Media & Events

State nears launch of online system for Medi-Cal fee-for-service Providers

9th May 2016

Source: Techwire

The State of California is replacing one of the lengthiest paper-based forms in all of government, perhaps the world, with a Web-based solution its designers say is like a more sophisticated version of TurboTax.

By the end of July, many of California’s 154,000 Medicaid fee-for-service providers — doctors and other medical personnel — will be able to securely enroll and validate their information through the Department of Health Care Services’ public-facing Provider Application and Validation for Enrollment (PAVE) system.

Fee-for-service providers will use a Web-based browser to access the application, which features e-signatures, “social” collaboration and chat functionality, private and secure messaging with the provider’s application team or enrollment staff, context-specific forms, and form sharing.

Tanya Homman, chief of the DHCS Provider Enrollment Division, said in an interview with TechWire that PAVE will become one of the most advanced, complete solutions of its kind in the nation. DHCS demoed the system’s Web-based application process during a two-week-long open house that concluded last month.

“Our approach needed to be a change toward innovation and automation,” Homman said.

Work on PAVE began about two and a half years ago, spurred in part by new reporting requirements within the Affordable Care Act. Historically, DHCS has processed Medicaid fee-for-service application forms through an entirely paper-based process that took anywhere from 90 days to a year and a half to complete. The voluminous forms run anywhere from 200 to 400 pages long and are stored in big filing cabinets under lock and key.

Seventy to 80 percent of the paper-based applications are returned to the applicant because they contain errors or incomplete information. PAVE should eliminate much of that because it interfaces with numerous back-end data systems at the national and state levels and includes intelligent features that assist the user.

“The system itself is going to help out providers complete the application and be more successful; it will help us be better business partners and be responsive,” Homman said.

To build PAVE, the department is partnering with Digital Harbor, which has developed similar types of systems in the health-care and financial sectors.

“It was public-private partnership between us and California because they have some very unique needs. Their application [form], for example, is one of the most complex in the world,” said Rohit Agarwal, Digital Harbor’s president and CTO.

The vendor helped integrate 74 “advanced” features into the PAVE portal, and 22 of them are unique to the world, Agarwal said. One is a “social forms” capability that is aware of the user’s needs and adapts the form as the application form moves along. Another is a “digital assistant” that will answer a user’s question for any field on the form. The project team also is working on voice functions that will enable doctors to talk to the application in order to fill out the form.

The system interfaces with 15,000 data sources on the back end. That will help the state identify, flag and investigate suspected cases of fraud, waste and abuse. Homman said the system already has flagged occurrences where a provider was barred from participating as a Medicare provider in another state and later moved to California.

PAVE is built atop a commercial-of-the-shelf system and platform called Social Enterprise Technology, Agarwal said. The state owns the data, and Digital Harbor is maintaining the platform as-a-service. The state is paying the vendor via a subscription.

DHCS says it’s changing the project’s project approach and is finalizing the total project costs. DHCS has spent $5 million to date on software licensing for PAVE. Additional releases in early 2017 will add more users to PAVE, and officials say the solution is designed to eventually become the system of record for California’s fee-for-service providers.

DHCS is using agile methodologies to integrate changes to PAVE based on user feedback gathered during a series of preview events. The department’s Scrum master says the project team has completed nearly 20 sprints during the project’s life cycle.