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Case Studies --> State Medicaid Agency

Management of a large Health Insurance Portability and Accountability Act (HIPAA) compliance initiative.

HIPAA mandates that all state Medicaid Agencies be treated as Health Plans. They are, therefore, required to be compliant with the HIPAA privacy and transaction set rules.

This state Medicaid agency had developed its own Medicaid Management Information System (MMIS) and, therefore, had to internally lead and manage the change to their system and business processes.  The custom nature of the MMIS made it difficult for them to outsource the HIPAA compliance initiative as some other states had done.

Radicle provided the project manager to co-manage this large HIPAA compliance initiative. With his health care industry expertise and HIPAA knowledge, the Radicle Project Manager became the focal point at the agency to provide direction and resolution to many intricacies and challenges faced by the agency in meeting the HIPAA compliance needs. The project manager helped drive the changes in the business processes and IT system to meet HIPAA regulations. We advised business users on different issues surrounding HIPAA compliance in transaction sets and privacy.

In addition, Radicle participated in various industry and state working groups like WEDI, X12 and NMEH that were working in a collaborative manner to make the HIPAA compliance a successful endeavor. Our active participation and contributions to the WEDI list servers were recognized by many experts in the HIPAA area.