Presented to Project Certification Committee October 24, 2012 Presenters:

1. Closeout of Project to Implement HIPAA-2 5010 Transaction Codes & Prepare for ICD-10 Remediation Presented toProject Certification Committee October 24, 2012 Presenters: Mark Pitcock, Medical Assistance Deputy Director, HSD/MAD Linda Gonzales, Program Information Bureau Manager, HSD/MAD Wayne Pendley, Medicaid IT Project Manager, HSD/ITD

2. Presentation Overview • Definitions • “HIPPA2 / 5010” “ICD-10” • Original Project Goals & Planned Schedule • Scope of System Changes • Goals Accomplished & Actual Schedule • Questions

3. Definitions • “HIPPA2 / 5010” • Health Insurance Portability and Accountability Act of 1996 (HIPAA) • Intended to make US health care system more efficient by setting national standards for electronic health care transactions and national identifiers for providers, health insurance plans, and employers • 2003 – Centers for Medicare and Medicaid Services (CMS) established American National Standards Institute (ANSI) Accredited Standards Committee (ASC) X12 004010 Transaction Code Set (“4010”) as the standard for Electronic Data Interchange (EDI) of health care claims and NCPDP 5.1 for pharmacy claims • 2012 – CMS replaced 4010 with ASC X12 005010 (“5010”) and NCPDP 5.1 with NCPDP D.0 5010 is also called “HIPPA2”.

4. Definitions (continued) • ICD-10 • International Classification of Diseases, 10th Edition, Procedure Coding System/Clinical Modification, ICD-10-CM/PCS or “ICD-10” enhances accurate payment for services rendered and enables more precise evaluations of medical processes and outcomes • 110 countries use ICD-10 for cause-of-death reporting,and 25 already use it for reimbursement and resource allocation in their health system • The former “ICD-9-CM” is 30 years old, has outdated and obsolete terminology, uses outdated codes that produce inaccurate and limited data, and is inconsistent with current medical practice • CMS originally set the deadline for implementation of ICD-10 at October 1, 2013. That has been postponed and the new deadline is currently October 1, 2014.

5. Original Project Goals • Replace the ICD-9-CM code set now used to report health care diagnoses & procedures • Adopt the updated X12 standard, Version 5010 for selected electronic health care transactions • Update the 5.1 standard for pharmacy-related transactions to D.0 • Update the standards for claims, remittance advice, eligibility enquiries, and other administrative transactions

6. Scope of System Changes • Affected five major systems • Omnicaid, Pharmacy, Data Warehouse, Fraud & Abuse Detection System, and OCR • OmniCaid impact: • Changed to 120 programs, 28 online windows and 27 reports • Data Warehouse impact: • Six mainframe table conversions, two new tables, • 14 tables reloaded – 870 million records impacted • 34,615 staff hours over 17 months

7. Goals Accomplished • Changed all MMIS data structures to accommodate larger field lengths of ICD-10 and added logic to distinguish ICD-9 input from ICD-10 • Successfully deployed the updated X12 5010 standard for all the transactions New Mexico had selected: • Claims, remittance advice, eligibility enquiries, and other administrative transactions • Successfully deployed the new D.0 standard for pharmacy-related transactions • Update the standards for claims, remittance advice, eligibility enquiries, and other administrative transactions

8. Milestone Schedule – Planned vs. Actual

9. Budget – Certified Funds vs. Actual Spending • Total Appropriated from All Sources • $4,701,177 • Total DoIT Certified Funds • $3,638,548 • Total Actual Spending • $3,669,595 (0.85% beyond Certified Funds).

10. Questions ?