Healthcare Challenges


MMIS

The California Medicaid Management Information System (CA-MMIS) is a large, complex, statewide IT project, chartered to replace the existing 30+ year old legacy system for Medicare/MediCal claims processing. It is in the process of being updated to a suite of modern and scaleable software applications that will enable the state to increase operational efficiencies, and to support the Department of Health Care Services (DHCS) strategic objectives. For years, The Ballard Group team has been involved with MMIS testing for several states, including test oversight and IV&V at CA-MMIS to protect the State of California's interests. Read more…

 

ICD-10/HIPAA 5010

The ICD-10 mandate has been called 'Y2K on steroids.' CMS (Centers for Medicare and Medicaid) has mandated that all health organizations be compliant with the American National Standards Institute (ANSI) Transaction Version 5010 (HIPAA v5010) by January 1, 2012, and ICD-10 (Internal Classification of Diseases) regulations by October 1, 2014. HIPAA version 5010 governs all electronic HIPAA transactions, such as enrolling members, checking patient eligibility, and claims processing. The Ballard Group can help ensure you meet those deadlines. Read more…

 

Health Insurance Exchanges (HIX)

If you are in the process of moving onto a government-sponsored HIX or setting up a private one, we can help. With over 15 years working with healthcare systems and health and human services programs--including HIX--we understand the issues involved. Our teams have firsthand HIX experience to assist you along the way.

Although Health Insurance Exchanges (HIX) are conceptually straightforward, the devil is in the details of the Affordable Care Act (ACA).  Read more...

 

FQHC/Health Center

The community of Health Centers, including FQHC’s, are facing many daunting challenges today.  First and foremost is how to provide the best possible health results to your patients with scarce resources.   Add to that the need to comply with the new governance and reporting requirements, which in turn necessitate better patient care coordination internally and with other facilities in your area.  The Ballard Group can help.

We offer solutions tailored to address these challenges for both internal improvements and better analytics and patient care coordination with your healthcare partners. Read more...

 

Medicare/Medicaid/MediCal Information Systems (MMIS)

For years, The Ballard Group has been involved with MMIS testing for several states, including test oversight at CA-MMIS to protect the State of California’s interests .  We understand how MMIS systems operate, and the subtle complexities involved.  If you are implementing the extensive system changes required to support the Medicaid extensions associated with the ACA, for example, our MMIS experience would enable us to immediately contribute to your team.   Of course, ICD-10 End-to-End (E2E) testing would also benefit from our deep understanding of MMIS.  Although relatively few claims submitters will be chosen to do full E2E testing with CMS prior to the October deadline, E2E testing will surely be required related to any problems encountered after the cutover.  The Ballard Group can help you prepare for that now.