TX HHS Form 5010. Enrollment Systems Attestation

The TX HHS Form 5010, Enrollment Systems Attestation, is a crucial document used to attest to the testing and successful processing of files outlined in the CHIP JIP, 834 Companion Guide, and the 834 CHIP Companion Guide. This form helps ensure that Managed Care Organizations (MCOs) or Designated Medicaid Organizations (DMOs) have all internal processes and procedures in place for operational start dates.

This attestation form requires key information, including the type of organization, date submitted, organization name, program type, and certification statements. The MCO/DMO must attest to having successfully tested and processed files outlined in the CHIP JIP, 834 Companion Guide, and the 834 CHIP Companion Guide, as well as having all internal required processes and procedures in place.

The form should be used by MCOs or DMOs when submitting their attestation in lieu of the requirements listed on the insert deliverables timeline. The TX HHS Form 5010 is an essential tool for ensuring compliance with federal and state laws, regulations, policies, and contracts. By completing this form, MCOs/DMOs demonstrate their commitment to operational readiness and compliance.