Pa. outsources Medicaid payments
- By Brian Robinson
- Mar 24, 2002
After decades of handling its Medicaid and human services provider systems
by itself, the commonwealth of Pennsylvania has opted to outsource that
responsibility, getting the benefits of a leading-edge Web-based system
as a result.
Pennsylvania officials recently announced the award of a five-and-a-half
year contract to EDS, which will use its interChange Medicaid Management
Information System (MMIS) to perform online process management services,
such as claims and financial processing, and to provide better program reporting.
Peg Dierkers, deputy secretary of the Pennsylvania Department of Public
Welfare's Office of Medical Assistance Programs called the move "the biggest
change in our provider payment technical and business solution in 23 years."
The decision to outsource was made after an analysis of the costs associated
with several actions, including making the current phone-based system compliant
with the Health Insurance Portability and Accountability Act, showed outsourcing
would be cheaper, said Jay Pagnini, a spokesman for the department.
In all, Pagnini said, it would have cost around $20 million a year for
the state to put the compliant system together and to run it in-house, whereas
it will cost $17 million through the EDS contract. Plus Pennsylvania officials
are confident about EDS' capabilities, because the company already performs
eligibility work for the department.
"It also gives us the ability of doing online, real-time remittance
checking with our providers, something that can't occur now with the phone-based
system," Pagnini said. "It gives us Web-enabled interaction with our providers."
Medicaid provides health care coverage to 1.4 million Pennsylvania residents,
and home- and community-based services are provided to more than 19,000
aged or disabled residents. Some 60,000 health care professionals around
the state participate as care providers.
Robinson is a freelance journalist based in Portland, Ore. He can be reached
Brian Robinson is a freelance writer based in Portland, Ore.