LACDMH CPTT / IBHIS Workgroup Meeting Notes - August 8, 2013

The Los Angeles County Department of Mental Health (LACDMH) held a CPTT IBHIS update meeting on August 8^th and covered the following topics. These notes reflect my best understanding of what has been communicated thus far:

1. The new process for
Trading Partner Agreement (TPA) application and enabling access to IBHIS

2. An overview of the new Web Services Companion Guide now available online!

3. An overview of the new COS Data Companion Guide now available online!

4. An overview of ProviderConnect, Day Treatment Authorization

5. An update for the IBHIS Claims process

6. Update on Reporting and SIFT Extracts

7. Update IBHIS Rollout schedule

8. Update PATS shut-down - shutting down Dec. 2013

Executive Summary:

LACDMH Presentation Materials found here: http://lacdmh.lacounty.gov/hipaa/IBHIS_EDI_homepage.htm and http://lacdmh.lacounty.gov/hipaa/IBHIS_EDI_Links.htm

LACDMH has provided a timeline now by 5 Contract Provider Groupings, the schedule is below. I recommend that each agency assign a project manager and develop a Project Plan / schedule for the tasks necessary to meet the deadlines below. Each EHRS vendor should begin reviewing the Companion Guides now published for Web Services and COS data to identify any gaps in their ability to comply. Your EHRS vendor should provide you with their timeline for development and internal testing to add to your plan. The schedule should have a place holder for the Claims transaction changes/develpmnet and testing, and once LACDMH has published the Claims Companion Guide, estimated for October, this schedule / timeline can be fleshed out. See outline for a plan below.

If you are currently submitting claims via manual data entry to the LACDMH Integrated System (IS), i.e. via DDE, then you and your EHRS vendor need to make a decision quickly as to whether you will GO-LIVE first to the IS with EDI transactions and then later to IBHIS with the modified transactions. There are benefits to doing this if you can implement before the end of the calendar year or soon thereafter. Otherwise you should wait for your IBHIS schedule below.

My open Questions submitted during the meeting are here, I will update this Blog when I have answers.

1. How much longer do we have to go-live with EDI to the IS?

2. When will the IBHIS TPA process and forms be provided so we can begin the process?

3. Will IBHIS extracts continue to have data not included in the electronic claim response transactions provided by LACDMH? I.e. how long will we continue to be dependent on the LE Extract data for these data elements?

4. For COS services, will the pipe-delimited file for upload to an FTP site be used in addition to an invoice or in lieu of an invoice? If ‘in addition to an invoice’, how will claiming/invoicing be done for COS?

Details:

1. The new process for a Trading Partner Agreement
(TPA) is going to be electronic. The TPA enables your access to and testing with IBHIS. An online TPA application will be made available which you will need to fill out, print, sign (wet signature), and then scan and submit electronically to LACDMH.

After you submit your signed and scanned TPA request electronically, you will begin the 10 step process below to gain access for IBHIS testing and then for production / GO-LIVE.

There are 10 steps in the process to approve your request for a TPA and certify your connection to IBHIS. Steps 1 thru 4 results in your receipt of the Test Keys necessary to begin testing with IBHIS, and are estimated to take about 30 days. The steps are as follows:

0) Submit a signed TPA application

1) Supervisor Approval

2) Technician Assigned

3) Enrollment Code Added

4) Test Keys Sent to Trading Partner (~ est. 30 days after receipt of application)

5) Acknowledge Files Received

6) HIPAA Validation Status

7) Structural Validation Status

8) Business Rule Validation Status

9) Ready for Production

10) Production Key Packet Sent

TPA Next Steps:

a. Develop a project plan!

b. LACDMH will provide the new TPA electronic forms and process (when?)

c. Your first step is to submit your signed TPA application, as follows:

