0. HEALTHCARE INTEGRATED GENERAL LEDGER ACCOUNTING SYSTEM (HIGLAS) Association of Government Accountants – DC Chapter Conference May 9, 2007

1. George E. Jenkins, CPA, MBA
Deputy Director, Financial Management Systems Group
Office of Financial Management
Centers for Medicare and Medicaid Services
Department of Health and Human Services
“Modernizing the Agency and Transforming Healthcare”

2. CMS Vital Statistics
“CMS - Modernizing One of The Largest Healthcare Purchasers In The World!”
Over 1.2 billion Medicare claims are processed each year.
Medicare enrollment includes approximately 44 million beneficiaries and is growing.
CMS is one of the largest purchasers of health care in the world and represents 33 cents of every dollar spent on health care in the United States.

3. What is HIGLAS?
Healthcare Integrated General Ledger Accounting System (HIGLAS)
HIGLAS provides CMS a uniform financial management system to account for over $600 billion spent in outlays for healthcare each year.
Oracle Federal Financials was selected by CMS as the base COTS application to improve the Agency’s ability to manage the benefits and administrative accounting functions.

4. HIGLAS Program Vital Statistics
To date, HIGLAS produced the following:
$138.2 billion in Medicare Benefit Payments (As of April 24, 2007)
284.6 million Claims Processed
(As of April 24, 2007)
$5.2 billion of AR/AP netted funds
(Through March 2007)
$36.3 million Interest earned in the trust funds (Through FY06)

5. Benefits Realization
Implemented COTS-Based Dual-Entry Accounting System (Meets Federal Standards)
Recoups Medicare Overpayments through Netting
Improves Collection of Debts
Savings as of January 2007:
Preserved $4.58 Billion in Medicare Trust Funds
Earned additional interest ($36.3M) in the Medicare Trust Funds (through FY06)
Other Savings and Benefits :
Fewer Improper Payments - Decreases the need for Recovery Actions (Less “Pay and Chase”)
Reduced Costs due to Decommissioned Cuff Record Systems
HIGLAS provides FFMIA Compliance & supports DHHS Compliance
Improvements in Automated Debt Collection/Referral Activities
Creates Audit Trails for every Transaction/Payment/Claim in HIGLAS
Improves Financial Audit Ability

6. Functionality Analysis for Integration -as an example…
Current Environment
HIGLAS Environment
Shared System - FISS
Shared System - FISS
Claims Adjudication
Claims Adjudication
837 Adjudicated
Claims
835 Remittance
Info
FISS Financial Module
Accounts
Payables
Accounts
Receivables
HIGLAS
Generate
Payment
Accounts
Payable
Netting
Cuff Systems
CFO
Reports
750/751
Accounts
Receivable
Integrated
Financial
Reports
General Ledger
No Transactional Accounting
Double Entry Accrual Accounting
No General Ledger
Integrated Financial Reporting
Multiple Cuff Systems
Single Transactional System
No Financial Integrity
Detail Accounting Audit Trail

7. General Ledger Business Processes – as an example…
Accounts
Payable
Set of Books
Accounts
Receivable
General Ledger
Journals
Manual Journals
Posting
Process Automated/Manual Journals
Process Recurring Journals
Automatic/Manual Journal Reversals
Manually Post Journals
Schedule Journal Posting
Daily Reconciliation Process
Maintain Accounting Calendar
Process GL Month End Close
Process GL Year End Close
Generate Period End Reports and Queries
Calendar
Every transaction carries the ACS
Daily transfer of entries from AP & AR to GL
For financial integrity you would be performing a month-end close based on the Accounting Calendar
Major Application Features provided
Set of Books Defined
Segment Values Defined
Accounting Calendar Defined to Sep-06
Cross Validation Rules
Aliases Defined
Rollup Groups Defined
Recurring Journals Defined
Security Rules
Transaction Codes Defined
GL Reports
Account Analysis Report
Chart of Accounts Reports
FSG Definition Reports
General Ledger Reports
Journal Reports
Trial Balance Reports
Reporting

8. Multiple Users within HIGLAS
Medicare Contractor A
Medicare Contractor B
Medicaid, Other Admin. Programs
FISS / MCS
Pricer & Claims
Adjudication
Pricer & Claims
Adjudication
Allotment, Pay & Monitor
HIGLAS
Accounts
Payable
Accounts
Receivable
Accounts
Payable
Accounts
Receivable
Accounts
Payable
Accounts
Receivable
Other
Accounts
Workload A
Workload B
CMS Integrated General Ledger
Financial Reporting
CMS Financial Reporting

