HIPAA Transactions and Code Sets LA County Department

Who are we? < John Galloway, Sierra Project Director, LA County Department of Mental

What is LACDMH L. A. County is a “Hybrid” covered entity under HIPAA <

DMH Statistics < Processes over 400, 000 claims per month < Operates approximately 60

What is the Integrated System Project? < Initiate testing of a HIPAA Compliant Transaction

What are the benefits? < Revenue Generation – Enrollment and Eligibility Verification – Reduction

DDE Principles Separate the Provider – Payer functions < Maintain the Clinical – Administrative

Slides: 12

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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 1000+ 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 subsystems;

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?