Readiness Group	Submit TPA as early as:	Submit TPA no later than:
Readiness Group 1	9/3/13	10/1/13
Readiness Group 2	11/5/13	1/1/14
Readiness Group 3	2/5/14	2/1/14
Readiness Group 4	3/4/14	3/1/14
Readiness Group 5	4/3/14	4/1/14

Your Project Plan should have these basic components:

1. TPA application / IBHIS Provisioning

1.1. Submit application

1.2. receive Test Keys

1.3. install and validate Test Keys

1.4. receive Production Key Packet

1.5. install and validate Production Key

2. IBHIS Provider Enrollment Updates

2.1. Review and Validate

2.2. Add new providers

2.3. Update and remove providers

3. Web Services Client Data Exchange:

3.1. Planning, ID Gaps

3.2. EHRS Development and Workflow Assessment

3.3. Testing

3.4. Training

3.5. GO-LIVE

4. COS Data Upload (if you provide COS services)

4.1. Planning, ID Gaps

4.2. EHRS Development and Workflow Assessment

4.3. Testing

4.4. Training

4.5. GO-LIVE

5. ProviderConnect Data Entry (if you provide Day Treatment services)

5.1. EHRS Development and Workflow Assessment (likely a report for data entry)

5.2. Training

5.3. Testing

5.4. GO-LIVE

6. IBHIS EDI Claims Submission and Responses

6.1. Obtain Companion Guide

6.2. Planning, ID Gaps

6.3. EHRS Development (workflow should not change)

6.4. Testing

6.5. Training

6.6. GO-LIVE

6.7. IS CUTOFF new claims (FY 13-14 and prior year new claims)

6.8. IS CUTOFF Void, Replace originating in IS

7. Reporting and SIFT

7.1. Testing

7.2. ID Gaps and report to LACDMH

7.3. Training

7.4. GO-LIVE

2. The new Web Services Companion Guide is now available online at: http://lacdmh.lacounty.gov/hipaa/IBHIS_EDI_homepage.htm

The guide provides details for the following transactions:

· Search Client

· Create and Admit New Client

· Admit Existing Client

· Update Client

· Discharge Client

· Get Client Information

· Get Client Treatment History

Web Services Next Steps:

a. LACDMH will release a supplemental Technical Design Document containing:

0) Location of WSDLs

1) Message Handling

2) Sequence Diagram

b. You must provide the Companion Guide and supplemental documentation above, to your EHRS vendor and I recommend you document any questions their technical staff has in order to complete development of the Client Web Services as specified. Submit your questions to LACDMH in writing, and copy me please: Keely@4Sahara.com

c. I recommend that you and your EHRS vendor should use the Companion Guide to identify a written list of gaps in your EHRS product’s ability to capture and provide the data required in the format specified, as well as gaps in your workflows and business rules to assure this data is captured in the correct format in the EHRS. For example, the companion guide specifies that date of birth must be in the following format: MM-DD-YYYY and it is a required field, so you should assure that your workflows capture this data correctly.

d. Develop a project plan.

e. LACDMH will schedule Readiness meetings with Legal Entity Providers, and provide a Readiness Checklist. I recommend your vendor attend at least one of these meetings.

f. Your EHRS vendor must complete their development of Client Web Services, based on the companion guide and supplemental information provided, and you must develop test cases and scenarios to be ready for testing as follows:

Readiness Group	IBHIS Testing begins	IBHIS Testing ends
Readiness Group 1	11/4/13	1/14/14
Readiness Group 2	2/4/14	4/15/14
Readiness Group 3	3/3/14	5/14/14
Readiness Group 4	4/2/14	5/30/14
Readiness Group 5	5/2/14	6/30/14

g. I recommend your testing include a unit testing and an integrated testing phase. The unit testing can be done by the vendor; with your staff validating the data sent and received is accurate. The integrated testing should be done by staff that will ultimately be using the Web Services to exchange client data with IBHIS.