9. HIGLAS Release 1 – Oracle Solution Modules
Oracle Federal Financials - Release 11i
Application
Foundation
Application
Modules
Third-party Integration
In/Outbound Staging
Trading
Community
Architecture
(TCA)
Enterprise Application Integration
271/274
Provider/
Beneficiary
837
Adjudicated
Claims
835
Remittance
Advice
Extended
Functionality
Multi-Org
Scheduler
Application
Security
Content Manager
Loans
Accounts
Receivable
Accounts
Payable
Audit Trail
File Transfer
Concurrent
Processing
Cash
Management
Federal Administrator
Online
Screens
& Reporting
General
Ledger
Archive & Restore

10. HIGLAS Release 1 - Financials & HTB Integration
HIGLAS Oracle eBusiness Suite - Release 11i
Application
Foundation
Application
Modules
Staging
Trading
Community
Architecture
(TCA)
271/274
Provider/
Bene.
837
Adjudicated
Claims
835
Remittance
Advice
Multi-Org
Application
Security
Accounts
Receivable
Accounts
Payable
Healthcare Transaction Base (HTB)
Audit Trail
ETL
Concurrent
Processing
Document
Summary
General
Ledger
Online
Screens
& Reporting
Cash
Management
Extended
Functionality

11. HIGLAS Technical Operations
AUDITS
External Audits
CFO EDP
Circular A-123, Job Mapping
Security Testing and Evaluation
Internal Audits
NESSUS
Vulnerability Assessment
Roles and Responsibilities
System Integrator
System Users
POA&M

12. HIGLAS Access
Job Roles, Responsibilities, and Job Role Constraints

13. Basic Design for Access
Functionality and Access is assigned based on the various HIGLAS Modules or Job Role Categories
Accounts Payable
Accounts Receivable
General Ledger
Cash Management , Bank Information
Loans Management
Audit
AR Collections
Third Party Payments (TPP)
Federal Administration
Healthcare Transaction Base (HTB)
User access to HIGLAS is defined and implemented through the Job Roles and Responsibilities matrix.
The users may be granted update or inquiry/view access to any of the Oracle applications employed by HIGLAS.
Most users need access to only a segment of each Oracle application to perform their assigned job duties.
Furthermore, to comply with security and segregation of duty requirements, the Standard Oracle applications listed on this slide and the previous slide are broken down into more detailed lower level segments called Job Roles and Responsibilities.
Access is granted by assigning the users one or more HIGLAS standard job roles.

14. Functionality
Within the modules you either have Update or Inquiry Capability
The capability is determined by what Job Role is assigned to you
Each job role has associated responsibilities and each responsibility provides specific functionality. It is a tiered approach.
A standard Job Role is a level of authority in the Oracle application that will allow HIGLAS users to access one of the listed applications within a “data partition” (i.e. workload or Org ID).
There are currently 33 Job Roles in the Job Roles and Responsibilities Matrix. Although there is not a one to one relationship between the Job Roles and Responsibility, each Job Role has at least one Responsibility.
Each of those responsibilities provides access to view and/or update various types of data, and in many cases run selected standard and/or custom reports.
These job roles provide the flexibility necessary for each Medicare Contractor to segregate and limit user access while protecting sensitive data.
Examples follow on the next few slides.

15. Functionality Outline Tiered Approach – AP Module
Update AP Payments
Add Update Inquire AP Payments
Add and Update AP Payments
Inquire AP Payments, payment batches form, payments form, payment overview form and withheld amounts form
View Accounting Lines
AP Setup Inquiry
Control Payables Periods Inquiry
Open Interfaces Invoices Inquiry
Run and View Selected AP Reports
Every Job Role has specific functionality and access determined by the responsibilities associated with that Job Role.
The first tier (Update AP Payments) represents the Job Role.
The second tier (Add Update Inquire AP Payments) represents the Responsibility.
The third tier represents the functionality and access associated with that Responsibility.
The purpose of this design and it’s application for the Medicare Contractors is to:
Define the appropriate access to HIGLAS for all users so that each individual may perform their assigned duties. (Not more access than they need)
Map all HIGLAS users consistently by the Standard Job Roles and Responsibilities
Validate that access granted to users in each job role does not violate security or segregation of duties requirements
Work with the HIGLAS Security Team to plan and validate system configuration and load users into the designated HIGLAS instance for testing, production, or maintenance.

