Presentation to: Georgia Medical Associations & Societies Presented by : Sonny Munter, CIO, DCH

1. Information Technology Overview Presentation to: Georgia Medical Associations & Societies Presented by: Sonny Munter, CIO, DCH June 12, 2013

2. Agenda • 4010/5010 HIPAA Transactions and Code Sets • ICD-10 • Integrated Eligibility System • Georgia Medicaid Management Information System (GAMMIS) Enhancements Underway • Medicaid Information Technology Architecture 3.0 • Transformed - Medicaid Statistical Information System • Centralized Prior Authorization Pre-Certification Portal • Office of Civil Rights HIPAA Certification • Technology Transformation

3. 4010/5010 HIPAA Transactions and Code Sets • The Department of Community Health successfully converted from the 4010 to 5010 HIPAA transaction standards on January 1, 2012 • The most important aspect of this change was to expand the ICD-9 field in the HIPAA 837 transaction claim form from 5 to 7 positions to accommodate the expanded ICD-10 code structure • Providers who relied on their Trading Partners or Clearing Houses to accommodate this change must move this process into their billing system before they can upgrade to ICD-10

4. International Classification of Diseases 10th Edition • October 1, 2014 – Go-Live, Compliance • 5010 Transactions and Code Sets implementation • Testing • Internally – Providers / Hospitals • Trading Partners/Clearing Houses • Payers • The number of changes will depend on your specialty

5. Integrated Eligibility System (IES) • Georgia is not a State Based Exchange State • Georgia will use the Federally Facilitated Marketplace (FFM) • ACA Mandated “Modified Adjusted Gross Income” (MAGI) • IES Open Enrollment begins October 1, 2013 • Go-Live is January 1, 2014 • Interface to and from the Federal HUB • Partnering with GTA Enterprise Services business team • Interface to the Medicaid Management Information System • Determine current Medicaid status • Members who are declined are referred back to the FFM for tax credit determination • Requires changes to the DHS Eligibility system and Maximus for PeachCare for Kids

6. GA Medicaid Management Information System (GAMMIS) Enhancements Underway • Medicaid Information Technology Architecture (MITA) version 3.0 • 5 level Maturity Model to modernize MMIS (National effort) • Streamline and move from Manual to Automated processes in the MMIS • CMS requirement following a new MMIS implementation • Transformed - Medicaid Statistical Information System (T-MSIS) • More timely and complete information from the states • Expanding the T-MSIS file from 400 fields of data to 1,000 • 8 files (Claims – inpatient, outpatient, managed care, provider, eligibility, etc.) • Monthly vs. Quarterly Reporting • Go-Live January 1, 2014

7. Medicaid Management Information System (MMIS) Enhancements Underway • Centralized Credentialing • ACA mandates that we revalidate provider enrollment every 5 years • An on-line application process will be available for providers to use to revalidate • Revalidation begins in September 2013 for providers whose enrollment became effective before January 1, 2012 • Revalidation will be scheduled in phases • Revalidation will be completed by June 30, 2015 • Approximately 105,000 revalidations will be processed over this two year period • Additionally it is expected that 50% of these providers will go through the revalidation process each year

8. Office of Information Security • Office of Civil Rights (OCR) Omnibus Rule • Sweeping changes to the HIPAA Privacy and Security Rules • OCR audits begin September 23, 2013 • DCH’s Office of Information Security is gathering and centralizing our responses to the 167 points of the audit • Encryption • Desktops, laptops, data at rest, transmission and off-site storage • Critically important to insure Protected Health Information (PHI) is secure

9. Data Center Transformation • Data Center Move • Moving application software, running on computers at our 2 Peachtree building, to state of the art computers running at the State’s Tier 4 Data Center managed by IBM in North Atlanta • Power supplied from two electrical sub-stations – Redundant Electrical Power • Uninterruptable Power Supply • Guards against electrical spikes • Sustains power to the Data Center until the Diesel Generator engages and provides electrical power to the Data Center in the event of a total loss of electrical power • Diesel Generators • Transfer Switch – automatically starts the Diesel Generator in the event of a power outage • Strong Physical Security

10. Questions?