The Centers for Medicare and Medicaid Services (CMS) was named to enforce Health Insurance Portability and Accountability Act (HIPAA) transaction and code set standards in October 2002. However, CMS’ own Common Working File’s Medicare eligibility inquiry system was not HIPAA compliant. Enforcement could not begin until a new system was in place. Thanks to CSC, CMS was able to implement a solution on a very tight timeline of under 10 months from contract startup.

CSC led the applications development project while interfacing with other contractors supporting the CMS data center and beneficiary database. We worked with CMS to develop HETS (HIPAA Eligibility Transaction System), a new subsystem used by Medicare providers to make electronic data interchange inquiries regarding patient eligibility for a type of service/claim. As mandated by CMS, it incorporates the use of commercial off-the-shelf (COTS) solutions.

The project responded to 59 business requirements, which translated to 174 system requirements. We began by facilitating a joint application development session early in the project to ensure a complete understanding of requirements and system components and that all stakeholders were on-board with the development and implementation schedule. We identified, analyzed, and recommended COTS products, working closely with the CMS data center to install and pilot the COTS and custom code solution against CMS architecture standards. Major COTS products incorporated included the SeeBeyond eGate, eXchange, and eWay products and Edifecs XEngine.