HCIC SUCCESS STORY: Assessment, Planning and Implementation Support

Assessment, Planning and Support for the Implementation of Eligibility Verification and Claim Status Transactions at Maryland Hospitals

Maryland Hospital Association - Linthicum, MarylandMaryland Hospital Association

Situation:

Maryland Hospital Association (MHA) engaged HCIC in a two-phase project:

  • Review the current use of electronic transactions by Maryland hospitals and determine if the hospitals would participate in a project to centralize transaction processing
  • If hospital participation was embraced, develop a Request for Proposal (RFP) specifications, manage the RFP, and assist in RFP response evaluations.

Solution:

Phase I: To understand the current status of electronic transaction use, HCIC conducted an online survey of all Maryland hospitals coupled with interviews of a subset of the state’s hospitals. Payers, clearinghouses and vendors were also interviewed to determine their capabilities and future plans.

To ensure that each hospital in the state and other appropriate parties were updated on the status of the project, a communication plan was developed outlining the methods, timing and recipients for correspondence.

To engage participants, HCIC developed areas of anticipated gains and a benefits calculator by type and size of hospital. A report was prepared describing the status of the hospitals, vendors, payers and clearinghouses in the State. The plan HCIC developed addressed each organizations needs and articulated the savings to gain the agreement of the parties to move forward.

Phase II: HCIC facilitated two committees to assist with: The development of recommendations regarding governance and operations of the proposed centralized Maryland clearinghouse; and review, provide input, and finalize the RFP specifications.

HCIC developed the RFP which included: Goals and assumptions regarding the Maryland Transaction Data Interchange (MTDI), technical and architectural requirements, functional requirements, operational requirements, etc.

HCIC worked with MHA and stakeholder groups to finalize the selection methodology and vendor (bidder) evaluation criteria, develop and distribute an RFP, and evaluate responses.