TRS Implementation Methods [NEW]

TPA Transfer Implementation Process

The Discovery Phase

The Discovery Phase is the first step in implementation. This phase is about making sure we get all the information we need for a successful transition, so it goes like this:

The Process

• Once you notify your Sales Representative that you are interested in this service, they will send the case setup form to your allsynx Account Implementer and TRS Liaison. This will initiate the entire process!
• Next, your Account Implementer will send out a questionnaire for some additional information needed about the group’s TRS Medical options
  • This questionnaire must be completed prior to moving on to the next steps.
• Then, the TRS Liaison will send the ‘TPA Transfer Notification’ to the Administrator to complete (this form is required by Blue Cross Blue Shield of Texas (BCBSTX) & bswift to transfer to TRS EDI inside THEbenefitsHUB).
• Once completed, the TRS Liaison will send the form to bswift.
• Next, the TRS Liaison & bswift will create the Implementation Schedule for the group.
• Finally, the TRS Liaison will send the schedule to the allsynx Account Implementer. They will then send this information to you.

The Construction Phase

The Construction Phase is where your plans are built, data is loaded into the system, and EDI Files are set up. Let’s go over how this process works:

Who Does What?

In the bswift system, here is what happens:

• bswift will move the group from their current TPA/or Manual bswift to be under THEbenefitsHUB TPA Access.
• bswift will shut down the Administrator’s current access and set them up with a new login that will have view-only rights.

In THEbenefitsHUB system, here is what happens:

• Your allsynx team will prepare the system by configuring and assuring the quality of the TRS Medical plans and eligibility into your group’s account.
  • In this phase, the broker and the admin must not make any changes within THEbenefitsHUB for the Medical, Shared Medical, or Declination benefits. All transactions need to be held until the system is released. If changes are made, they will not be sent on the export and exceptions will have to be filed.
• allsynx will review and prepare the data received from bswift to load into the newly added TRS Medical plans within the group’s account.
  • We might reach out to you with questions on how to handle a few employees based on discrepancies we found between THEbenefitsHUB and bswift/Prior TPA’s data.

Lastly, bswift and THEbenefitsHUB systems work together to set up the EDI Files:

• The allsynx team will send the EDI Test File to bswift for review.
  • bswift will review the EDI Test File.
  • If the file passes, we will proceed to the next step.
  • If the file has discrepancies, THEbenefitsHUB Team will work with you and the administrator to resolve the issues and repeat the above EDI steps until the EDI file passes.
• THEbenefitsHUB Team will set the group up to run on the next EDI production schedule.

The Deployment Phase

The Deployment phase is the release of all the hard work that went into creating this service! Once the first EDI production file is processed, THEbenefitsHUB Account Implementer will release the TRS Medical administration over to you and the Administrator.

From here on, all changes will be made within THEbenefitsHUB!

The Administrator will still have access to bswift to view the employee’s information and elections. They will also have access to the discrepancy reports, reports, billing, and tracker tickets for TRS Exceptions.

The Discrepancy Review Phase

The Discrepancy Review phase is a very important phase to help you take control of your data in THEbenefitsHUB! Our TRS Liaison will set up a series of meetings with you to review any TRS Discrepancies that arise with your group during implementation and will work with you to get them corrected.

Some of the information covered during the scope of these meetings includes, but is not limited to:

• Where to Find Reports with the bswift portal and THEbenefitsHUB
• Fixing Discrepancies within THEbenefitsHUB
• The 45-day Window
• Exception Request

TRS Discrepancy Review Agreement sample:

Joining or Re-Joining TRS-ActiveCare Process

TRS formally requests a 6-month notification to join TRS-ActiveCare. However, there is an exception process to the 6-month notification rule but will require notification at least 45 days prior to the desired effective date of coverage in TRS-ActiveCare.

Please Note: With TRS-ActiveCare providing the opportunity for a group to leave TRS they have also put in place that all decisions for joining or leaving must have all documentation be completed by 12/31 prior to the 09/01 effective date of the change. TRS will start to enforce this more in the coming years.

To become a participating entity on an earlier date, include in your notice of election, a request to Brian Guthrie, TRS Executive Director, to consider an exception to the 6-month notification rule requirement. The notice of election must include the earlier date on which the entity desires its coverage to begin. The executive director will grant the exception, at his sole discretion, upon considering the following criteria, he finds that an exception is in the best interest of TRS-ActiveCare.

