Customer issue:
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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.
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How we solved it:
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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.
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[1]
HIPAA 837P Outpatient Claims, 270 Eligibility Inquiry (submission), 271
Eligibility Inquiry (results), 834 Eligibility from Payer, 820 Payments
