Quick implementation
Pervasive Data Integrator™ allowed CSC to incorporate HIPAA-compliant transaction formats into the eMedNY environment while maintaining a rapid response time commitment. Using Pervasive tools for map development was roughly two times faster than with a mainframe translation alternative.
Experience
Pervasive Professional Services brought extensive healthcare-sector knowledge to CSC.
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CSC and Pervasive tackle HIPAA translation for state of New York's Medicaid process
As a leading global technology consulting, integration and outsourcing company, CSC leverages its technology alliances to offer its clients the most comprehensive solutions at the lowest cost. When the state of New York wanted to modernize its Medicaid system while staying within budget, it relied on CSC to bring the best providers to the table. After analyzing the state’s needs, CSC chose Pervasive Data Integrator for its healthcare solution to help New York process Medicaid claims more efficiently with a new HIPAA translation engine.
Accelerate Medicaid processing, while meeting HIPAA regulations, for the state of New York
When CSC was tasked to migrate the state of New York’s Medicaid processing system (eMedNY) to the federally mandated HIPAA transaction formats, detailed analysis was conducted which indicated that a front-end data translation approach would be required in order to meet the development timeline and performance requirements of the system. Additionally, the high transaction volumes and 24x7 processing requirement dictated that there could be no system downtime to accommodate the migration. eMedNY Phase 1 handles more than four million Medicaid transactions per week, resulting in more than $6 billion in prescription payments per year by the state of New York. The challenges for the new system included SLA’s for both reliability (true 24x7 availability) as well as transaction response time. In the first implementation phase, Eligibility and Service Authorization transactions are submitted through various input paths for real-time processing. In addition, batch-oriented pharmacy claims were transformed to adjudicate in real time, with direct access by more than 50,000 providers (pharmacies, hospitals and doctors) serving 4 million consumers eligible for Medicaid.
The second phase of eMedNY would include all medical claim types. Meeting the HIPAA-compliance mandate required additional complex and compute-intensive processing while still delivering nearly instantaneous transaction response times. The HIPAA implementation had to be completed within six months in order for New York state to meet the federally mandated deadline.
Pervasive mapping and HIPAA rules definition help CSC on its eMedNY project
CSC integrated Pervasive’s Data Integration Engine into its custom IP-based multi-threaded gateway in order to provide eMedNY with the infrastructure to send and receive millions of Medicaid responses in real time, including eligibility verification, service authorizations and prescription claims. The ability to deploy multiple engines across multiple servers helps to eliminate single points of failure, as well as provide unlimited scalability. “CSC’s core integration expertise, combined with Pervasive’s extensive data translation experience, complete with complex mapping and HIPAA rules definition, enabled CSC to provide New York state with the nation’s first HIPAA-compliant Medicaid system,” says John Palter, senior partner and program architect for CSC.
Pervasive pre-built the schema for Medicaid processing (a component that interprets and transforms data in XML formats) in less than four weeks. “The eMedNY system currently processes four million Medicaid transactions per week, peaking at rates of 60 transactions per second,” says Palter. “We are extremely focused on meeting our 24x7 availability and rapid response time commitments. Pervasive’s Data Integration Engine for HIPAA translation has added less than 50 milliseconds to our overall response time per transaction. This was critical to us in product selection.”
According to Palter, the alternative of performing HIPAA translation on the mainframe would have been up to ten times more costly. “The implementation of Pervasive Data Integrator took only six months from product selection to deployment, because of the development efficiencies delivered by Pervasive’s Data Integrator design tools,” he explains. “Mainframe capacity upgrades were minimized by performing the HIPAA translation outside of our core processing application on the mainframe. We have been able to maintain the back-end Medicaid processing application and database with relatively minor modification. This approach provided significant risk mitigation, and allowed for parallel development and testing by tier.”
Pervasive praised for assisting CSC in creating the nation's first HIPAA-compliant Medicaid system
Pervasive’s technology was key to enabling New York to become the first state to meet the federal HIPAA mandate while processing a higher volume of Medicaid transactions more efficiently. “With Pervasive’s Data Integrator, we were able to incorporate HIPAA compliant transaction formats into the eMedNY environment while maintaining our rapid response time commitment, and still achieve throughput of up to 60 transactions per second,” says CSC's John Palter. “Using Pervasive tools for our map development was roughly two times faster than with our mainframe translation alternative.”
eMedNY’s service levels, with two-second response time, and true 24x7 processing are among the most stringent in the industry. “The Data Integrator is a lightweight, reliable and simple programming environment that allowed us to meet an extremely tight deadline by increasing productivity,” says Palter. “From a transaction throughput perspective, we can do more processing while still meeting our response time and 24x7 availability commitments. Due to teamwork with Pervasive Professional Services, we were able to configure and install the Data Integrator middle tier into our production environment while the system was live without dropping a single transaction.”
“Patients now only have to swipe their Medicaid card through a POS device at their pharmacy to get eligibility approval virtually instantaneously,” explains Palter. “This technology helps with fraud detection, saving pharmacies and the state precious funds and sheltering them from potential liability. We also perform sophisticated drug interaction, side-effects and generic-equivalent analysis for improved patient safety and additional fraud prevention.”
Pervasive Professional Services is a plus on major projects
Leveraging Pervasive’s Professional Services team’s extensive experience and best practices in healthcare, CSC was able to accelerate the project against a tight deadline and get the state of New York’s first HIPAA-compliant Medicaid system up and running. Providers, patients and the state of New York have seen significant results since the implementation of eMedNY.
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