Prior to the first day of coverage, an initial 31-day enrollment period is required to allow employees to elect coverage. TRS-ActiveCare enrollment is done on a fiscal year (FY), Sept 1—Aug 31, calendar. For more information about the available plan options, you may visit:

• https://www.trs.texas.gov/Pages/healthcare_trs_activecare.aspx
• https://www.bcbstx.com/trsactivecare/

Once all documentation is completed, TRS will let us know so that we can prep the system to handle TRS. We will then build the system out to accommodate TRS-ActiveCare and the HMO plans. Once the group starts to enroll in the system, we will begin our file testing with bswift. The file should be approved prior to the first scheduled annual enrollment file for all groups.

The next step is to host the Discrepancy Review Phase (please refer to this information within the TPA Transfer section, click here) for this will be the same process for these groups.

Quick Checklist

• TRS requires a 6-month notification, *moving forward this will be 12/31 prior to 09/01
• District will need to contact Marisa Campuzano
  • Direct Number: (512) 542-6396
  • Email Address: Marisa.Campuzano@trs.texas.gov
• After the discussion with the district, Marissa will email the district to confirm the conversation and list the required documentation needed to approve the request (forms below)
  • If the deadline is missed, the district must write an exception letter to Brian Guthrie, TRS Executive Director, requesting to join for the next 9/1
• Documents the district will need to submit to TRS:
  • Below Required Forms
  • Board approval / Certificate of Resolution with date
  • Boarding meeting minutes
  • Number of employees
  • Effective Date
  • Prior Coverage Termination Date
  • The district must acknowledge if they join TRS-ActiveCare, they cannot opt-out for five years
• TRS Provides approval
• Group conducts enrollment and file testing starts
• TRS Discrepancy Review Service with the group

Required Forms

The below Required Forms are all the necessary information needed in order to process a request for participation in the TRS-ActiveCare Medical.

Joining or Re-Joining Implementation Process

The Discovery Phase

The Discovery Phase is the first step in implementation. This phase is about making sure we get all the information we need for a successful transition, so it goes like this:

The Process

• Once you notify your Sales Representative that you are interested in this service, they will send the medical case setup form to your allsynx Account Implementer and TRS Liaison. This will initiate the entire process!
• The TRS Liaison will send the ‘TPA Transfer Notification’ to the Administrator to complete (this form is required by Blue Cross Blue Shield of Texas (BCBSTX) & bswift to transfer to TRS EDI inside THEbenefitsHUB).
• Once completed, the TRS Liaison will send the form to bswift.
• Next, the TRS Liaison & bswift will create the Implementation Schedule for the group.
• Finally, the TRS Liaison will provide the schedule to the allsynx Account Implementer. They will then send this information to you.

The Construction Phase

Your plans are built in the construction phase, and EDI Files are set up. Let’s go over how this process works:

Who Does What?

In the bswift system, here is what happens:

• The bswift team will prepare the system by configuring and assuring the quality of the TRS Medical plans and eligibility into your group’s account.

In THEbenefitsHUB system, here is what happens:

• Your allsynx team will prepare the system by configuring and assuring the quality of the TRS Medical plans and eligibility into your group’s account.

The Deployment Phase

The Deployment phase is the release of all the hard work that went into creating this service! THEbenefitsHUB Account Implementer will release the TRS Medical administration over to you and the Administrator.

From here on, all changes will be made within THEbenefitsHUB!

The Administrator will have access to bswift to view the employee’s information and elections. They will also have access to the discrepancy reports, reports, billing, and tracker tickets for TRS Exceptions.

Lastly, bswift and THEbenefitsHUB systems work together to set up the EDI Files:

• The allsynx team will send the EDI Test File to bswift for review.
  • bswift will review the EDI Test File.
  • If the file passes, we will proceed to the next step.
  • If the file has discrepancies, THEbenefitsHUB Team will work with you and the administrator to resolve the issues and repeat the above EDI steps until the EDI file passes.
• THEbenefitsHUB Team will set the group up to run on the next EDI production schedule.

The Discrepancy Review Phase

The Discrepancy Review phase is a very important phase to help you take control of your data in THEbenefitsHUB! Our TRS team will set up a series of meetings with you to review any TRS Discrepancies that arise with your group during implementation and will work with you to get them corrected.

Some of the information covered during the scope of these meetings includes, but is not limited to:

• Where to Find Reports with the bswift portal and THEbenefitsHUB
• Fixing Discrepancies within THEbenefitsHUB
• The 45-day Window
• Exception Request

TRS Discrepancy Review Agreement sample:

Leaving TRS-ActiveCare Process

The following is what to expect once TRS has approved the group to leave TRS-AcitveCare.

Conclusion

This should wrap up new groups joining TRS-ActiveCare, TPA Transfers, and groups leaving TRS. Please feel free to reach out to the allsynx TRS Team at TRSEscalations@THEbenefitsHUB.com with any additional questions you may have. It is our pleasure to help you and our clients wherever we are able.