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TEXAS TRUE CHOICE, INC. May 2006

TEXAS TRUE CHOICE, INC. May 2006. 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.

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TEXAS TRUE CHOICE, INC. May 2006

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  1. TEXAS TRUE CHOICE, INC. May 2006

  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

  3. Multiple Lines of Business • Commercial • ASO (Self-Funded) • Fully Insured • CHIP • Student Accident

  4. Organizational Structure • Number of Payors - 102 • Number of Employer Groups – 6,000+ • Number of Members (CHIP) – 76,500 • Number of Members (Commercial) - 703500

  5. TTC Operational Overview

  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

  7. Operations TTC Does not Conduct • Take Risk - Insurance • Pay Claims • Utilization Management • Benefits / Coverage

  8. TTC Organization Components • Data Management / IT • Re-Pricing • Provider Relations / Contracting • Credentialing

  9. Data Management / Information Technology • Demographic data on providers • Fee schedule information on all providers • Reporting • EDI Transactions • Scanning

  10. Claims Re-Pricing • All paper claims – Hospitals, Providers, and Ancillary providers. • Safety Net – Not all claims can be priced electronically • Audit Function

  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.)

  12. Credentialing • NCQA Qualifications • Licensure • Malpractice History • Education • Violations / Sanctions • Primary Source Verification • Re-credential every three years • Physician Advisory Committee

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