16. We will take a look at some examples of the Job Role Functionality Outline from the AP Module. The format is the same across all Oracle modules.
AP Module

17. Update AP Payments Add Update Inquire AP Payments
Provides access to view, update, and add claim payment data in the AP module and drill down capability to the invoice information.
Provides access to run selected standard and custom AP reports.
Add Update Inquire AP Invoices
Provides access to view, add, and update invoice claim information in the AP module.
Provides access to run selected standard and custom AP reports.
Update AP Payments is the Job Role.
Add Update Inquire AP Payments is the associated responsibility.
Specific Functionality for this responsibility is:
add/update AP payments,
inquire AP payments, payment batches form (form is an Oracle term for screen), payments form, payment overview form and withheld amounts form,
view accounting lines,
control payables periods inquiry,
run and view selected AP reports.
Add Update Inquire AP Invoices is the Job Role
Add Update Inquire AP Invoices is the Responsibility
Functions associated with this responsibility are:
add and update AP invoices, invoice batches form and invoices form;
inquire AP invoices, invoices batches form, invoices form, invoice overview form and withheld amounts form;
view accounting lines;
AP setup inquiry;
control payable periods inquiry;
view profile settings and change personal profiles;
run and view selected AP reports; and
enter settlement transactions (Part A only).

18. Update AP AR Customer /Supplier Add
Add Update Inquire AP Suppliers
Provides access to view, add and update Provider / Beneficiary / Employee / Insurers data in the AP module.
Provides access to run selected standard and custom AP reports.
Add Update Inquire AR Customers
Provides view, update and add capability to Provider / Beneficiary / Employee / Insurers data in the AR module. (Quick Standard and Summary Customer Forms, and Customer Profile Classes).
Provides access to run selected standard and custom AR reports.
Update AP AR Customer / Supplier Add is the Job Role
Add Update Inquire AP Suppliers is the Responsibility
Specific functionality for that Responsibility is
view accounting lines;
add and update suppliers;
supplier inquiry;
update supplier holds;
supplier holds inquiry;
AP setup inquiry;
control payables periods inquiry;
view profile settings and change personal profiles;
run and view selected AP reports
Update AR AR Customer / Supplier Add is the Job Role
Add Update Inquire AR Customers is the Responsibility Note that this Job Role has two associated responsibilities. – Add Update Inquire AP Suppliers (previous screen) and Add Update Inquire AR Customers. (see the Job Role Functionality Outline)
Specific functionality for this Responsibility is –
add and update customers standard form, summary form, profile classes and quick entry form;
AR setup inquiry;
run and view selected AR reports;
HIGLAS invoice status setup inquiry;
multiple fund setup inquiry;
PSA lookups inquiry;
auto invoice interface lines inquiry;
auto invoice interface exceptions inquiry.

19. Job Role Constraints
Part of our Job Role Functionality Outline is the Job Role Constraints Section.
A work group reviewed the Job Roles and Responsibilities and developed a listing which indicates how to provide access without compromising segregation of duty requirements.
One of our biggest challenges is to make sure that the HIGLAS users have the access they need to do their jobs without providing access that will cause them to violate segregation of duty requirements.
For example, if a user is able to update AP payment information, they should not be able to update the provider or beneficiary data in the AP module, or update their address or banking information.
Examples follow on the next screens.

20. Job Role Constraints Access To Update AP Payments Update AP Invoices
Add and update claim payment data in the AP module or
Update AP Invoices
Add and update invoice claim information
Update AR Apply Receipts /AR Transactions
Add update receivable transaction data
Apply /reverse receipts (e.g. apply cash receipt to a receivable)
Should Deny Access To
Update AP AR Customer Add or
Update AP Supplier Address or
Update AP Supplier EFT or
Update Banks
Update AR Receipts
Add update cash receipts in AR module, but can’t apply/reverse the receipt to an AR.
Example:
With Update AP Payments Job Role you can add and update claim payment data in the AP module and have drill down capability to the invoice information.
With Update AP Invoices Job Role you can add and update invoice claim information in the AP module. You can also enter settlement transactions ( Part A only).
Based on the fact that you can impact payments, you should not have access to the Job Roles on the right side of the screen.
They allow you to:
Add or update Provider /Beneficiary / Employee/ Insurer data in the AP module;
Add or Update Provider/Beneficiary/Employer/ Insurer data in the AR module;
Update Provider/Beneficiary address information;
Update Provider/Beneficiary EFT information; and
Update Provider, Customer bank account information.
If you have access to Update AR Apply Receipts / AR Transactions Job Role, you can (see the two bullets).
You should not have access to Update AR Receipts Job Role.
Having both would allow you to complete the circle of adding or updating a receivable transaction, adding or updating a cash receipt in the AR module and applying that cash receipt to a receivable or reversing that receipt.