3. The new COS Data Companion Guide now available online at: http://lacdmh.lacounty.gov/hipaa/IBHIS_EDI_homepage.htm

LACDMH will require contract providers to submit Community Outreach Service (COS) information to support invoices, via a file upload process, to a secure File Transfer Protocol (FTP) site. Much like the current IS EDI claim file upload process.

The COS data must be in a pipe-delimited (“|”) file (a pipe is a vertical line used to separate data elements in the file, you may have heard of the more common format “tab delimited”). See the companion guide for data required.

COS Next Steps:

a. LACDMH will provide samples of the expected COS File Layout

b. Other actions are same as above for Web Services, b) thru e).

4. ProviderConnect is a Netsmart product to be used as the Provider Portal for entering Day Treatment data and receiving authorizations for treatment. The current Day Treatment TBS will go away. Each agency will need to complete user access request forms and there will be a process for approval and assignments of user rights/roles. No date given.

ProviderConnect Next Steps:

a. Provide LACDMH with a list of ProviderConnect users and roles;

b. LACDMH will provide ProviderConnect Training

c. You should conduct testing for Day Treatment authorizations

5. The Companion Guides for IBHIS Claims are not yet available, but LACDMH plans to publish them in October. Once these are published your EHRS vendor can assess the changes they need to make to the following EDI transaction sets:

· 837P (Outpatient and Residential Claim)

· 837I (Inpatient Claim)

· 835 (Remittance Advice)

· 277CA (Claims Acknowledgement)

· 999 (Implementation Acknowledgement)

Here is a chart of the process for submitting claims to IBHIS:http://lacdmh.lacounty.gov/hipaa/documents/IBHIS_Pilot_1_Kickoff_Meeting_Claims_Processing_Handout.pdf

You should discuss with your vendor, the option to GO-LIVE with EDI transactions to the IS and then later to IBHIS. The general workflow should be the same, only the transaction set will be different (which will be transparent to your staff), the only difference will be that your billing staff will need to process EDI claims to both the IS and IBHIS for a period of time while the IS claims are cleared out (voids, replacements, etc.). You need to be sure your vendor can handle processing of both transaction types simultaneously.

IBHIS Claims Next Steps:

a. Make a decision as to whether you will GO-LIVE via EDI to the IS first.

b. Develop a project plan.

c. LACDMH will release Companion Guides for claims in mid-October 2013

d. LACDMH will schedule a Companion Guide Review Meeting for: October 23^rd, 11:00 – 1:00, at 600 S. Commonwealth 2^nd Floor Rm 113

6. Reporting and SIFT
Extracts will be made available for testing and validation, but no date given. Contract provides will be able to run the available reports and view results, in order to determine if they must modify any internal reports or workflows to accommodate any changes in data format.

The following data will continue to be made available with IBHIS:

· SIFT/EFT

· FIN Claim List

· Reports: 630B, 701U, and 701UP

Reporting and SIFT Data Next Steps:

a. Develop a project plan.

b. Review SIFT extract formats

i. Identify modifications in data content, format

ii. Identify staff training requirements to utilize the reports and extracts

c. Make necessary changes to internal reports using SIFT data

d. Develop test scenarios and test reports and extracts

i. Ensure tables populated with SIFT data populate as expected.

e. Resolve problems encountered in testing

7. IBHIS Rollout schedule

DMH has changed their pilot and rollout process a bit, as well as the timeline. The First Pilot #1 has been split into two, first the directly operated providers, then one month later 11 Legal Entity Providers will pilot, called 1a and 1b now. Pilot 1b is also known now as Readiness Group #1. Each Contract Provider was placed into a Readiness group, see below, with a staggered schedule for testing. Groups 3-5 will all GO-LIVE together, BIG BANG approach.

As part of readiness, contractor providers will be given an opportunity to review their converted practitioner data and make changes to this data, i.e. addition and termination of providers. No date was given for the converted data will be available, and the method of review is undetermined. The Pilot groups (Readiness Group 1&2) will likely use an interim process and the others the long term solution for provider updates.

