. LGA USER ACCESS
LGA USERS’ access to the TCM system is limited to entering and modifying TCM encounter data.
The LGA Users manually enter, modify and view TCM encounter data.
LGA administrator assigns the TCM system user ID and password for LGA user access. LGA users can only enter, modify and view information regarding the TCM encounter and do not have the capability to upload encounter files and create invoices.

8. ENTERING ENCOUNTERS TWO WAYS TO ENTER ENCOUNTER DATA FOR BILLING
Manually enter into the TCM system individually.
Add to enter encounters
Save to submit entered data for processing then the system will assign an encounter ID number
Reset to erase data entered but not saved
Back to return to prior screen. Data not saved will be erased if back button is used to go back to previous screen.
Default button check – all fields with * will stay the same during entering TCM encounters
Additional commands within the TCM System are:
View button - to access encounters to view.
Modify button - to make changes to an encounter.
Show matches button - when at a view page of an encounter if it has a “Y” duplicate indicator, this command will return possible duplicates for that encounter.
LYNDA - All required information must be entered into each fields in the encounter screen. Program type or target population, case manager id (this can be assign by LGA coordinator), Case Manager NPI, Date of service (system will calculate the 12 month limit), Date of Birth of client , client ID, (MEDS match cannot be performed without the Client ID and DOB), First MI and Last name of client (Last name is required if Client ID has not been entered), Newborn Date of Birth (claiming requirements information). Note that a system error will occur when an invoice exceeds 1900 encounters. This is the limit per invoice.

9. UPLOAD ENCOUNTERS 2. Uploading Encounters into the TCM system
Requirements
Data must be in fixed block text format
Data fields must match the file format of TCM encounter record
Instructions
Data transfer then upload
Submit
Edit duplicates
TCM system will provide summary of the uploaded data
DION - TCM encounters from an electronic database can be uploaded.
Requirements for Uploading:
-data must be in a fixed block text format.
-data fields must match the layout described in the file format for uploaded TCM encounters record. You can request the specs from your TCM analyst via .
Show TCM system screen “Data Transfer”.

10. DOWNLOAD ENCOUNTERS TCM system download function
LGA Administrators may only download TCM encounters data for their LGA
WinZip program is required on your computer
Download instructions
Data Transfer > download
Select data to download: Program type, quarter, FY
Submit > will return with text file to a zip file
Decide whether to open or save the file
Noora The Download file can be imported into any database program as a fixed length text file and can be exported from the spreadsheet application or imported into a database application.

11. TCM ENCOUNTER STATUS CODES
Claimable (CLAM)
Denied (DENY)
Duplicate (DUPE)
End Program (ENDP)
Exceeded (EXCD)
Expired (EXPD)
Hold (HOLD)
Inactive (INAC)
Invoiced (INVC)
Not Eligible (NELG)
PAID
Pending (PEND)
LYNDA - The TCM system do a nightly sweep of encounters entered to check eligibility against the MEDS and may result to many encounters becoming eligible for invoicing so it is important for LGA coordinator to check on your TCM encounters to create invoices regularly. Those encounters if not invoiced may become expired and lose your reimbursement.
It is also important that LGA should revisit the pending encounters so they can complete missing information: Common codes are Date of Birth does not match MEDS. CIN not found, no record found on MEDS, client has unmet share of cost. Medi-Cal beneficiaries with a share of cost are individuals who must pay a portion of the cost of their health care each month before Medi-Cal coverage becomes effective. If the Medi-Cal beneficiary’s monthly share of cost is not met, a TCM claim denial registrar report listing this reason for claim rejection will be sent to the LGA.
The TCM encounters with status codes such as Denied, duplicate, Not Eligible, Inactive, Pending and Expired will need to be modified before being submitted to DHCS. Failure to modify TCM encounters with these status codes before creating an invoice could result in denied TCM encounters. Denied encounters cannot be modified.

