Information Technology Overview

Presentation to: Presented by: Georgia Medical Associations & Societies Sonny Munter, CIO, DCH ©2012 Hewlett-Packard Development Company, L.P. The information contained herein is subject to change without notice

Agenda

• 4010/5010 HIPAA Transactions and Code Sets • ICD-10 • 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 2

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 structure • 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 3

International Classification of Diseases 10

th

Edition

• October 1, 2014 – Go-Live, Compliance • 5010 Transactions and Code Sets implementation • Testing – Internally – Providers / Hospitals – Trading Partners/Clearing Houses – Payers – The number of changes will depend on your specialty

ICD-9

14,000

ICD-10

69,000 Clinical Modification Codes Procedural Coding System Total 4,000 18,000 72,000 141,000 4

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 5

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 6

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 revalidate – 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 period – Additionally it is expected that 50% of these providers will go through the revalidation process each year 7

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 secure 8

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 power – Diesel Generators – Transfer Switch – automatically starts the Diesel Generator in the event of a power outage – Strong Physical Security 9

Questions?

10