I put the dates provided into this Rollout Schedule Table to make it easier to review and track, as well as the EHRS vendors in each group (based in DMH EDI status posted):

Go-Live Readiness Group	Providers	Vendors	1 IS CUTOFF     FY 13-14 and prior year new claims	2 IS CUTOFF Void, Replace originating in IS	4  IBHIS Provisioning (TPA Certification & Provider Data Updates)	6 IBHIS Testing	3  START FY 13-14 new claims to IBHIS    (also Void, Replace originating in IBHIS)	START FY 14-15 new claims to IBHIS
Pilot 1(a)	Directly Operated	Netsmart/ Avatar	??	??	??	??	12/11/13
Pilot 1(b) a.k.a Readiness Group 1	11 Legal Entities (see below)	Clinivate, Exym, Welligent	1/9/14	9/30/14	9/3/13 to 10/31/13	11/4/13 to 1/14/14	1/15/14 IBHIS GO-LIVE (new claims hold 1/9/14 to 1/15/14)	7/1/14
Pilot 2 a.k.a Readiness Group 2	5 Legal Entities (see below)	Askesis, Exym, Netsmart / Avatar, Welligent	4/3/14	9/30/14	11/5/13 to 1/31/14	2/4/14 to 4/15/14	4/16/14 IBHIS GO-LIVE (new claims hold 4/3/14 to 4/16/14)	7/1/14
Readiness Group 3	36 Legal Entities (see below)	Askesis, Caminar Clinivate,  Exym, HST, Netsmart / Evolv, Welligent	9/30/14	9/30/14	2/5/14 to 3/1/14	3/3/14 to 5/14/14	5  N/A	7/1/14 IBHIS GO-LIVE
Readiness Group 4	38 Legal Entities (see below)	Anasazi, Clinivate, Exym, Netsmart/ Evolv, Welligent	9/30/14	9/30/14	3/4/14 to 4/1/14	4/2/14 to 5/30/14	5  N/A	7/1/14 IBHIS GO-LIVE
Readiness Group 5	36 Legal Entities (see below)	Askesis, Claimtrak, Clinivate, Exym, Netsmart / Avatar, Netsmart/ Evolv, Welligent	9/30/14	9/30/14	4/3/14 to 4/30/14	5/2/14 to 6/30/14	5  N/A	7/1/14 IBHIS GO-LIVE
Final Rollouts	Directly Operated	Netsmart/ Avatar	??	??	??	??	5  N/A	July – August 2014

¹ Claims for years prior to FY13-14 will no longer be accepted by the IS, and will also not be accepted by IBHIS. New claims for FY 13-14 must now be submitted to IBHIS on or after your Group’s ³ IBHIS GO-LIVE date.
² Voids and replacements for claims submitted to the IS (via EDI or DDE) must be completed in the IS before this date. Voids and replacements for claims submitted to the IS (via EDI or DDE) will not be accepted by IBHIS.
⁴ You may submit your TPA (trading partner agreement application)
⁵ You cannot submit new FY13-14 claims to IBHIS on your Go-Live date, you must submit FY13-14 new claims via the IS thru 9/30/14 when you are cut-off from IS, e.g. You are live with IBHIS in July 2014 and in July 2014 you have a new claim for service date of June 2014.
⁶  Testing will include: Client Data exchange via Web Services both uploading and downloading data, Claims submission & response via EDI transactions uploaded to and downloaded from a secure FTP site (including 837 & 835, COS data upload, Day Tx data input / ProviderConnect, and Reports)

The Five Readiness Groupings for each contract provider I put into this table, so you can see when your EHRS vendor must initially be ready as well as when you must be ready to GO-LIVE:

