January 15th CPTT Meeting - Translated

Here are my Notes on the January 15th CPTT Meeting. DMH Slides HERE.

Tip: DMH is using the term "Pilot" in their slides, to reflect the first “GO-LIVE” with approximately 10 hand-picked “bleeding edge” agencies in October 2013. I.e. looks like they will be testing / EDI certifying these providers sometime during July thru September 2013, and they GO-LIVE in October 2013.

Tip: Make sure your EHRS vendor has a contractual obligation to comply with the new transaction set and deadlines listed here. They must be able to submit not only HIPAA X12N transactions, but also File Transfer (via XML), and support Web Services.

IBHIS Schedule Update and what this means for LACDMH Contract Providers (CPs). (They only presented some disconnected dates, no full schedule, so some of this required reading between the lines and asking a lot of questions).........

LACDMH is calling this phase, PILOT #1, and then I imagine they will call it Pilot 2, 3, etc. as they phase their roll-out to more provider in IBHIS. These Pilots are truly GO-LIVEs for each set of providers and will include both existing EDI transactions and new ones, see the bottom of my article here. I prefer to call the first set of providers rolling on, as Pilot #1, and this phase as GO-LIVE Phase I. I imagine that after all providers are in production with the initial 12 transaction sets, more will be rolled out in Phase II etc.  More when this is clarified over time.

· January 2013: The initial IBHIS Pilot #1 Contract Providers are selected. The Pilot vendors are: Clinivate, Exym, and Welligent. Each vendor proposed some of their customers to be considered in this Pilot, each will be asked to participate voluntarily. They are looking for ten willing providers.

· February - March 2013: Rendering Provider data clean-up for Pilot #1 Contract Providers. During this period, LACDMH will provide each Contract Provider with the rendering provider data they have in their system (the IS) and ask that you provide any corrections to prepare for their IBHIS data migration. They will also be asking for additional data elements that you will need to provide for each rendering provider, such as "discipline". There will be about 8-10 new data elements you must provide for each rendering provider. They will start with the Pilot #1 providers and then possibly in April being with all Contract Providers.

· March 1st, 2013: Final MHSA application deadline, to request all remaining MHSA funds (100%) allocated to your agency by LACDMH. The process continues to take 6+ weeks to get approved, during which you can make changes if necessary to your submitted costs and schedule. More on this in a subsequent article.

· Also, Pilot #1 Contract Providers must provide their Dunn and Bradstreet Number (DUNS) to LACDMH. This take about 30 days after you request one. This will replace the number DMH assigns to providers for claims submitted.

· Also, Pilot #1 Contract Providers must provide single Pay-to-Provider NPI, to be used for 835 responses, (not clear how to move from multiple NPIs to one).

· April 2013: Companion Guides published - these are the specifications for the Electronic Data Interchange (EDI) transactions that your EHRS vendor must develop to, in order to send and receive data with LACDMH IBHIS. I.e. this is when you can begin development to change existing EDI claims transactions and the new transactions to exchange data such as: client openings, closings, transfers, and client searches. More on this below.

· April - August 2013: Rendering Provider data clean-up, and additional data updates. LACDMH estimates in April, that they will provide each Contract Provider with the rendering provider data they have in their system (the IS) and ask that you provide any corrections to prepare for their IBHIS data migration. They will also be asking for additional data elements that you will need to provide for each rendering provider, such as "discipline". There will be about 8-10 new data elements you must provide for each rendering provider.

· April – October 2013: All non-Pilot #1 providers and vendors should be developing and testing their new transaction sets, and preparing to test with LACDMH after October.

· May 2013: DSM-5 is scheduled for release - more on this topic in an upcoming article. http://www.dsm5.org/Pages/Default.aspx

· October 2013: First Pilot #1 Contract Providers GO-LIVE with IBHIS.  It is not yet clear how long this set of providers will be supported in production to stabilize, before the next set is rolled into production.

