HIPAA Transactions and Code Sets LA County Department of Mental Health Solution June 5, 2003
Who are we? John Galloway, Sierra Project Director, LA County Department of Mental Health HIPAA Remediation Project Lisa Miller, COO, Washington Publishing Company Who are you?
What is LACDMH L.A. County is a “Hybrid” covered entity under HIPAA DMH is a health entity designated by the County DMH has been working towards compliance for 2 years –Privacy –Security –Transactions and Code Sets
DMH Statistics Processes over 400,000 claims per month Operates approximately 60 mental health clinics Contracts with over private sector providers Contracts with 66 Hospitals Contracts with 97 Retail Pharmacies
What is the Integrated System Project? Initiate testing of a HIPAA Compliant Transaction not later than April 16, 2003 (“April Test Approval”), as required by the Electronic Health Care Transactions and Code Sets Standards Model Compliance Plan; Implement the Integrated System at County Data Center in Downey no later than October 1, 2003; Enable DMH to conduct all HIPAA Transactions with all of its trading partners no later than October 16, 2003; Preserve current functions and business processes of DMH systems; Avoid changes to the code, data structures, internal coding systems, and reporting of the MHMIS and all of its sub-systems;
How does the IS work?
What are the benefits? Revenue Generation –Enrollment and Eligibility Verification –Reduction in rejected and/or resubmitted claims –More timely claims processing Process Improvement –Eliminate manual processes for claims –Consistent data entry via Help screens, drop down lists, auto-populating data fields Single Source of Data –New HIPAA repository Electronic Medical Record –Capture both clinical and administrative data Standards Based Environment –Foundation for future growth and integration of network
DDE Principles Separate the Provider – Payer functions Maintain the Clinical – Administrative duality Facilitate the business process Minimize the data entry
Today’s Environment?
New Environment
DDE Demonstration
Questions?