HVS partnered with the Financial Systems and Business Operations division to map the provision of service provider data with student information, service encounter details, and IEP details, to enable cross-system reporting of billable services for submission to Medicaid.
Executive Summary Client Challenge
1. The NYC Department of Education has over 244,000 special education students, many of whom received mandated services that were eligible for Medicaid Reimbursement.
2. The agency was not automated to identify and analyze provided services for eligibility and submission to Medicaid for reimbursement. The information required for Medicaid reimbursement of provide resources existed in multiple silos, with no facilities for aggregate analysis and no clear roadmap for integration.
3. From an agency perspective, significant revenue was left unrealized because the mechanisms were not in place to identify, analyze, report, and submit billable services to Medicaid for reimbursement.
HVS’s Solution
1. HVS partnered with the NYC Department of Education HR division to create employee and service provider automated vetting and background check systems. These systems verified that the vendors and individuals providing mandated services passed background investigations, and were eligible to provide services to students.
2. HVS worked with the Financial Budgeting division, to incorporate systems into the school budgeting and onboarding systems, to enable linking of service providers to the students to whom services were being provided.
3. HVS worked with multiple partners in the DOE to aggregate information together from multiple sources, to enable aggregate analysis of provided services, combined with student data, service provider data, and school financial information.
4. HVS partnered with the Financial Systems and Business Operations division to map the provision of service provider data with student information, service encounter details, and IEP details, to enable cross-system reporting of billable services for submission to Medicaid. These same systems reconciled responses from Medicaid as to which services were paid, rejected or denied, to enable reconciliation of revenue to services, and resubmission of rejected/denied services where permitted.
Impact on Client’s Business
1. Realized Revenue The NYC Department of Education was able to realize revenue for services that were provided to most of the 244,000 special education students attending any of the over 1700 school in New York City.
2. Automated Reconciliation, Reporting, and Communications Operations that were manual and laborious in nature, particularly in regards to reviewing services for Medicaid reimbursement eligibility, were automated, enabling quicker review and approval for submission to Medicaid. Additionally, the centralization of information enabled for efficient communications, as multiple parties were reviewing the same reports derived real-time from centralized repositories.
Turning on the tables on Lost Opportunities
The NYC DOE had the pieces of information required for Medicaid reimbursement in multiple silos. Various, disparate systems had the different components that were required for integration, but those systems were not integrated for Medicaid billing, and there was no clear roadmap for putting the information together. HVS partnered with the agency divisions to visualize and enable the aggregation of student, IEP, service encounter, service provider, and school financial data to enable the reporting of provided services for Medicaid billing. Eligibility rules were automated, and reports were designed and distributed to provide multiple parties with the same centralized service encounter data. This enabled reports of eligible service encounters to be reviewed quickly and submitted to Medicaid for reimbursement, resulting in additional revenue generation for the agency.
Hudson Valley Systems, Partner for Strategic Vision and Execution
Hudson Valley Systems provided the management consulting to assist executive leadership in creating a vision for business automation in an enterprising processing model. HVS facilitated communication between distinct divisions, each with legacy processing procedures and silo subject matter expertise, and navigated division interests towards the enterprise mission. HVS provided the technical and implementation expertise to create the agency’s business automation toolset, and connected existing enterprise systems across different technology platforms for real-time transactions utilizing web services and message queues. Through this strategic vision and expert execution, Hudson Valley Systems transported a segmented institution into an iautomated, intelligent enterprise.