Wednesday, July 20, 2016

How We Solved It:

Customer issue:
A multi-county government entity needed to convert their legacy mental health Management Information System (MIS) from a HIPAA clearinghouse model paying their contracted agencies a capitated rate or cost based (i.e. not requiring HIPAA standard transactions), to a fee-for-service model using a browser based MIS interface and requiring HIPAA standard transactions from their contracted agencies.
How we solved it:
This was a huge undertaking that required much coordination, project management, attention to detail, with industry knowledge and expertise. In addition to creating scripts to import/export HIPAA standard transactions[1] that involved programming for complicated rules for data allowed/not allowed, we also created fully customized screens in their browser-based MIS that enforced entry edits to ensure accurate data.
We were able to successfully complete all aspects of this project on time and within budget.

[1] HIPAA 837P Outpatient Claims, 270 Eligibility Inquiry (submission), 271 Eligibility Inquiry (results), 834 Eligibility from Payer, 820 Payments