HIPAA Transactions and Code Sets LA County Department of Mental Health Solution June 5, 2003.

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Presentation transcript:

HIPAA Transactions and Code Sets LA County Department of Mental Health Solution June 5, 2003

Who are we?  John Galloway, Sierra Project Director, LA County Department of Mental Health HIPAA Remediation Project  Lisa Miller, COO, Washington Publishing Company Who are you?

What is LACDMH  L.A. County is a “Hybrid” covered entity under HIPAA  DMH is a health entity designated by the County  DMH has been working towards compliance for 2 years –Privacy –Security –Transactions and Code Sets

DMH Statistics  Processes over 400,000 claims per month  Operates approximately 60 mental health clinics  Contracts with over private sector providers  Contracts with 66 Hospitals  Contracts with 97 Retail Pharmacies

What is the Integrated System Project?  Initiate testing of a HIPAA Compliant Transaction not later than April 16, 2003 (“April Test Approval”), as required by the Electronic Health Care Transactions and Code Sets Standards Model Compliance Plan;  Implement the Integrated System at County Data Center in Downey no later than October 1, 2003;  Enable DMH to conduct all HIPAA Transactions with all of its trading partners no later than October 16, 2003;  Preserve current functions and business processes of DMH systems;  Avoid changes to the code, data structures, internal coding systems, and reporting of the MHMIS and all of its sub-systems;

How does the IS work?

What are the benefits?  Revenue Generation –Enrollment and Eligibility Verification –Reduction in rejected and/or resubmitted claims –More timely claims processing  Process Improvement –Eliminate manual processes for claims –Consistent data entry via Help screens, drop down lists, auto-populating data fields  Single Source of Data –New HIPAA repository  Electronic Medical Record –Capture both clinical and administrative data  Standards Based Environment –Foundation for future growth and integration of network

DDE Principles  Separate the Provider – Payer functions  Maintain the Clinical – Administrative duality  Facilitate the business process  Minimize the data entry

Today’s Environment?

New Environment

DDE Demonstration

Questions?