FINANCIAL SUBSYSTEM. The financial function encompasses claim payment processing, adjustment processing, accounts receivable processing, and all other financial transaction processing. This function ensures that all funds are appropriately disbursed for claim payments and all post-payment transactions are applied accurately. The financial processing function is the last step in claims processing and produces remittance advice statements/explanation of benefits and financial reports. The Contractor’s financial subsystem shall contain such items as: update of provider payment data, tracking of financial transactions, including TPL recoveries and maintenance of adjustment and recoupment processes.
FINANCIAL SUBSYSTEM. 121 10.7 UTILIZATION/QUALITY IMPROVEMENT SUBSYSTEM................................................................ 122 10.8
FINANCIAL SUBSYSTEM. The financial subsystem must provide the necessary data for 100% of all accounting functions including cost accounting, inventory, fixed assets, payroll, general ledger, accounts receivable, accounts payable, financial statement presentation, and any additional data required by TDH. The financial subsystem must provide management with information that can demonstrate that the proposed or existing HMO is meeting, exceeding, or falling short of fiscal goals. The information must also provide management with the necessary data to spot the early signs of fiscal distress, far enough in advance to allow management to take corrective action where appropriate. Functions and Features:
(1) Provide information on HMO's economic resources, assets, and liabilities and present accurate historical data and projections based on historical performance and current assets and liabilities.
(2) Produce financial statements in conformity with Generally Accepted Accounting Principles (GAAP) and in the format prescribed by TDH.
(3) Provide information on potential third party payers; information specific to the Member; claims made against third party payers; collection amounts and dates; denials, and reasons for denials.
(4) Track and report savings by category as a result of cost avoidance activities. 1999 Renewal Contract Xxxxxx Service Area August 9, 1999 98
(5) Track payments per Member made to network providers compared to utilization of the provider's services.
FINANCIAL SUBSYSTEM. (A) The System implemented by CONTRACTOR must include a Financial Subsystem that provides the necessary data for all accounting functions including:
(i) Cost accounting;
(ii) Inventory;
(iii) Fixed assets;
(iv) Payroll;
(v) General ledger;
(vi) Accounts receivable and payable; and
(vii) Financial statement presentation.
(B) The Financial Subsystem must be capable of providing CONTRACTOR's management staff with information that:
(i) Demonstrates that CONTRACTOR is meeting, exceeding, or falling short of fiscal goals; and
(ii) Provides CONTRACTOR management with the necessary data to identify signs of potential fiscal distress and to enable management to take appropriate mitigating or corrective action.
FINANCIAL SUBSYSTEM. 25 (5) Utilization/Quality Improvement Subsystem......................................................26 (6)
FINANCIAL SUBSYSTEM. The financial subsystem must provide the necessary data for all accounting functions including cost accounting, inventory, fixed assets, payroll, general ledger, accounts receivable and payable, financial statement presentation, and any additional data required by TDH. The financial subsystem must provide management with information that can demonstrate that the proposed or existing HMO is meeting, exceeding, or falling short of fiscal goals. The information must also provide management with the necessary data to spot the early signs of fiscal distress, far enough in advance to allow management to take corrective action where appropriate. Functions and Features:
(1) Provide information on HMO's economic resources, assets, and liabilities and present accurate historical data and projections based on historical performance and current assets and liabilities.
(2) Produce financial statements in conformity with Generally Accepted Accounting Principles and in the format prescribed by TDH.
(3) Provide information on potential third party payers; information specific to the client; claims made against third party payers; collection amounts and dates; denials, and reasons for denials.
(4) Track and report savings by category as a result of cost avoidance activities.
(5) Track payments per Member made to network providers compared to utilization of the provider's services.
FINANCIAL SUBSYSTEM. The financial subsystem must provide the necessary data for 100% of all accounting functions including cost accounting, inventory, fixed assets, payroll, general ledger, accounts receivable, accounts payable, financial statement presentation, and any additional data required by HHSC. The financial subsystem must provide management with information that can demonstrate that the proposed or existing HMO is meeting, exceeding, or falling short of fiscal goals. The information must also provide management with the necessary data to spot the early signs of fiscal distress, far enough in advance to allow management to take corrective action where appropriate.
FINANCIAL SUBSYSTEM. TDHS/HMO CONTRACT August 11, 1999
FINANCIAL SUBSYSTEM. 86 10.7 UTILIZATION/QUALITY IMPROVEMENT SUBSYSTEM . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 87 10.8
FINANCIAL SUBSYSTEM. The financial subsystem must provide the necessary data for 100% of all accounting functions including cost accounting, inventory, fixed assets, payroll, general ledger, accounts receivable, accounts payable, financial statement presentation, and any additional data required by TDH. The financial subsystem must provide El Paso Service Area HMO Contract management with information that can demonstrate that the proposed or existing HMO is meeting, exceeding, or falling short of fiscal goals. The information must also provide management with the necessary data to spot the early signs of fiscal distress, far enough in advance to allow management to take corrective action where appropriate. Functions and Features:
(1) Provide information on HMO's economic resources, assets, and liabilities and present accurate historical data and projections based on historical performance and current assets and liabilities.
(2) Produce financial statements in conformity with Generally Accepted Accounting Principles (GAAP) and in the format prescribed by TDH.
(3) Provide information on potential third party payers; information specific to the client; claims made against third party payers; collection amounts and dates; denials, and reasons for denials.
(4) Track and report savings by category as a result of cost avoidance activities.
(5) Track payments per Member made to network providers compared to utilization of the provider's services.
