Ochsner Health Plan 2021: SUCCESS STORY

Overview

The Ochsner Heath Plan’s third-party administrator (TMG) requested assistance with supplementing their Member Eligibility Attributes File with “Other Health Insurance” (OHI) data from the “Centers for Medicare Services” (CMS). ISDM receives the files, merges the information from the CMS file into the original member eligibility attributes file, and sends the augmented file (along with the untouched Eligibility File) directly to the vendor Med-Impact.

Details

Two daily files are used operationally to interface with a third-party system MedImpact. This system can use CMS data if in the proper format. Data Management created a routine, using programming languages, to break the files into their components, load the data to secure location and match data within the CMS files.

The data is then reinserted into the source, in the proper format, and forward to the vendor.

Accomplishments

Ochsner Health Plan was able to send out files to their vendor in the proper format and are augmented with proper CMS data prior to the January 1, 2022, go-live