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Cross-Platform Integration of User Applications |
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A Medicare claim is reviewed by a medical review specialist through a single interface. This interface provides data about the claim, data input fields for the claim review, drop-down coding information, error/completeness-checking, images of the medical documentation being reviewed, markups of the imaged documentation that previous reviewers have made, and automated routing determination after the review is complete. The simple interface that the user sees is a complicated linking of two Oracle databases running on two Windows servers and one image database running on a Unix server.
Despite the complicated nature of such an application, we have built it for quick modification and easy customization for specific review needs. This flexibility in design allows us to react quickly to changes in policy or process. It also allows for near immediate implementation of enhancements. In all situations, it allows us to make maximum use of hardware resources and user time. These benefits, combined with reduced application maintenance costs, result in a better product to our customer at a lower cost.
Monitoring tools attached to the application allow managers to monitor individual workloads and make instant adjustments. These tools also allow the development of metrics that are used to further streamline processes and applications, ultimately saving money and time.
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Mainframe Data Sampling and Transfer |
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AdvanceMed has extensive experience with data sampling and extraction from the following Medicare data files to conduct standard data analyses and special studies.
- Mainframe Data Sampling and Transfer
- National Claims History
- Beneficiary Program Liability
- Enrollment Data Base File
- Medicare Physician Identification Eligibility Record
- Provider of Services File
- Common Working File
- Medicare Provider Analysis and Review
- Part B Extract and Summary System (BESS) File
- Fraud Investigation Database
- Beneficiary Identification Crosswalk File
- HCFA Customer Information System(HCIS)
- Standard Analytical Files
- National Supplier Clearinghouse File
- Carrier/Intermediary Master Reference File
- EDB Workbench
- Unique Physician Identification Number
- DSAF: MEDPAR, HISKEW, SAF, Denominator
- DMERC Medicare Claims Records (VMS)
- Carrier Medicare Claims Records (MCS)
- Intermediary Medicare Claims Records (FISS)
For many of the files, we have developed automated data sampling applications that run daily, weekly, and monthly to refresh our internal databases. The internal databases are then linked to our data analysis applications, which are used for studies and daily operations.
The daily sampling applications that AdvanceMed developed were the first to successfully be deployed by a CMS contractor. They involved over 100 mainframe jobs to be executed in proper order and via an NDM connection that had to be established. This very complicated process saved the customer money and improved the data that we use daily.
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Multiple Database Synchronization |
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Keeping data current and correct is essential to any organization. It is always a challenge . . . especially when the users of the data reside in multiple locations, use different databases to house the data, and access the data through different interfaces. AdvanceMed has met this challenge through innovative use of current technology based on web methods, Oracle database synchronization, and Oracle database replication.
For situations requiring real-time data, we have developed multiple web methods that push data to remote locations for immediate action. These methods have email notification mechanisms and error trapping that ensures both locations are seeing the same data at the same time.
Daily synchronization applications perform batch processing of data that does not require immediate changes or actions. This allows the transfer of large amounts of data at times when the communications links are not being used for daily operations. Additionally, this improves daily operations without sacrificing data quality and correctness across multiple platforms.
We have also created web DMZs so non-PHI data can be shared with and received from organizations that are not a part of our secure network. Originally, this data was updated to a separate database weekly, due to long run times for the processing. In response to user feedback, we developed applications that streamlined this processing and therefore perform these updates nightly.
We firmly believe that database integrity is at the heart of all that we do. We also believe that there is not a "one size fits all" solution. The design of any database synchronization solution must get the right data, to the right people, at the right time. A firm understanding of these three factors requires knowledge and understanding of what options are available. We possess that knowledge and understanding.
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Web Applications for Data Reporting and Gathering |
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Simple informational web pages can be grown into interactive tools, but the users need to drive the change and the web developers need to understand the needs. This is what has happened within the Comprehensive Error Rate Testing (CERT) program at AdvanceMed. It started with claims processing centers expressing a need to provide comments on review decisions made within the CERT program. That grew from the exchange of CDs and emails to a full-blown web application that does much more.
Now, the CERT Internet Website provides CERT contractors, CMS, OIG and AdvanceMed users access to claims processing statistical information. The website provides several web reports for this purpose. The website also allows contractors to enter contractor feedback including:
- Appeals from medical service providers
- Contractor responses to CERT’s claim decision disagreements
- Payment adjustments (overpayments and underpayments)
The website is an ASP.Net application, using VB.Net as the programming language and Oracle as the data base management system. Batch data transfer programs are coded in VB.Net. This application continues to evolve, as related business processes undergo change and our customers request additional functionality.
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Intranet and Extranet Applications |
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AdvanceMed has developed intranet and extranet applications to support AdvanceMed management and staff, and to share information with our business partners. These applications provide information on the status of any claim that has been sampled for review.
Our intranet provides a library search facility to all professional staff, allowing them to access internal documents and link to external information sources on the web. All staff can access information on claims and look up medical codes. Secured sections allow clerical personnel to access functions that support their duties, including maintenance of provider information and recording the receipt of documents.
An extranet, developed in partnership with our primary client (CMS), allows sharing of information with our business partners. Management-level statistical summaries, with access to the underlying detail, are available to management at different organizations. This application allow views of the claims as they progress through the review process. It has tools for following trends and for importing the data into Microsoft Excel for further analysis.
Though simple in design, the underlying programs are quite complicated. By reusing code from the web applications, the development time for the intranet/extranet applications was reduced significantly. This saved time and money.
Like all other applications, these were developed in partnership with internal users and client management. The result is an intranet site that is used every day by AdvanceMed management and staff, and an extranet application that provides the information necessary in coordinating with our business partners on a daily basis.
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For more information please Contact Us.
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Starting with our IT professionals and your users, we form a team that focuses on providing what your organization needs. That team then goes to work to develop goals for the solution that is to be put in place. We translate those goals to a proposed system or application design. This forms the basis for a prototype that is reviewed by the team to refine goals to requirements. From those requirements, the full solution is developed with iterative reviews and testing. Finally, deployment of the solution involves user training and support in addition to "flipping the switch". 
