DXC solutions, along with our healthcare experts, are best positioned to assist you in navigating a clear and productive path along the 7SCs.
In healthcare, change happens now more than ever. As guidance for State Medicaid transformation, the Centers for Medicare & Medicaid Services (CMS) designed the Seven Standards and Conditions (7SCs) to achieve progressively higher levels of capability, compatibility, and modularity in patient support. These 7SCs have immediate and long-term implications to healthcare delivery.
In order to qualify for enhanced federal funding, projects resulting from all Advanced Planning Documents must align with the 7SCs guidance. DXC solutions, along with our healthcare experts, are best positioned to assist you in navigating a clear and productive path along the 7SCs. We enable clients to successfully achieve these conditions with innovative solutions.
As you have come to expect, DXC is proactively evolving the interChange Healthcare Platform business functions. We incorporated Medical Information Technology Architecture (MITA) and 7SCs guidelines when recently adding advanced features and architectural capabilities to the most successful MMIS solution on the market today.
Focus on the modularity standard
This standard seeks to reduce the amount of custom software for all requests for approvals. DXC incorporates service-based modular components, extensive configuration, business rules, and open-sourced or commercial-off-the-shelf (COTS) software to minimize custom code. Our approach increases the flexibility and adaptability of our systems to the constantly evolving healthcare landscape.
- Healthcare Portal for members and providers is a free-standing module enabling self-service and advanced features such as ePrescribe, web-based provider enrollment, and claim submission.
- Care management through DXC Atlantes enables proactive care for the population segment requiring the greatest amount of oversight and management of their benefit expenditures.
- Capabilities include chronic condition and disease management, plan of care coordination, and prior authorization review.
- Business Policy Administration rules are responsible for the vast majority of claims adjudication, pricing, editing, and auditing decisions. These rules can be exported, managed, and maintained outside the system in a human readable form and published to an external registry.
- DXC interChange Business Intelligence and Analytical Reporting Module provides unparalleled transparency into the healthcare program.
- The interChange Healthcare Platform uses open APIs and COTS products—delivering best-in-class correspondence generation, call tracking, monitoring, and electronic document management components.
Make the MITA condition actionable
DXC took the big picture topics of MITA and made them actionable through direct integration of Business Process Steps within the DXC interChange Healthcare Platform user interface. Process steps are documented at the task level, enabling users to achieve process standardization, quality, and heightened maturity—fundamental condition goals of MITA.
- The new interChange Healthcare Platform user interface is closely aligned with MITA business processes. MITA Business Process Steps documentation is built directly within the user interface (UI).
- The interChange workflow standardizes business processes and enhances efficiency, optimizes outcomes, and brings greater maturity to the MMIS Concept of Operations.
- Business owners have complete control in the generation and update of MITA process documentation available through the UI. This enables process updates to go from idea to implementation across the entire business.
Conform to industry standards condition
In return for CMS financial participation, states must seek solutions that conform to industry standards and enhance interoperability and accessibility for healthcare processing. DXC solutions use numerous standards including HIPAA (X12 5010, NCPDP D.0), ePrescribing (NCPDP 8.3), HIE (HL7 Continuity of Care Document–CCD), and evolve to the changing standards landscape.
- DXC helps shape the direction of the healthcare transformation—our industry experts participate with industry standards boards, affecting transactional data standards, operating rules, and security specifications. CAQH CORE operating rules are being adopted to support section 1104 of the Affordable Care Act.
- Health Insurance Portability and Accountability Act (HIPAA) standards, including security and privacy, are enforced across our solutions.
- Each application’s user interface is designed to be 508c compliant in support of the Americans with Disability Act, enabling the solution to the broadest set of users.
- Available DXC HIE, ePrescribe, and EDI solutions support NCPDP, HL7, and Nationwide Health Information Network (NwHIN) standards in the larger healthcare ecosystem.
Engage with the leverage condition
States are encouraged to move to regional or multistate solutions when cost-effective, and seek to support and facilitate such solutions. DXC interChange modules are proactively designed to maximize configuration and rules-based processing, minimize customization, and maximize transferability. DXC has multistate experience with Healthcare MMIS, resulting in components and solutions that leverage participation and contributions by other states.
- Medical Assistance Provider Incentive Repository (MAPIR) is an DXC-developed, web-based portal designed with contributions from 14 state clients. This leveraged application was the first to track participation and compliance with Meaningful Use adoption and authorization of provider payments.
- DXC Exstream uses open APIs and can be deployed with a cloud-based software-as-a-service solution for correspondence generation.
- At its core, interChange is a multipayer system proven to support multiple healthcare programs, such as Medicaid, CHIP, Managed Care and State only programs, through a single instance of the solution.
- interChange Connections electronic data interchange/electronic service bus (EDI/ESB) and File Tracking System simplifies receipt, orchestration, and tracking of all message-based transactions and files. Adapters facilitate interoperability with automated protocol translation.
Meet business results condition
The 7SCs are designed to promote efficiency and effectiveness in healthcare management — with CMS funding only available for proven and measurable performance results. DXC has been delivering transformative business results for over 40 years. The MMIS modular offerings continue evolving—delivering business results for our many clients.
UI enhancements spotlight @neTouch functions, enabling staff to significantly improve productivity. Information they seek is literally available at the touch of a button.
- Our Healthcare Portal enables member and provider self-service: Provides self-service capabilities anytime and enables independence—find a doctor, check on claims, review prior authorizations, or find and download important information
- ––Manages care—with Atlantes—in coordination with the case manager and physician in a shared environment
- interChange inSight operational dashboards keep staff informed of KPIs at a glance. Servicelevel agreements (SLAs) and KPI monitoring is simplified.
- interChange Connections business services provide a centralized dashboard for tracking, monitoring, and auditing every transaction processed over the ESB.
Support the reporting condition
States must increase the transparency and measurability of operational performance and healthcare outcomes. From operation reporting to analytical reporting, DXC interChange Healthcare Platform helps states achieve this condition. Through interChange inSight dashboards, analytics, and ad hoc reporting, states can determine the effectiveness of their programs and delivery systems.
- The interChange inSight reporting services enable users to take actual data generated from operational reports and export the data in comma separated values format files into the selected application to be filtered and refined. This data can be published through defined APIs to CMS data hubs or repositories.
- The interChange Business Intelligence and Analytical Reporting produces required federal reports and point-in-time operational analysis to help track changing conditions.
- Predefined online performance reports enable system management, provider feedback, and effective operational oversight.
Support the interoperability condition
CMS technology investments must result in a higher degree of interaction and interoperability to maximize value and minimize stakeholders’ burden and costs. The data sharing architecture must address data semantics, data harmonization strategies, shared-data ownership, security and privacy implications, and quality of shared data. DXC interChange Connections meets these challenges.
- DXC provides state-of-the-art network monitoring and NIST-based security standards controlling authorization and authentication within a high-availability private cloud processing hub to maximize controlled data sharing.
- These adaptable data sharing tools extend to connect systems supporting the evolving HIE and HIX transaction standards.
- The interChange Connections EDI/ESB empowers security, management, control, and transformation of critical healthcare data exchanges simplifying sharing standard transaction sets with trading partners.