Changes for Medicaid Compass21 implementation

by Pat Harris, Harris County Medical Society director of socioeconomics

Compass21, developed by the National Heritage Insurance Company, in partnership with the Texas Department of Health, is the new claims and encounter processing system for Texas Medicaid, Children with Special Health Care Needs, and long-term-care programs.

Texas Provider Identifier
Compass21 will require the use of the Texas Provider Identifier instead of the traditional Medicaid provider number. TPIs were mailed in late April to the accounting address on file at NHIC. If no accounting address is on file, the TPI was mailed to the physical address on file.

Providers may not use the TPI until Compass21 is implemented on Aug 6. Although NHIC encourages providers and vendors to convert to the TPI for claims submitted beginning Aug 6, physicians will have a six-month transition period. For claims submitted from Aug 6, 2001, through Feb 6, 2002, the “old” Medicaid provider number may be submitted. The provider number will be converted to the TPI; however, all responses to the provider and vendor will contain only the TPI. This transition period is only for claims submission; all other transactions (claim status inquiry, appeals, eligibility inquiry) will require use of the TPI.

Implementation Dates
Implementation of Compass21 requires that historical claims information be converted to Compass21. To ensure the accuracy and timeliness of this conversion, several deadlines and “cutover” dates have been established.

July 19. Last day for NHIC to receive vision services on form T19-007. After this date, vision services must be received on the HCFA 1500 claim form.
July 19. Last day for NHIC to receive paper claims for family planning professional services on the HCFA 1500. After this date, paper claims for family planning professional services must be received on the new 2017 claim form.
July 19. Last day for NHIC to receive paper claims so they will appear on a Remittance and Status Report before Compass21 implementation. Claims received after this date will be keyed, but will not appear on an R&S or be available for claim status inquiry until after Compass21 is implemented.
July 19. Last day to submit electronic appeals using current formats or TDHconnect version 1.7.
July 25 at 11:59:59 pm. Last day to submit all other electronic transactions in pre-Compass21 formats or using TDHconnect version 1.7.
July 25 from 11:59:59 pm to 7:59:59 am on Aug 6. Providers and vendors may not transmit any electronic transactions. They can send paper claims.
July 25. Last day NHIC will receive claims from THIN or crossover claims from Medicare before Compass21 implementation.
July 25 at 4:59:59 pm. Last day to use telephone appeals.
July 26. This weekend will be the final check-write and R&S from the current claims processing system.
August 3. Last day for providers and vendors to download ER&S and other electronic response files using pre-Compass21 formats and software.
August 3. This weekend will be the first check-write and R&S from Compass21.
August 6. Start using TPI number on HCFA 1500 as the provider identifier number.
August 6 at 8 am. All electronic transactions submitted to NHIC must be in the Compass21 format or submitted using TDHconnect version 2.0. Appeals through the Automated Inquiry System (AIS) will be available.
August 6. First day NHIC will accept claims from THIN or crossover claims from Medicare in Compass21.