SD/MC HIPAA Project

Short-Doyle Medi-Cal HIPAA Project

Impacted Covered Entities

Providers (county mental health plans, county substance abuse programs, and direct substance abuse treatment providers).

Overview

Short-Doyle Medi-Cal (SD/MC) is group of related local assistance programs and activities associated with Medi-Cal behavioral health claims. The SD/MC system processes health care claims submitted from counties and direct providers to the Department of Mental Health (DMH) and Alcohol and Drug Programs (ADP). DMH and ADP act as agents of the Medicaid Program, Medi-Cal. The Department of Health Services, Information Technology Services Division (CDHS-ITSD), maintains the SD/MC mainframe-based system, performing application maintenance, daily system operation, batch program execution, and key data entry. ADP and DMH make the actual payments to counties and direct providers. The SD/MC processes approximately one million claims monthly.

SD/MC Phase I

The Short-Doyle Medi-Cal (SD/MC) HIPAA Phase I Project allows SD/MC providers to submit HIPAA-compliant health care claims and receive adjudication results in a HIPAA-compatible format; complete advice in HIPAA-compliant format is not available.

The SD/MC Phase I Project is the implementation of a translator service from the Department of Technology Services Data Center. The translator is integrated into the existing electronic claim submission process through the DMH Information Technology Web Services website. The translator solution allows minimal changes to the existing SD/MC. SD/MC providers that have not achieved HIPAA compliance may currently continue to submit claims in proprietary formats.

The SD/MC HIPAA Phase I project was implemented on January 2004 for the Department of Mental Health (DMH) and in March 2004 for the Department of Alcohol and Drug Programs (ADP). For additional information on current SD/MC Phase I operations, policies, and technical documents, please review the following links containing information maintained by ADP and DMH:

Alcohol and Drug Program (ADP)

Department of Mental Health (DMH)

SD/MC Phase II

The Short-Doyle Medi-Cal (SD/MC) HIPAA Phase II project addresses several gaps between the Phase I project solution and the full set of HIPAA compliance requirements. SD/MC Phase II is intended to be fully HIPAA-compliant; significant business and system changes are expected.

As of November 2007, the SD/MC Phase II design, development, and implementation vendor has started work. It is anticipated they will follow an 18-month project plan. The request for proposal and bidder’s library is available through the link below.

SD/MC Phase II RFP Documents