Success Stories
Online Medicaid Management Solution Delivers Benefits Far Beyond Its Scope
Client:
New York State Department of HealthChallenge:
- Provide information systems to process claims and manage data for one of the largest Medicaid programs in the U.S.
- Make systems available round the click, 365 days a year
Solution:
- The largest, most complex and most technically sophisticated Medicaid solution in the nation
- Real-time processing of claims, review of transactions, and verfication of eligibility and status
- Many redundancies to ensure 100% uptime
Results:
- Lightning fast processing
- Millions of dollars saved
- Advances in administration, disease tracking, and forecasting thanks to data warehousing
The New York State Department of Health (DOH) oversees one of the largest Medicaid programs in the nation. It provides health care services to more than 3.8 million participants and annually processes more than 325 million claims totaling more than $44 billion. CSC has operated and maintained New York's Medicaid systems since 1986.
For many years, separate systems were used to confirm recipient eligibility and to process New York's Medicaid claims. Providers submitted claims in batches using electronic tape, computer linkages or even paper forms, then typically waited about two weeks to learn whether a claim was approved. When New York DOH decided to modernize and consolidate its systems, it awarded CSC the contract to implement the system known as eMedNY.
A Powerful System That Never Sleeps
As it turns out, the benefits of eMedNY reach far beyond New York's Medicaid operations. Real-time processing plus instant access to eMedNY's huge data warehouse has delivered unprecedented advantages to DOH. The State of New York – along with a growing number of other governmental entities – is able to make better, faster and more informed decisions about all kinds of issues relating to Medicaid and more. For instance, eMedNY could detect potential epidemics by analyzing pharmacy claims and provider services in a given region.
The eMedNY contract provides no planned downtime for system maintenance. In fact, DOH emphasized its requirement for high system availability by making downtime subject to hefty penalties. Depending upon when it occurs, DOH can charge CSC as much as $2,000 per minute of outage. Consequently, CSC established a robust technical infrastructure and strict policies and procedures for eMedNY, with a goal of eliminating single points of failure while building processes for disaster recovery and institutionalizing them, so that the processes were understood. Then CSC spent a month running a simulated production environment in which system failures were created intentionally so that the team could practice recovering from them.
The eMedNY solution also incorporates technologies that specifically address system stability and availability, in particular, Hitachi's disk mirroring technology, which replicates data to a disaster recovery site, and IBM’s parallel sysplex data sharing, which allows hardware and software maintenance and upgrades with no service disruption.
Greater Than the Sum of its Parts
EMedNY integrates claims processing, eligibility verification and reporting capabilities in one HIPAA-compliant system. With Phase 1 of the implementation, which went live in November 2002, DOH was able to verify Medicaid eligibility, issue service authorizations and process prescription claims online and in real time. Phase 2, implemented in March 2005, added functionality to process all other claims and broadened the range of submission options.
The eMedNY data warehouse is garnering rave reviews from all quarters. By summer of 2004, it was credited with millions of dollars in cost savings for DOH and a number of other major advances that benefit the Medicaid program and reach beyond it:
- Detecting 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
Learn more about eMedNY.
Learn more about CSC's work for Public Sector.
Explore our Government Health Services offering.
Read an interview with CSC's chief medical officer, Dr. Robert Wah.
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