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1 2012 Hewlett-Packard Development Company, L.P. The information contained herein is subject to change without notice Presentation to:Georgia Medical Associations & Societies Presented by: Sonny Munter, CIO, DCH June 12, 2013 Information Technology Overview Slide 2 2 Agenda 4010/5010 HIPAA Transactions and Code Sets ICD-10 Integrated Eligibility System Georgia Medicaid Management Information System (GAMMIS) Enhancements Underway Medicaid Information Technology Architecture 3.0 Transformed - Medicaid Statistical Information System Centralized Prior Authorization Pre-Certification Portal Office of Civil Rights HIPAA Certification Technology Transformation Slide 3 3 4010/5010 HIPAA Transactions and Code Sets The Department of Community Health successfully converted from the 4010 to 5010 HIPAA transaction standards on January 1, 2012 The most important aspect of this change was to expand the ICD-9 field in the HIPAA 837 transaction claim form from 5 to 7 positions to accommodate the expanded ICD-10 code structure Providers who relied on their Trading Partners or Clearing Houses to accommodate this change must move this process into their billing system before they can upgrade to ICD-10 Slide 4 4 International Classification of Diseases 10 th Edition October 1, 2014 Go-Live, Compliance 5010 Transactions and Code Sets implementation Testing Internally Providers / Hospitals Trading Partners/Clearing Houses Payers The number of changes will depend on your specialty ICD-9ICD-10 Clinical Modification Codes 14,00069,000 Procedural Coding System 4,00072,000 Total18,000141,000 Slide 5 5 Integrated Eligibility System (IES) Georgia is not a State Based Exchange State Georgia will use the Federally Facilitated Marketplace (FFM) ACA Mandated Modified Adjusted Gross Income (MAGI) IES Open Enrollment begins October 1, 2013 Go-Live is January 1, 2014 Interface to and from the Federal HUB Partnering with GTA Enterprise Services business team Interface to the Medicaid Management Information System Determine current Medicaid status Members who are declined are referred back to the FFM for tax credit determination Requires changes to the DHS Eligibility system and Maximus for PeachCare for Kids Slide 6 6 GA Medicaid Management Information System (GAMMIS) Enhancements Underway Medicaid Information Technology Architecture (MITA) version 3.0 5 level Maturity Model to modernize MMIS (National effort) Streamline and move from Manual to Automated processes in the MMIS CMS requirement following a new MMIS implementation Transformed - Medicaid Statistical Information System (T-MSIS) More timely and complete information from the states Expanding the T-MSIS file from 400 fields of data to 1,000 8 files (Claims inpatient, outpatient, managed care, provider, eligibility, etc.) Monthly vs. Quarterly Reporting Go-Live January 1, 2014 Slide 7 7 Medicaid Management Information System (MMIS) Enhancements Underway Centralized Credentialing ACA mandates that we revalidate provider enrollment every 5 years An on-line application process will be available for providers to use to revalidate Revalidation begins in September 2013 for providers whose enrollment became effective before January 1, 2012 Revalidation will be scheduled in phases Revalidation will be completed by June 30, 2015 Approximately 105,000 revalidations will be processed over this two year period Additionally it is expected that 50% of these providers will go through the revalidation process each year Slide 8 8 Office of Information Security Office of Civil Rights (OCR) Omnibus Rule Sweeping changes to the HIPAA Privacy and Security Rules OCR audits begin September 23, 2013 DCHs Office of Information Security is gathering and centralizing our responses to the 167 points of the audit Encryption Desktops, laptops, data at rest, transmission and off-site storage Critically important to insure Protected Health Information (PHI) is secure Slide 9 9 Data Center Transformation Data Center Move Moving application software, running on computers at our 2 Peachtree building, to state of the art computers running at the States Tier 4 Data Center managed by IBM in North Atlanta Power supplied from two electrical sub-stations Redundant Electrical Power Uninterruptable Power Supply Guards against electrical spikes Sustains power to the Data Center until the Diesel Generator engages and provides electrical power to the Data Center in the event of a total loss of electrical power Diesel Generators Transfer Switch automatically starts the Diesel Generator in the event of a power outage Strong Physical Security Slide 10 10 Questions?