The multi-tiered public welfare environment and its numerous often poorly coordinated funding authorities make regulatory compliance and reporting a demanding task. State and federal regulatory agencies, as well as other funding institutions, frequently require reports that are not easily generated by public welfare data systems. Reporting problems are often compounded by the transition to the so-called "standardized" transaction code sets mandated by HIPAA for electronic data interchange.
To submit mandated reports in a timely, competent manner, three distinct areas of information management are necessary: collecting information, verifying third-party information, and delivering submissions according to the requirements.
ACA’s services can jointly or separately address the tasks of data collection, receipt, and submission. We help our customers interpret regulations and achieve compliance while preserving the integrity of their existing systems and procedures, thus causing the least disruption to their operations. Our products and services address the challenges posed by complex and sometimes contradictory requirements from a myriad of funding and regulatory authorities in the public welfare system.
Initial Data Collection
Our MASTRR™ Solutions software has an array of features designed to assist in maintaining public welfare data:
- A claims entry and adjudication system that allows all HIPAA-compliant data elements to be collected, including procedure codes, procedure modifiers, place-of-service codes, provider identifiers, consumer identifiers, etc.
- Electronic claims processing capacity for receiving, uploading, and adjudicating electronic claims in HIPAA-compliant 837 format
- Customizable assessment functionality that allows users to configure rating scales to meet their specific needs
- Capacity to maintain a complete history of service and assessment data
- Comprehensive cross-referencing functionality, allowing users to maintain their own internal identifiers of providers, consumers, services, etc. and to cross-reference them to changing external identifiers
Data Validation
Participants can validate their own data and contract with us to submit it to a regulatory authority, or we can receive and validate data from third parties before we submit it to a regulatory authority. In either case, our in-house software automates the data validation process and provides responsible management of file submissions, which may contain confidential data.
Report Generation
Our software also produces detailed reports of errors and exceptions, as well as summaries of data to meet specific regulatory reporting requirements.
- MASTRR™ Solutions software accommodates complex code cross-referencing to meet changing reporting requirements. The application suite currently includes an add-on module that produces person-level encounter data files and consumer assessment data files that meet requirements of the Pennsylvania Consolidated Community Reporting Performance Outcome Management System (CCR POMS). Additional state-specific modules can be added to address requirements in effect in other localities.
- We provide custom, stand-alone software solutions to interface with an existing data system to produce reports and data submissions.
- Our service bureau receives raw data files from an existing system, provides extensive validation and cross-referencing, and then uses this validated, cross-referenced raw data to generate reports and data submissions that meet requirements.
Public Welfare Industry Needs
ACA provides products and services that meet a range of specific public welfare industry needs in regulatory compliance and reporting, such as:
- Compliance with reporting requirements from funding agencies in order to continue receiving funding.
- Reducing administrative burdens from potentially contradictory regulatory compliance and reporting requirements.
- Freeing staff and resources from involvement in resolving technical issues.
- Generating healthcare encounter data in a format that is consistent with HIPAA-compliant 837 transactions.
- Ensuring that data provided by third parties is consistent with requirements.
- Flexible reporting capacity, allowing an agency to meet changing requirements without overhauling existing data systems.
- Accountable management of large volumes of confidential data essential for regulatory compliance and reporting.
- Advocacy with regulatory entities on behalf of agencies to clarify ambiguous requirements and resolve misunderstandings.
Innovative Solutions for Regulatory Compliance and Reporting
We have implemented the following innovative solutions and many more in the field of regulatory compliance and reporting:
- Two Pennsylvania counties have successfully used MASTRR™ Solutions for several years to meet the complex and changing reporting requirements of the Pennsylvania Consolidated Community Reporting Performance Outcome Management System (CCR POMS).
- ACA has acted as a service bureau on behalf of four Pennsylvania counties to meet these CCR POMS reporting requirements. ACA worked with each customer to devise a means of extracting raw data from their legacy systems so that it could be validated, cross-referenced, and formatted to meet CCR POMS requirements.
- ACA developed a stand-alone application for a public managed care organization (MCO) to transform data from their existing transaction processing system into the required 837 encounter data.
- As a component of the managed care monitoring services currently utilized by eight Pennsylvania counties, ACA has reviewed behavioral health data submissions prepared by MCO subcontractors to ensure their compliance with state reporting requirements. ACA has been successfully providing this service since the inception of the managed behavioral health program over eight years ago.
We offer personalized consultations to assist organizations wishing to utilize our products and services for regulatory compliance and reporting. Contact the Sales and Marketing Department at 610-359-1210 or information@acainc.com.