When the Health Insurance Portability and Accountability Act (HIPAA) was signed into federal law in 1996, it had far reaching effects on the medical community. Intended to improve the portability and continuity of health insurance coverage using national standards for electronic data interchange, HIPAA promised reduced costs and increased efficiency, but also presented numerous challenges for healthcare agencies.

Included in this group was the New York State Department of Health (DOH), which was already leading the way in Medicaid management through its 20-year relationship with CSC. In developing eMedNY, the new and innovative online Medicaid system for New York, we worked tirelessly with the DOH to incorporate HIPAA standards and implement the first fully HIPAA-compliant transaction processing system in the nation. Five years after the system's 2003 launch, we're once again hard at work planning for HIPAA 2.

HIPAA Partnership with DOH

To design a system that would meet diverse needs and include all elements of Medicaid processing, we relied on valuable insight and requirements definition from the DOH, Medicaid providers and HIPAA industry experts. In addition to 24x7 availability and robust processing capabilities, eMedNY had to be designed with all HIPAA standards in mind: Transaction and Code Sets, Security and Privacy compliance, as well as the necessary preparation for future HIPAA requirements, such as unique identifiers for employers, providers and health plans. As mandated by the act, providers must send and payers must accept standard-format electronic transactions. The act also includes far-reaching information security and privacy stipulations to protect patients' medical information.

We began by analyzing the requirements to bring HIPAA functionality and security to the former legacy Medicaid Management Information System (MMIS), which CSC had run successfully for more than 15 years. We were also involved in implementing eMedNY, the new MMIS for New York State. In a parallel effort, we analyzed the HIPAA functionality requirements for the first phase of the eMedNY implementation. Working closely with DOH and selected providers who assisted in extensive testing, we implemented the first fully HIPAA-compliant MMIS in the United States, meeting the Federal deadline for compliance in October of 2003.

CSC Supports Providers Throughout the Transition to HIPAA

To accommodate providers who also were challenged to meet the HIPAA deadlines, CSC maintained multiple format acceptance capabilities on the active legacy and eMedNY systems. This allowed NYS Medicaid trading partners to migrate to the HIPAA-compliant environment, depending on their readiness, while CSC maintained the existing MMIS system and data exchange for those partners that needed more time.

In March 2005, with the full implementation of eMedNY Phase II, CSC rolled out a fully functional HIPAA transaction-processing system that supported New York’s Medicaid provider community through a variety of batch and real-time channels to perform HIPAA-mandated healthcare transactions. The system operates 24x7, delivering around-the-clock transaction processing and adjudication of over 3 million claims and other HIPAA transactions per day.

eMedNY HIPAA-Compliant Web Interface

Many of the providers who use eMedNY are small, and they did not have the resources or expertise to change their processes to comply with HIPAA when it was rolled out. To assist them in the transition to HIPAA compliance, CSC developed the Electronic Provider Assisted Claim Entry System (ePACES) Web-based application. ePACES lets Medicaid providers create, transmit, and receive HIPAA-compliant claims, eligibility and other service transactions. The ePACES application has user-friendly navigation and data entry fields, as well as extensive on-line help documentation. As a result of CSC’s design, HIPAA-compliance is transparent and assumed, freeing providers to focus on patient care.

Planning for the Future of HIPAA

As of June 2008, CSC is supporting DOH and the New York provider community in the transition to the use of HIPAA-required Universal Provider Identifiers for the New York Medicaid program. Implementation is planned for Fall 2008.

• eMedNY Main Page
  
• A Model Medicaid System for New York State
  
• State of the Art Technology, User-Friendly Interfaces
  
• eMedNY Helps Providers Navigate HIPAA Mandates
  
• Provider Relations Crucial to eMedNY Success
  
• Case Study: Online Medicaid Management Solution Delivers Benefits Far Beyond Its Scope