· April  2013 – June 2014: All DDE, non-EDI providers, should be selecting and signing agreements with EHRS vendors to GO-LIVE no later than June 2014.

· October 2013 - June 2014: All providers roll into production in phases.

************* IS Shut Down begins ***********

· June 30th, 2014: LACDMH IS stops accepting new claims, and presumably any new client openings. (Some questions come to mind here for future meetings: what about client discharges/closings?). All Contract Providers must be ready to submit claims via EDI.

· July 1st, 2014: All Contract Provider in production with IBHIS, meaning this is when the last Contract Provider will GO-LIVE to send and received the new EDI transactions.

· LACDMH IS (Legacy system) will continue to accept only claim voids and replacements for claims submitted prior to July 1st.

· Also the deadline for signing a TNFA Agreement for your MHSA funds. (Note: December 2017 is the deadline for you to spend it.)

• October 1^st, 2014: ICD-10 compliance date. This was just changed from 2013 - more on this topic in an upcoming article. http://www.ihs.gov/Cio/BH/documents/RPMS_ICD_10_BH.pdf; http://library.ahima.org/xpedio/groups/public/documents/ahima/bok1_049753.hcsp?dDocName=bok1_049753
• December 31^st, 2014: LACDMH IS Shut down! No transactions accepted.

Note: LACDMH also indicated at the last meeting that each claim would require an Authorization number. Some will be assigned by client if referrals are required for that client. Others will be assigned by contract max per funding source or plan.

Note: Residential claims will use the 837P EDI format, which is the same as the Outpatient format being used now. You will see this specified in the Companion Guide.

Note: Some data will be exchanged via direct EDI transactions; others will be thru the local health information exchange (LANES). Transactions will be of the types: HIPAA X12N, File Transfer (via XML), and support Web Services.

Note: You will have a minimum of 180 days from the release of the Companion Guides (April 2013) to develop your new EDI transactions and 90 days for your modified claims transactions. This means that if you are not in the Pilot #1 group, you will have more than the minimum amount of time to develop these and are expected to be ready to go by October 2013.

Note: PEI Outcomes will initially be optional to exchange with LACDMH electronically, so you may continue using manual data entry (DDE) method into OMA during this phase.

Tip: You can see above that there are a few steps you will need to take before you can participate in one of the subsequent Pilots to GO-LIVE with IBHIS:

1. Select and sign an agreement with an EDI EHRS vendor, to GO-LIVE by end of June 2014.
2. Assure your vendor is preparing to change EDI transaction sets, and developing support for File Transfer (XML) and Web Services. Modify your Agreement as necessary.
3. Obtain your Dunn and Bradstreet Number (DUNS). You can do this now.
4. Provide single Pay-to-Provider NPI, to be used for 835 responses. (not clear yet what this entails).
5. Have your vendor begin developing changes to existing EDI transactions, and developing the new ones. You can start this work when the Companion Guides re published in April 2013.

For a list of transactions that will be included in the first Pilot and your first GO-LIVE, see the slides HERE starting on slide #24:

• Exchange of Client Information – via Web Services

• Claims and Remittance Advices – via HIPAA X12N transactions: 837, 999, 277, and 835s

• Community Outreach Services – via File Transfer (transaction type undetermined)

• PEI Outcomes – this will be optional and not a requirement of initial GO-LIVE -  via File Transfer (XML).

It looks like the following transactions will not be accepted electronically in GO-LIVE Phase I, but will come in a later phase, therefore they will continue to be accepted these on paper:

·         Exchange of Treatment Information

·         Referrals in and out

·         Search for prior providers of care (SFPR) – (so will you continue to have look-up capabilities?)

·         Exchange of Outcomes, although PEI Outcomes will be accepted electronically as optional.

·         Exchange of Assessments and Treatment Plans

·         Requests for Authorizations exchange of Rendering Provider information

Hope this helps!