Case Studies

Central Provider Repository Reduces Time and Labor Costs

Project at a Glance

RDA developed a single, centralized provider repository (CPR) for Health Services for Children with Special Needs (HSCSN) which automated data synchonization between two distinct systems and fed provider data to additional applications. This solution reduced labor costs by eliminating the need for manual data entry into two separate databases. Additionally, staff time was reduced by allowing service providers to update data to the system themselves.

About Our Client

Health Services for Children with Special Needs (HSCSN) is an innovative care management network coordinating health, social, and education services for the pediatric Supplemental Security Income (SSI) and SSI-eligible populations of Washington, D.C. Benefits to members and their families include traditional Medicaid benefits plus expanded health care services including individualized care management; 24-hour access to care coordination; outreach services; respite care; medically necessary home modifications; and mental, behavioral, and developmental wrap-around services.

Background

HSCSN has several applications that contain information on their providers. These systems collaborate with each other for day-to-day business and use provider information to perform different tasks. As is the case in any situation where data is duplicated in various applications, there were inconsistencies. Additionally,, there were data quality and integrity issues as a provider moved from one practice to another or retired. The following specific issues were identified:

• It was difficult to keep the provider information up to date with changes such as group affiliation or practice location.
• Two IT systems (RIMS and Case Trakker) were not in sync with each other when it came to provider information.
• These systems did not have a common key to match providers with each other.
• The Provider Affairs team needed to manage changes in provider information in two different systems. This was causing data quality and integrity issues among systems.

Solution Detail

RDA developed a central provider repository (CPR) that feeds provider information to all of the applications that require it. The Provider Affairs Team has full control over this database. CPR includes information such as provider demographic data, provider identification information, associated hospitals, and site data.

Solution Modules and Features

Provider Update User Interface Module
Using this module, the Provider Affairs team can edit provider information, associate a provider with multiple sites and track changes to provider data.

Provider Reports Module
Using this module, users are able to extract information related to providers. They can cross reference Case Trakker and RIMS data to summarize claims by providers and their sites.

Extranet Module
This module allows external users (i.e. providers) to update their own data, eliminating the need for the Provider Affairs department to provide user assistance.

Interface Module
The CPR system includes automated interfaces with RIMS and Case Trakker. The RIMS system is updated using custom code and Case Trakker is updated using DTS package code. Based on the requirements of each connecting system, the CPR system provides/builds an adaptor to interchange data to each system used by HSCSN. This eliminates duplicate data input and synchronizes applications with provider information.

Challenges

A big challenge to this project was matching the data between the two systems. We worked with the users to create business rules on how to match providers from the different systems based on several scenarios. We were able to match many of the providers, but not all of them. We are in the process of building an automated mechanism to show users possible matching providers, and let them specify the correct match.

Benefits

Health Services for Children with Special Needs is realizing the following benefits from this project:

• The Provider Affairs department is now saving time by only updating provider information in one place (CPR) vs. two distinct systems (RIMS and Case Trakker).
• External users (providers) can now update their own information, freeing the Provider Affairs Team from user support tasks.
• By centralizing data entry to a single system, data integrity is maintained throughout HSCSN applications.

Technically Speaking

CPR is an ASP .NET application with a SQL Server back-end. The reports are built using SQL Server Reporting Services.