CSC Implements New York State Medicade Management Information System

Working closely with the New York State Department of Health, CSC has implemented the largest, most technically sophisticated Medicaid Management Information System (MMIS) in the U.S.  Referred to as eMedNY, this Web-enabled system processes eligibility verifications, claim submissions, and prior-authorization requests from the state's 75,000 participating healthcare providers. It manages over 450 million claims and encounters, and 150 million eligibility and prior authorization transactions.

Twenty-year Relationship

Since 1986, CSC has worked with the state of New York, which has one of the largest Medicaid programs in the United States. As its fiscal agent, CSC operated and enhanced the legacy MMIS through periods of great transition; the emphasis on managed care, adaptations for Y2K, and the initial introduction of electronic provider interfaces.

In 2000, CSC signed a contract with the state to modernize its Medicaid applications systems. For many years, separate systems had been used to process eligibility verifications and claims. Other systems processed prior authorizations, electronic transactions, and drug rebate information. The modernization effort involved integrating these systems into a single whole, with common base technologies, accessibility through Web interfaces, and totally compliant with the Health Insurance Portability and Accountability Act (HIPAA) - a stringent set of rules to improve the portability and continuity of health insurance coverage using national standards for electronic data interchange.

Innovation Ensures Availability and Productivity

Fully Internet Protocol (IP)-enabled, eMedNY employs thin client technology for state and county users and a user-friendly Web application for providers. An innovative imaging system captures digital images, converting the information to electronic records. The eMedNY data warehouse provides more than 18 terabytes of Medicaid data.

To ensure stability under high-use conditions, the CSC-developed system provides true 7x24x365 availability through the use of multiple mainframes, UPS systems, telecommunications feeds, and many other hardware and software technologies. To keep the system resilient if faced with a catastrophic failure, disk mirroring technology is used to replicate data from the operations site to a separate disaster recovery site on a continuous basis.

Substantial design effort was also invested into the implementation of IBM's Parallel Sysplex data sharing technology, which allows hardware and software maintenance and upgrades with no service disruption. This design allowed the incorporation of several major new processing changes to occur during the course of the phased implementation, without interruption in services, including the addition of two new and major Web-based user interfaces.

The document management systems designed for eMedNY provide online retrieval of document images through secure Web interfaces. These innovative systems handle more than 10,000,000 documents annually. For claims and other documents that still come in on paper, CSC's automated forms processing system uses imaging and OCR/ICR technology. This system has been fine-tuned and is performing at maximum rated speeds, with reliability and throughput that has doubled operator productivity and produced an accuracy rate exceeding 99.7 percent for processed documents.

Workflows are designed to maximize the use of automation for functions such as imaging, data capture, error correction and document routing. This maximization makes it possible to standardize many internal control and balancing functions, providing consistent data integrity, quality and efficient processing. This approach provides an integrated and comprehensive solution - a data and information processing system that fully supports the imaging of paper documents, data capture from images, inventory control, and ease of access.

Since the redundant architecture came online in March 2005, CSC has delivered 100% system availability.

Benefits are Far-Reaching

Today, the benefits provided by the eMedNY systems are revolutionizing the administration of the state Medicaid program. For the state and county staff, eMedNY has produced workplace efficiencies and the ability to achieve significant program savings. Claim and eligibility verification transactions are handled instantaneously. What were formerly lengthy turnarounds for file updates have shrunk to days or hours, policy and administrative changes are communicated more rapidly through the Web, and providers are realizing reduced paperwork and administrative costs, using eMedNY's interactive electronic interfaces.

In addition to realizing millions of dollars in cost savings, eMedNY also facilitates a number of other major advances that benefit the Medicaid program and reach far beyond it:

• The detection of potential fraud and abuse
• Tracking bioterrorism indicators
• Analyzing the effectiveness of service delivery
• Forecasting utilization of expensive drugs for budgeting purposes
• Creating other predictive models
• Providing information to make informed policy decisions
• Responding quickly to legislative inquiries