PHOENIX, – Arizona’s Medicaid program, the Arizona Health Care Cost Containment System, is implementing an IT platform to manage its healthcare transactions.
“The purpose is to improve the efficiency for submitting transactions for both our system and its trading partners,” said Rainey Daye Holloway, the program’s chief public information officer.
The agency was concerned about the accuracy of the data within the transactions. While the program’s processing system caught inaccuracies, the data then had to be fixed or cleaned by health plans, providers or the staff of the Medicaid program.
The agency is implementing Foresight Corp.’s Transaction Insight platform to help monitor incoming data and address problems before the data is loaded into the program’s processing system.
“Claims that fail to adjudicate can spawn multiple errors, including bad data in the database, slowdown of processing and demand for manual and expensive intervention by customer service or IT personnel,” said Robert Fisher, Foresight’s CEO.
“The objective of this project is to provide a tool to change the focus of Arizona’s program from using its resources to identify bad data to a focus on keeping it out of our databases,” Holloway said. “This tool will also improve the feedback mechanism for our trading partners and allow them immediate opportunity to correct the information submitted.”
The Arizona program expects to see a reduction in time and effort required to process the transaction, and greater focus on using the data to make sound business decisions and provide care for its members.
Users of the Transaction Insight platform reported reduction in time to reconcile claim errors to five minutes from 25 minutes, Fisher said at Foresight’s Focal Point conference in May. Payment times improved to five to 10 minutes, from as long as four hours, he added.
Calls to call centers were reduced by 20 percent, and provider electronic submission rates reached 97 percent.
Centers for Medicare & Medicaid Services spokesperson Jenny Chen said the agency provides matching funds to state Medicaid programs to support IT and automation projects, including administrative, claims processing, analytic program reporting and managed care enrollment functions.