Medical Association Group Meeting

Information Technology
Presentation to:
Georgia Medical Associations & Societies
Presented by:
Sonny Munter, CIO, DCH
©2012 Hewlett-Packard Development Company, L.P. The information contained herein is subject to change without notice
June 12, 2013
4010/5010 HIPAA Transactions and Code Sets
Integrated Eligibility System
Georgia Medicaid Management Information System
(GAMMIS) Enhancements Underway
– Medicaid Information Technology Architecture 3.0
– Transformed - Medicaid Statistical Information System
– Centralized Prior Authorization Pre-Certification Portal
• Office of Civil Rights HIPAA Certification
• Technology Transformation
4010/5010 HIPAA Transactions and Code Sets
• The Department of Community Health successfully converted
from the 4010 to 5010 HIPAA transaction standards on
January 1, 2012
• The most important aspect of this change was to expand the
ICD-9 field in the HIPAA 837 transaction claim form from 5 to 7
positions to accommodate the expanded ICD-10 code
• Providers who relied on their Trading Partners or Clearing
Houses to accommodate this change must move this process
into their billing system before they can upgrade to ICD-10
International Classification of Diseases
10th Edition
October 1, 2014 – Go-Live, Compliance
5010 Transactions and Code Sets implementation
– Internally – Providers / Hospitals
– Trading Partners/Clearing Houses
– Payers
– The number of changes will depend on your specialty
Clinical Modification
Procedural Coding
Integrated Eligibility System (IES)
• Georgia is not a State Based Exchange State
• Georgia will use the Federally Facilitated Marketplace (FFM)
• ACA Mandated “Modified Adjusted Gross Income” (MAGI)
• IES Open Enrollment begins October 1, 2013
• Go-Live is January 1, 2014
• Interface to and from the Federal HUB
• Partnering with GTA Enterprise Services business team
• Interface to the Medicaid Management Information System
• Determine current Medicaid status
• Members who are declined are referred back to the FFM for tax
credit determination
• Requires changes to the DHS Eligibility system and Maximus for
PeachCare for Kids
GA Medicaid Management Information System
(GAMMIS) Enhancements Underway
• Medicaid Information Technology Architecture (MITA) version 3.0
– 5 level Maturity Model to modernize MMIS (National effort)
– Streamline and move from Manual to Automated processes in the MMIS
– CMS requirement following a new MMIS implementation
• Transformed - Medicaid Statistical Information System (T-MSIS)
More timely and complete information from the states
Expanding the T-MSIS file from 400 fields of data to 1,000
8 files (Claims – inpatient, outpatient, managed care, provider, eligibility, etc.)
Monthly vs. Quarterly Reporting
• Go-Live January 1, 2014
Medicaid Management Information System
(MMIS) Enhancements Underway
• Centralized Credentialing
– ACA mandates that we revalidate provider enrollment every 5 years
– An on-line application process will be available for providers to use to
– Revalidation begins in September 2013 for providers whose enrollment
became effective before January 1, 2012
– Revalidation will be scheduled in phases
– Revalidation will be completed by June 30, 2015
– Approximately 105,000 revalidations will be processed over this two year
– Additionally it is expected that 50% of these providers will go through the
revalidation process each year
Office of Information Security
• Office of Civil Rights (OCR) Omnibus Rule
– Sweeping changes to the HIPAA Privacy and Security Rules
– OCR audits begin September 23, 2013
– DCH’s Office of Information Security is gathering and centralizing
our responses to the 167 points of the audit
• Encryption
– Desktops, laptops, data at rest, transmission and off-site storage
– Critically important to insure Protected Health Information (PHI) is
Data Center Transformation
• Data Center Move
– Moving application software, running on computers at our 2 Peachtree building,
to state of the art computers running at the State’s Tier 4 Data Center
managed by IBM in North Atlanta
– Power supplied from two electrical sub-stations – Redundant Electrical Power
– Uninterruptable Power Supply
• Guards against electrical spikes
• Sustains power to the Data Center until the Diesel Generator engages and
provides electrical power to the Data Center in the event of a total loss of electrical
– Diesel Generators
– Transfer Switch – automatically starts the Diesel Generator in the event of a
power outage
– Strong Physical Security

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