© 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)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 BusinessMultiple Lines of Business

• Commercial

• ASO (Self-Funded)

• Fully Insured

• CHIP

• Student Accident

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Organizational StructureOrganizational Structure

• Number of Payors - 102

• Number of Employer Groups – 6,000+

• Number of Members (CHIP) – 76,500

• Number of Members (Commercial) - 703500

© 2005 Texas True Choice. All rights reserved. 5

TTC Operational OverviewTTC Operational Overview

PROVIDER

TEXAS TRUE CHOICE

CLAIMS ADMINISTRATOR

EMPLOYER

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How does TTC Operate?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

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Operations TTC Does not ConductOperations TTC Does not Conduct

• Take Risk - Insurance

• Pay Claims

• Utilization Management

• Benefits / Coverage

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TTC Organization ComponentsTTC Organization Components

• Data Management / IT

• Re-Pricing

• Provider Relations / Contracting

• Credentialing

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Data Management / Information TechnologyData Management / Information Technology

• Demographic data on providers

• Fee schedule information on all providers

• Reporting

• EDI Transactions

• Scanning

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Claims Re-PricingClaims 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 DevelopmentPR 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.)

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CredentialingCredentialing

• NCQA Qualifications– Licensure

– Malpractice History

– Education

– Violations / Sanctions

• Primary Source Verification

• Re-credential every three years

• Physician Advisory Committee