Scalability

CDHS achieved continuity of support in the U.S.’s largest state Medicaid program while also supporting a myriad of state employee managed care plans, each with differing transactions that require complex data validation and translation processes.

Affordability

Replacing legacy systems, custom building a solution, or conventional EDI-focused translators would not be cost effective, would require much more support, and have higher maintenance costs and total cost of ownership. The Pervasive solution enables CDHS to\ leverage its existing platform with modern technology while freeing up resources to focus on other projects.

Ease of Use

The graphic mapping tool is easy to use. CDHS staff can quickly design and test data transformations and processes on a workstation and then deploy them as an embedded service on the mainframe for execution on demand.

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CDHS meets HIPAA compliance affordably with Pervasive

With federal mandates requiring HIPAA compliance, the State of California’s Department of Health Services (CDHS) searched for the most affordable, usable and effective solution to help it achieve compliance without disrupting service to millions of beneficiaries or delaying payment to providers. The state’s limited budget and resources eliminated the option of a custom-built product, and many of the alternative solutions were either unable to support the state’s large volume of transactions or were cost-prohibitive.

The state wanted to utilize its existing technology platform and needed a solution that was flexible enough to be used with legacy systems yet offer technology capable of managing 10 million transactions per month. After a thorough review process, CDHS selected Pervasive Data Integrator™ for its affordable, scalable and easy-to-use components.

Compliance concerns, legacy platforms

CDHS supports the country’s largest state Medicaid program with 6.5 million beneficiaries as well as 40 different managed care plans, such as Blue Cross and Blue Shield, in which nearly 50 percent of the state’s employees are enrolled. CDHS exchanges multiple transactions with these care plans, including HIPAA 820 (premium payments to a health plan) and HIPAA 834 (enrollment and disenrollment) transactions, requiring complex data validations and translation processes (around 10 million transactions per month). To achieve HIPAA compliance while ensuring medical coverage to beneficiaries, the state needed a solution that could easily fit into its existing legacy platform. The solution also would require little maintenance or support from CDHS’s already inundated IT staff.

Although HIPAA compliance was the focus, CDHS’s primary goal was to ensure uninterrupted medical care and coverage for 6.5 million Californians. In addition, CDHS’s legacy system runs on a mainframe and contains up to 13 million records the state agency did not want to move to a server to process. The solution had to run on both a mainframe and a server.

Embeddable Pervasive integration handles high volume, legacy data to ensure HIPAA compliance

Pervasive Data Integrator was embedded within medical benefits programs that run on the state’s mainframe server. This cost-effective solution enables the high volume of transactions per month to continue without problems. 

The Pervasive solution will enable CDHS to leverage existing hardware to move towards complete HIPAA compliance without interrupting beneficiary medical care. Pervasive allows CDHS to combine existing legacy systems with modern technology so it can get more out of its existing investment.

834 Production Environment 

Compliance met affordably

Federal compliance has been facilitated with an affordable solution that does not require technical expertise. Pervasive Business Integrator’s point-and-click mapping is easy enough for CDHS analysts, despite the complexity of the data issues which would otherwise require programming skills. Now, legacy processes that once required three people to code and maintain only take one person a few hours for basic modifications.

Accurate, compliant data with no worries for IT

Pervasive Data Integrator, California’s CDHS will support HIPAA compliance while satisfying its primary goals of uninterrupted medical coverage and timely payment to health care providers. CDHS will not have to replace legacy systems or dedicate resources for mapping or programming. It’s critical that CDHS’s enrollment and eligibility processes are accurate; the Pervasive solution is a valuable tool that gives the agency these capabilities in an affordable and surprisingly easy-to-use format.