ECI Provides Expert Professional Services to Remediate Healthcare Claims Management System

On January 23, 2004, Health and Human Services (HHS) published the Final Rule that adopts the National Provider Identifier (NPI) as the standard unique health identifier for healthcare providers. The effective date of the rule was May 23, 2005, 16 months after its publication date. Healthcare providers were able to apply for NPIs beginning on the effective date. The compliance date for all covered entities was May 23, 2007.
ECI provided remediation services to the California Department of Mental Health (DMH) for their Online Provider System (OPS), to incorporate the Health Insurance Portability and Accountability Act (HIPAA) National Provider Identifier (NPI), and to customize the Electronic Data Interchange (EDI) Translator.

Within 6 months, ECI implemented a custom solution around existing EDI translator environment that allowed the Dept to smoothly integrate over to the new NPI numbers without adversely affecting claims flow.

• Improved reliability of overall system because of redesign of existing troublesome components
• Modular, intrusive less design provided quick and reliable testing feedback which accelerated delivery of solution by 2 months.
• Allowed State to meet federal compliance mandates while maintaining solid partnership relationships with trading partners (counties)
• Robust technical design provided maximum flexibility for respective trading partners while still adhering to federal compliance rules.

The ECI team worked closely with teams consisting of members from Department of Health Services (DHCS), Department of Mental Health (DMH) and Department of Technology Services (DTS) departmental teams as well as representatives from the counties to implement the solution.   The ECI team responsibilities included:

• Project Management services consistent with the Project Management Body of Knowledge (PMBOK) published by the Project Management Institute. 
• Enhancement, maintenance and continued operation of the DMH Online Provider System (OPS) and to incorporate the Health Insurance Portability and Accountability Act (HIPAA) National Provider Identifier (NPI). OPS is a multi-tiered database application with a web-based user interface that allows DMH to maintain information about mental health legal entities and providers and to share that information with authorized users in all 58 counties.

Deliverables included:

• Enhancements to existing web-pages, data objects, business rule objects, data access objects and stored procedures to accommodate the NPI
• New web-pages, data objects, business rule objects, data access objects and stored procedures to accommodate the NPI
• Enhancements to existing system interfaces
• New system interfaces
• Enhancements for reporting to county users and DMH users
• Approved system test scripts and system test plans for each change made to OPS
• Successful unit testing and system testing for each change made to OPS
• Program migration between the Development, Test, Quality Assurance and Production environments
• Resolution of technical issues

• Visual Studio 2005
• C#
• ASP.Net 2.0
• Generics
• Objects Data Sources
• Page Life Cycle
• Custom Controls
• SQL Server 2005
• Stored Procedures and Transact SQL (T-SQL)
• XML
• SeeBeyond
• Claredi
• X12