FOX HIPAA Consulting

HIPAA MMIS Remediation

Because of its diverse, multi-state background in Medicaid, public health, and community health programs, FOX Systems, Inc. (FOX) is able to provide cost-effective approaches to healthcare information system compliance related to national health initiatives.

FOX consultants track and participate in major federal e-health initiatives such as the Consolidated Health Informatics (CHI) Initiative, the electronic Health Records Functional Standards, Medicaid Information Technology Architecture (MITA), Public Health Data Standards, and HIPAA standards development. What makes FOX different is that we bring both the big picture perspective on policy trends and innovative technologies as well as the hands on technical expertise to get the job done.

FOX has strong qualifications in the MMIS domain, which ensures that FOX consultants are able to relate compliance issues to Medicaid’s unique program and architectural characteristics. FOX’s Medicaid and MMIS experience, combined with its work at the federal level, gives us the edge for understanding how federal IT policy will impact Medicaid and other public sector health IT in the near future. We can give our clients the preview they need to make well-informed system choices.

At this point, most states have conducted the necessary assessments, compliance planning, and remediation that is necessary to achieve HIPAA transaction standards compliance for their MMIS. This process has primarily involved Code Sets remediation and ensuring the ability to receive HIPAA-standardized electronic transactions. While many electronic transactions have already been standardized, several other transactions (as well as nationally standardized identifiers) are due to be implemented in the coming years. With its unique combination of Medicaid and HIPAA expertise, FOX is prepared to advise states on the level of necessary Code Sets remediation and can determine the appropriate compliance plan to comply with the formats for the standardized HIPAA electronic transactions.

Typical compliance options for transactions include:

Contracted clearinghouse with external translator and internal or external HIPAA data store
Contracted clearinghouse with internal translator / HIPAA data store
No clearinghouse with direct trading partner Interface and internal translator / HIPAA data store
Fully remediated & enhanced MMIS with optional HIPAA data store as part of remediated MMIS

FOX is well-versed in all system remediation options, including the multitude of technical environments used to achieve each remediation option. As part of its remediation recommendation, FOX analyzes one-time and ongoing costs and short, medium, and long-term benefits. This analysis, combined with the state’s strategic goals for healthcare IT, will determine a compliance path for the state’s MMIS that maximizes the longevity of the state’s healthcare IT investment.