12. HOW TO SUBMIT VALID AND ACCURATE ENCOUNTERS?
Go to encounter search
Select a status by using the drop down menu
Narrow search by entering additional information
Open each encounter to find the reason for the encounter status
Modify encounter to make it a valid encounter
Save an encounter will change status
LYNDA - Search limit is 1900 encounters. Suggest to narrow by using date field

13. DUPLICATE ENCOUNTERS
Potential duplicates are determined using the following data:
LGA
Program type
Client ID
Date of Service
Newborn date of Birth, if applicable
LYNDA - The TCM system identifies all matching TCM encounters using the data above. The LGA coordinator must review these TCM encounters by clicking the show matches button and determine the cause of the duplication. Duplicates appears on your encounter report or view with DUPE status code. The DUPE status may be overridden or modified by selecting a valid reason on the encounter view. The valid reason codes are Significant additional visits (01) Multiple births (02) or Other (00). If other is selected as a reason, the documentation for the reason must be provided immediately via to your TCM Analyst and documented in the client record. Significant additional visits means that the client had a compelling need for TCM services on same day where a TCM service had already been provided. This compelling factor can be for services that were not provided by the same case manager earlier that day or that could not be provided by the same case manager. Documentation is required to support the claim for multiple TCM encounters on the same day. When a case manager makes multiple referrals or provides multiple TCM services during a single visit, the referrals or services cannot be billed as separate encounters. Multiple births means that 2 or more children share the same newborn date of birth and the mother’s Medi-Cal ID number.

14. CLAIMING NEWBORN
Information to enter into the TCM system after the Newborn Date-Range
INFANTS’ DATE OF BIRTH
INFANTS’ MEDI-CAL CLIENT ID NUMBER
Leave the Newborn Date of Birth blank
In the absence of Medi-Cal client ID number for newborn all LGAs are advised in accordance with CCR section 50733(c ) that a mother’s Medi-Cal card shall be the authorization for services for her newborn child during the month of birth and the month following the month of birth. Subsequent to the grace period, TCM services provided to the infant must be claimed using the infants’ own Medi-Cal client ID and the infants’ date of birth.
DION – An infant is considered a newborn only from the time of birth until the end of the month following the month of birth- this is also referred to as Newborn Date-Range.
In order to claim for service for a newborn infant using the Infant’s Medi-Cal Client Id number or after the Newborn Date-Range.
TCM encounters with a Newborn date of Birth and with a date of service beyond the newborn date range will have a status of “EXPIRED” in the TCM system. You can claim a newborn using the mother’s information entered into the encounter to claim as long as the claim does not go beyond the Newborn Date-range which is from date of birth through the end of month following the month of birth. For example an infant was born May 15, the expiration to use the mother’s medi-cal ID and DOB ends on June 30. It will expire July 1.

15. NOT ELIGIBLE TCM ENCOUNTER
Not Eligible encounters are:
TCM system cannot verify the client’s Medi-Cal eligibility at the time the encounter was entered
TCM encounter goes beyond the Newborn date range mark
Expired Status - Encounter goes beyond the 12 month mark
Dupe status – Encounter with duplicates
Client has unmet share of cost
Client is listed within the long term care status
Entered wrong information like date of birth does not match client name
Client has no record or not found
Noora - Most of these reasons for not eligible status can be modified once requirements has been fulfilled or corrected and may become claimable.

16. CREATE AND SUBMIT INVOICES
The TCM system generates separate invoices per LGA by:
Fiscal year
Program Type
Quarterly
Only LGA Administrator can create an invoice
Per W&I code section – TCM program invoices must be postmarked to DHCS within 12 months from the end of the month in which the service was provided.
LYNDA - To claim for Federal reimbursement for TCM encounters, an LGA must submit a summary invoice generated by the TCM system with original authorized signature in blue ink using the LGA’s letterhead. An invoice is a summary of claims for TCM encounters from one of the five program types that have service dates that fall within the State Fiscal year (July 1- June 30)
The LGA Administrator is responsible for ensuring that all TCM encounters included on the invoice are eligible for claiming federal reimbursement.
TCM invoices postmarked after the 12 month limit will not be reimbursed.

