HP Enterprise Services - DHHR

HPES Response to West Virginia MMIS Re-procurement RFP
4.1.10 Solution Alignment with BMS’ Business and Technical Needs
processing. We went live for the other claims June 26, 2008. The first financial cycle executed on June 28, 2008.
Achievement of Federal MMIS certification and approval for the maximum allowable enhanced FFP within 12 months
of cutover to the replacement system retroactively to the day the system becomes operational.
Each interChange implementation has received the official seal of approval from CMS—certification back to the first day of
operations (with a single two-week exception in Kentucky). The most recent certification is the Wisconsin interChange MMIS—
the transfer system that we are proposing for West Virginia. Additionally, Wisconsin became the first state to complete and
pass certification using the new CMS checklist and process. No other vendor can equal these achievements.
Compliance with all HIPAA requirements.
The WV-iC is designed to comply with the current and final technical guidelines established by CMS for a system compliant
with the Health Insurance Portability and Accountability Act (HIPAA) for transactions, code sets, identifiers, privacy, and
security requirements. HPES provides a double set of assurances concerning compliance with HIPAA requirements through
the functional capability built into the interChange MMIS solution and through our personnel, who meet the standards for
privacy and security each day.
We have a thorough understanding of the final and proposed HIPAA requirements. Through our involvement in standardsetting
organizations and other industry groups, we often anticipate future changes to HIPAA requirements. In our work during
the past decade, the HPES team has assisted states and other healthcare organizations in analyzing the effect of HIPAA on
their systems and operations. From this analysis, our teams have developed appropriate and HIPAA-compliant systems and
operational solutions that meet the healthcare program’s strategic needs.
Timely design and development of components affecting providers, e.g., web portal, web-based claims submission.
HPES is an industry leader of web-enabled HIPAA transactions. We were first in the nation to accept 270/271 and 276/277
transactions, as demonstrated in the Massachusetts Recipient Eligibility Verification System (MassREVS) project. Throughout
our healthcare accounts, web functions include claim submission access for multiple claim types, claim status inquiry, member
eligibility verification, prior authorization (PA) submission and inquiry, and the capability to allow providers to upload 837
transactions for processing.
The following testimonial received after implementing interChange for the Massachusetts Executive Office of Health and
Human Services (MassHealth) demonstrates the positive effect of our web-based solutions on the provider community.
“The new system makes our daily dealings with MassHealth much more efficient and effective. The updated automated web
solutions through the Provider Online Service Center accessing functionalities such as but not limited to electronic claims entry
and payment, eligibility verification, security, provider updates to the provider file, and reporting are just the sort of
improvements providers were looking for to aid our business transactions. These system implementations and developments
have allowed providers like us to become more self-sufficient than ever.”
— Jason Schofield, Manager, NewMMIS Corporate Facilitation High Point Treatment Center
MMIS that improves efficiency and convenience for BMS staff through reduction of manual processes, increased
automated processes, increased workflow capabilities, and increased system capabilities and efficiency.
Business processes are the focus of MITA, and HPES sets out to work with each customer to increase efficiencies, reduce
manual efforts, and grow the maturity level of processes as follows:
• The new Connecticut interChange increased the real-time and near real-time processing capabilities for claims. Previously,
Connecticut did not have real-time processing for any claims type except for pharmacy. Before interChange, nonpharmacy
claims were processed in batch every two weeks. With interChange, editing and auditing is performed in real time for web
submission and near real time for electronic batch uploads, enabling providers to work through the web portal to correct
claim issues before financial processing.
• The design of the new MMIS brings significant enhanced features to the State of Oregon, including real-time claims
processing to replace legacy batch claims processing, user-configurable benefit plans to replace hard-coded business
rules requiring programming effort to change, online claims resolution to replace paper worksheets, real-time eligibility
updates to facilitate timely update of critical data, and enhanced access to data through consolidation of data from multiple
sources into the MMIS.
The interChange MMIS provides a scalable architecture that can grow and change with the Medicaid program—for example,
new benefit plans such as those administered in a state’s breast and cervical cancer program. By implementing a few table
changes to the system, the state can add a new category of eligible individuals.
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RFP # MED11014