A Model Medicaid System for New York State
CSC and New York have produced the largest, most technically sophisticated Medicaid system in the country.
Like most industries, healthcare relies heavily upon technical innovation to realize improvements in costs, efficiency and customer service. And like many other government and healthcare agencies, the State of New York Department of Health relies on CSC to help make those goals a reality. Working together, CSC and New York have produced the largest, most technically sophisticated Medicaid system in the country.
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 Medicaid Management Information Systems (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 New York's Medicaid 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, accessible through Web interfaces, and totally compliant with the Health Insurance Portability and Accountability Act (HIPAA).
Working closely with the Department of Health, and using a carefully controlled, phased approach, CSC implemented this modern system, 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. Today, the system has grown to manage over 350 million claims, 150 million eligibility verification transactions, and over $49 billion in payments annually.
CSC’s role encompasses a full range of fiscal agent services, including: provider services and outreach, claims processing, systems development, data center and facility operations, and network support.
Innovation Ensures Availability
To ensure stability under high-use conditions, the CSC-developed system comprises state-of-the-art components. It provides true 24x7 availability, combining multiple mainframes and other built-in technical platform and power system redundancies to prevent service interruptions. 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 of more than 10,000,000 documents annually, converting the information to electronic records. The eMedNY data warehouse provides a comprehensive view of more than 18 terabytes of Medicaid data, and capabilities for rapid conversion of data into valuable information.
The system was also the first Medicaid system in the nation to comply with HIPAA, a stringent set of rules to improve the portability and continuity of health insurance coverage using national standards for electronic data interchange. In May 2006, the Centers for Medicare and Medicaid Services (CMS) announced that the New York State Medicaid system developed by CSC successfully passed a comprehensive certification review.
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. This is due to the integration of the systems, which allows access to the entire range of Medicaid data through a common user interface.
Perhaps most important, eMedNY has enabled the state to offer better service to providers and become a national leader in Medicaid management. 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.