21. Job Roles, Responsibilities, and Job Role Constraints
The Job Role and Responsibility Matrix was used to create the Job Role Functionality Outline.
This document outlines the Job Roles, Responsibilities, and associated functionality. It also defines Job Constraints in a format that is easy to read and understand.
The contractors determine access needs based on the functionality as defined by the job roles.
HIGLAS access is defined based on the Job Roles and Responsibilities in each of the modules.
The Oracle application administers it via the HIGLAS Menu Matrix which sets access to screens, inquiry or update capability, and access to view and run reports. This is done for each HIGLAS User within their contractor workload.

22. The next several slides represent the job role constraints that were identified by the Job Mapping Workgroup. The Job Roles are identified followed by the job role constraints.
Job Role Constraints

23. Job Role Constraints Update AP Payments
Non-Manager Job Role Constraints: Should not have Update AP AR Customer/Supplier Add or Update AP Supplier Address or Update AP Supplier EFT or Update Banks
Update AP Invoices
Update AP AR Customer/Supplier Add
Non-Manager Job Role Constraints: Should not have Update AP Invoices or Update AP AR Collections / Refunds or Update AP Payments or Update AP CM Recon or Update AP Supplier EFT or Update Banks or Update Interface AP Invoices or Update CM
Each contractor is provided with the Job Role Functionality Outline during their Transition Kick Off meeting. This way they can review what access is provided, and be fully aware of the Job Role constraints and guidelines that have been identified.

24. Job Role Constraints Update AP AR Collections / Refunds
Non-Manager Job Role Constraints: Should not have Update AP AR Customer/Supplier Add or Update AP Supplier Address or Update AP Supplier EFT or Update Banks or Update AR Receipts
Update AR Apply Receipts / AR Transactions
Non-Manager Job Role Constraints: Should not have Update AR Receipts
Update AP CM Recon
Non-Manager Job Role Constraints: Should not have Update AP AR Customer/Supplier Add or Update AP Supplier Address or Update AP Supplier EFT or Update Interface AP Invoices or Update Banks or Update GL
It is the responsibility of the Contractor’s CMS Authorized Approver (CAA) to request HIGLAS access sufficient for job performance, while avoiding situations that would create Segregation of Duty violations. This document serves as a great resource when making decisions concerning employee access.

25. Job Role Constraints Update AR Receipts
Non-Manager Job Role Constraints: Should not have Update AP AR Collections / Refunds or Update AR Apply Receipts / AR Transactions
Update GL
Non-Manager Job Role Constraints: Should not have Update CM or Update AP CM Recon
Update Banks
Non-Manager Job Role Constraints: Should not have Update AP Payments or Update AP Invoices or Update AP AR Customer/Supplier Add or Update AP AR Collections / Refunds or Update AP CM Recon or Update AP Supplier Address or Update CM or Update AP Supplier EFT or Update Interface AP Invoices

26. Job Role Constraints Update AP Supplier Address
Non-Manager Job Role Constraints: Should not have Update AP Invoices or Update AP AR Collections / Refunds or Update AP Payments or Update AP CM Recon or Update AP Supplier EFT or Update Banks or Update Interface AP Invoices or Update CM
Update CM
Non-Manager Job Role Constraints: Should not have Update AP AR Customer/Supplier Add or Update AP Supplier Address or Update AP Supplier EFT or Update Interface AP Invoices or Update Banks or Update GL

27. Job Role Constraints Update AP Supplier EFT
Non-Manager Job Role Constraints: Should not have Update AP Invoices or Update AP AR Collections / Refunds or Update AP Payments or Update AP CM Recon or Update AP AR Customer/Supplier Add or Update Banks or Update Interface AP Invoices or Update AP Supplier Address or Update CM
Update Interface AP Invoices
Non-Manager Job Role Constraints: Should not have Update AP AR Customer/Supplier Add or Update AP CM Recon or Update AP Supplier EFT or Update Banks or Update AP Supplier Address or Update CM
Loans Agent
Non-Manager Job Role Constraints: Should not have Loans Manager