Physicians Medical Group of Santa Cruz County (PMGSCC) is a network of primary care physicians in Santa Cruz, California. Their Data Analysis department handles claims transactions for the network.

The Challenge

PMGSCC sought to significantly reduce the complexity in handling the contents of their inbound and outbound HIPAA data, and remain HIPAA compliant through the conversion process. At the time that PMGSCC was looking for HIPAA software, they had the following needs:

• Convert HIPAA 837 to their database
• Generate HIPAA 835 from their database
• Generate HIPAA 837 from their database
• Convert delimited text file (CSV) to their database
• Convert text image file to their database

The Solution

PMGSCC licensed the following Redix products:

• HIPAA package
• DataBase module
• RMAP module

PMGSCC uses the Redix HIPAA package to convert HIPAA 837 to the Redix RMAP data format which significantly reduces the complexity in handling the contents of HIPAA stan-dards. According to Daniel Tarsky of PMGSCC, “The RMAP has less segments than HI-PAA and puts the contents in fields which are much easier to read and analyze.” After converting the HIPAA file to the RMAP file, PMGSCC then converts the RMAP file to a SQL database using the Redix DataBase module. Tarsky stated: "Redix improves our healthcare claims processing by several orders of magnitude. It provides exactly the data conversion engine we need to get the job done, at any speed we choose to run".

The workflow diagram below demonstrates how Redix integrates into the process.

The Results

PMGSCC was able to accomplish all of the HIPAA tasks in four months. Testing with their trading partners was completed in two months. PMGSCC employees also received formal training from Redix and continue to receive on going customer support.

"PMGSCC was able to accomplish all of the HIPAA tasks in four months. Testing with their trading partners was completed in two months. PMGSCC employees also received formal training from Redix and continue to receive on going customer support."

Daniel Tarsky, Operational Data Analyst.