Texas Health and Human Services Commission
EDW/BI Solution - RFP No. 529-16-0001
Exhibit E
Exhibit E: Source Systems Listing
The following table lists the Primary Source Systems that are currently identified for this RFP:
System Name
System Description
Database Size
Database Platform
(GB)
Texas Integrated Eligibility
Integrated eligibility system for Texas Works, Food Stamps, Medicaid,
Redesign System (TIERS)
and Long-Term Care.
Task List Management (TLM)
Work Flow Management data
Oracle
16384
Oracle
1
Compass21 Claims Processing System is operated by (Texas Medicaid
Compass21 (C21)
& Healthcare Partnership) TMHP. It provides an integrated solution that
5,600
Tandem Non-Stop
supports fee-for-service claims, encounter data processing and analysis,
and captures data relative to multiple health care models
Vision21 is a “Fee for Service Claim” and “Managed Care Encounter”
focused Medicaid data warehouse with a broad set of applications that
Vision21 (V21)
help HHSC and Texas Medicaid & Healthcare Partnership users make
better business decisions through on-line analytical processing (OLAP),
Tandem Non-Stop
9000
query and reporting functions, extracts, statistical analysis, and
forecasting. This system stores historical claims data.
Provider Management
Provider Management Database holds provider data enrolled via PEP
Database (PMDB)
application
100
MS SQL 2005
3,200
Oracle
The Electronic Data Interchange (EDI) system for the Encounters project
enables trading partners to conduct business with TMHP electronically,
ENCOUNTERS Operational
Data Store (ODS)
via batch and/or real-time mode. The Texas Encounters Data
Enhancement project offers greater ability to analyze the practices of
Managed Care Organizations (MCOs) and Behavioral Health
Organizations (BHOs), which provide health care services to Medicaid
and Children's Health Insurance Program (CHIP) members in the State
Page E-1
Texas Health and Human Services Commission
EDW/BI Solution - RFP No. 529-16-0001
System Name
Exhibit E
System Description
Database Size
Database Platform
(GB)
of Texas.
The Claims Management System (CMS) processes long-term care
claims for the Texas Department of Aging and Disability Services
(DADS). DADS consist of former departments such as the Department of
Long Term Care (LTC)
Claims Management System
(CMS)
Human Services (TDHS) and the Department of Mental Health and
Mental Retardation (MHMR). CMS handles claims filed via through
TexMedConnect software, and by third-party business partners (no
Tandem Non-Stop
533
longer process any paper claims). It also processes claims filed
retroactively by the system. TexMedConnect and EDI can also be used
to access claim status or client eligibility lookups based on information
from CMS.
Primary system for Vendor Drug Program (VDP). Performs drug
Pharmacy/Pharmacy Rebate
utilization review at the point of sale and on-line adjudication of
Pharmacy/Pharmacy Rebate system is
pharmacy claims. The RxPert application is a prior authorization
under procurement and the EDW
processing system that makes a determination for a prior authorization
Contractor will work with the new
request submitted via the PCRA system, PAXpress website, or the PA
Pharmacy/Pharmacy Rebate Vendor to
Call Center. The following types of data are contained in the system: (1)
Client Information, (2) Pharmacy Information, (3) Provider Information,
obtain system information and acquire
data to meet the functional needs of this
(4) Medical Claims Data, (5) Pharmacy Claims Data, (6) PA Details, and
RFP.
(7) Determination Information.
Premiums Payable System
(PPS)
Health Services Delivery. Manage Premiums Payable records and
3,697
Oracle
375
Oracle
calculate premium amounts. Managed care capitation rates are
provided.
Texas Medical Transportation System (Previously known as Tejas
Texas Medical Transportation
System (TMTS)
(MTP). This system will integrate with Telecom to support scheduling
and authorization for non-emergency medical transportation, including
interfacing with the claims administrator and providing enhanced
reporting. Contains (Health Insurance Portability and Accountability Act)
Page E-2
Texas Health and Human Services Commission
EDW/BI Solution - RFP No. 529-16-0001
System Name
Exhibit E
System Description
Database Size
Database Platform
(GB)
HIPAA and (Personal Health Information) PHI.
When women who are enrolled in Medicaid or CHIP managed care
delivers, the HMO is eligible for a supplemental payment (in addition to
their regular premium payment).
Each HMO send in DSP “claims” in a specific format in excel workbooks.
Visual basic applications reads the claims, check the claims against copy
of the managed care eligibility data, check for a series of ‘edits’, and if
the claim passes all edits it is accepted, otherwise it is rejected.
Delivery Supplemental
Accepted and rejected data is submitted for each HMO in excel
Payments (DSP)
workbooks, and produce a count and a voucher file which is used by
200 MB
SQL Server and
Data also stored in
Excel File
HHSC accounting to generate payments. Accepted and rejected data is
maintained in SQL Server.
More info about DPS can be found in:
Texas Medicaid and CHIP Uniform Managed Care Manual
http://www.hhsc.state.tx.us/medicaid/managed-care/umcm/
section 5.3.5
LTSS Provider
Long Term Services and Supports Provider data
1
MS Access
The Long Term Care (LTC) Provider system contains information about
NE Provider - Long Term
Care (LTC) Provider
DADS Providers, Contracts, Rates, and Budgets. The information from
this database is mainly used for paying the providers for services
rendered and this is done by the Claims Processing System
administered by TMHP.
Page E-3
3
Oracle