HHSC Transitioning to New Medicaid Claims Administrator

The Texas Health and Human Services Commission (HHSC) is working to move the Medicaid claims administration contract from Xerox to Accenture. HHSC is reviewing Accenture's readiness to take over the contract, which also includes processing claims for the Children with Special Health Care Needs Services Program and vendor drug services.

On May 9, the Texas Attorney General's Office sued Xerox Corporation and its wholly owned subsidiary, ACS Healthcare LLC in state court. The state's legal action seeks to recover fraudulent Medicaid payments for orthodontic and dental services improperly approved by Xerox. 

HHSC notified Xerox the state would terminate the company's Medicaid claims administration contract after Xerox staff approved thousands of requests for braces that weren't medically necessary. 

HHSC is finalizing an agreement with Accenture, the largest subcontractor under Xerox, to take over as the lead vendor until the state can competitively rebid the work. Accenture has been operating the Medicaid claims payment system under the contract since 2004. Accenture will take over the work performed by Xerox on Aug. 1.

HHSC says staff members will continue to work with Accenture and Xerox to identify and resolve issues or risks before Accenture assumes full responsibility for the contract. That work includes reviewing and improving the prior authorization process. Most other functions will transfer "as is" to Accenture, meaning the current policies and procedures will largely remain the same, according to HHSC.  

Action, July 15, 2014