17. TCM SUMMARY INVOICE Helpful Tips for submitting invoices to DHCS:
Type or Print full name and title of the authorized person on file with DHCS
Whiteout is prohibited; use strikeout when making corrections and initial it
Send a cover letter: identify the invoices enclosed with special instructions
Do not send encounter data
Only original invoices will be accepted by DHCS
Do not staple invoices or Cover letter
LYNDA -

18. INVOICE STATUS CODES
CREATED – Invoice has been created in the TCM system
SUBMITTED – Invoice has been submitted to DHCS An original summary invoice must still be submitted via post office mail
APPROVED – DHCS approved the invoice for payment
ADJUSTED – an adjustment has been made to the amount of invoice submitted or an encounter
DENIED – DHCS denied the invoice for some reason
PAID – Receipt of payment was entered by LGA
CANCEL – Invoice created was cancelled by LGA
VOID – Invoice created was voided by LGA or DHCS
LYNDA -

19. DHCS INVOICE PROCESS Invoice approval Invoice denial
Printed on Official LGA letterhead
Original signature in blue ink
Within 12 month limitation
No duplicate encounters
Valid duplicate with reasons submitted
Number of Encounters is below 1500 per invoice
Invoice denial
0001 – Not on official LGA letterhead
0002 – Signature requirement not met
0003 – All TCM encounters are questionable
Exceed the remaining CAP
0005 – LGA request for Denial
0006 – Older than 12 months
Noora - Invoices that have been approved by DHCS for reimbursement will be submitted to DHCS accounting for payment. DHCS accounting will process the payment and will give it back to TCM. TCM analyst enter the claim schedule paid date into the TCM system. LGA will received a payment around the paid date that was entered into the system. If not received should contact their analyst to follow up.
Invoice

20. DHCS INVOICE PROCESS (continued)
Invoice that are voided
If an LGA submits an invoice with expired but not valid newborn TCM encounter, the LGA may request from their analyst to void the invoice. The invoice can be modified to enter corrected information.
If an LGA has an invoice with TCM encounter that was incorrectly billed. Once the invoice was voided, the encounter status may be changed to “INACTIVE” by the LGA. The LGA can then re-invoice for the rest of the encounters and re-submit the invoice to DHCS within the 12 month limit.
If an LGA billed under the wrong target population. Once the invoice has been voided, then the LGA can make necessary corrections.
Invoices that have more than 1500 encounters per invoice
Noora

21. ENTERING RECEIPT OF PAYMENTS
TCM payments are issued by the State Controllers office and a remittance advice will identify that payment is for TCM, the invoice numbers and the amount.
LGA coordinator/administrator must enter the receipt of payment into the TCM system.
DION - Entering receipt of payment will ensure that proper payment has been received for the proper invoice. DHCS requires the LGA enters invoice payments into the TCM system to update the status of the invoice from “Approved” to “Paid”. SHOW SCREEN FROM TCM SYSTEM ON WHERE TO ENTER DATE OF PAYMENT.

22. RECONCILIATION How to reconcile:
Run the encounter summary report from the TCM system using the LGA User report summary that includes TCM encounters entered and invoiced, submitted and approved and summary totals.
DION - Reconciling the TCM encounter log with the TCM system generated report is a best practice to ensure that the TCM encounters in the encounter log are accurately billed in the TCM system to properly secure payments from DHCS. The TCM encounter log is also utilized to ensure that the TCM encounters reported in the TCM Cost Report are correct.
The encounters entered and invoiced should match the claimable TCM Medi-Cal only encounters in your TCM encounter log. The total amount received and recorded in your accounting system must equal the amount of invoices submitted and approved in the TCM system. In order for the LGA user to reflect accurate payment information, the LGA must enter the payment information into the TCM system.
There are common ways to enter TCM encounters into the TCM system:
If claimable TCM only encounters are entered individually or uploaded into the TCM system, then the encounter log that is reconciled with the invoice and payments only included those claimable TCM only encounters. This means that the TCM encounter log match what was entered in the TCM system.
If all TCM encounters, whether claimable or not claimable, were uploaded into the TCM system, then all the TCM encounters in the TCM system is your encounter log. To reconcile with payments received, you will download a report to filter only the invoiced claimable encounters and it should match your payments receipt. If you used the TCM system to upload all your encounters, you can download the report into excel and summarize the different encounter categories into claimable TCM medi-Cal only, Non-claimable TCM medi-cal and TCM Non-Medi-cal encounters. The categorization of TCM encounters are reported in the TCM Cost Report.

23. QUESTIONS
Subject matter experts are also available to answer your questions at the conference lounge located by the registration desk
THANK YOU!
This concludes the presentation of TCM system.