	Readiness Group 1 IBHIS GO-LIVE: 1/15/14	Readiness Group 2 IBHIS GO-LIVE: 4/16/14	Readiness Group 3 IBHIS GO-LIVE: 7/1/14	Readiness Group 4 IBHIS GO-LIVE: 7/1/14	Readiness Group 5 IBHIS GO-LIVE: 7/1/14
1	Community Family Guidance Center	Child and Family Guidance Center	Alcott Center for Mental Health Services	1736 Family Crisis Center	AIDS Project Los Angeles
2	Five Acres	Didi Hirsch Psychiatric Service	Alma Family Services	Amanecer Community Counseling	ASC Treatment Group
3	Foothill Family Service	Exodus Recovery	Asian Pacific Health Care Venture	Barbour and Floyd	Asian American Drug Abuse Program
4	Intercommunity Child Guidance Center	Hathaway Sycamores	Aviva Center	Bienvenidos Children’s Center	Bayfront Youth and Family Services
5	Masada Homes	Penny Lane Centers	Behavioral Health Services	California Hispanic Commission	BRIDGES
6	McKinley Children’s Center		Child and Family Center	Center for Integrated Family & Health	CA Institute of Health & Social Services
7	Pacific Lodge Youth Services		ChildNet Youth and Family Services	Children’s Bureau	Children’s Institute
8	Special Service for Groups		Children’s Hospital Los Angeles	City of Gardena	Counseling for Kids
9	Tessie Cleveland Community Services		Clontarf Manor	Dignity Health	Department of Health Services
10	The Guidance Center		D’Veal Family and Youth Services	Drew Child Development Corporation	Eggleston Youth Center
11	VIP Community Mental Health Center		David and Margaret Home	Eldorado Community Service Center	El Centro de Amistad
12			Emotional Health Association	Ettie Lee Homes	El Centro del Pueblo
13			ENKI Health and Research Systems	Florence Crittenton Services	Families First
14			Exceptional Children’s Foundation	Helpline Youth Counseling	Filipino-American Service Group
15			For The Child	Hillsides	Gateways Hospital & Mental Health Ctr.
16			Heritage Clinic	Inst. For Multicultural Counseling & Ed.	HealthView
17			Junior Blind of America	Jewish Family Service Los Angeles	Hillview Mental Health Center
18			Koreatown Youth and Community Center	Korean American Family Service	Homes for Life
19			LeRoy Haynes Center	LAMP	JWCH Institute
20			Maryvale	Los Angeles Unified School District	Kedren Community Health Center
21			Mental Health America of Los Angeles	Pediatric and Family Medical Center	Los Angeles Child Guidance Clinic
22			Olive Crest	Personal Involvement Center	Los Angeles Child Guidance Clinic
23			One in Long Beach	Phoenix Houses of LA	New Directions
24			Pacific Asian Counseling Services	Prototypes	Ocean Park Community Center
25			Para Los Ninos	Rosemary Children’s Services	Optimist Boys Home and Ranch
26			Providence Community Services	Social Model Recovery Systems	Pacific Clinics
27			South Central Health & Rehabilitation	South Bay Children’s Health Center	Pasadena Unified School District
28			SPIRITT Family Services	St. Anne’s Maternity Home	San Fernando Valley Community MH
29			St. Francis Medical Center	St. John’s Health Center	San Gabriel Children’s Center
30			Telecare Corporation	Stirling Academy	SHIELDS for Families
31			The Children’s Center of Antelope Valley	SunBridge Harbor View Rehabilitation	So. Cal. Alcohol and Drug Programs
32			The LA Gay and Lesbian Svc. Center	The Institute for Redesign of Learning	St. Joseph Center
33			Tri-City Mental Health Center	The LA Free Clinic (Saban)	Star View Adolescent Center
34			United American Indian Involvement	Tobinworld	Step Up on Second Street
35			Watts Labor Community Action Comm.	Trinity Youth Services	Tarzana Treatment Center
36			Wise and Healthy Aging	University Muslim Medical Association	The Help Group Child & Family Center
37				Vista Del Mar Child and Family Services	The Village Family Services
38				Westside Center for Independent Living

I hope this is helpful and let me know how I can help further!