On July 1,
2013 a much anticipated change will take place in the North Carolina Medicaid
system when the state’s 34-year-old claims processing computer system, known as
Legacy, will be retired and replaced by the new system, NC Tracks. After being
awarded a contract in 2008, Computer Sciences Corporation (“CSC”), a Virginia-based
company, developed the system based on a similar system currently in place in
New York. CSC will manage call centers, claims processing, prior authorization
reviews, pharmacy processes, and medical policy reviews.
The old
system, administrated by Hewlett Packard, is no longer able to adapt to the
numerous changes happening across the landscape of state and federal healthcare
law. NC Tracks has been developed to grow
and change as healthcare changes and has the ability to expand if additional programs
or government payers are added. NC Tracks has many other capabilities that will
be of more immediate benefit. The system has the ability to process claims from
multiple divisions of the Department of Health and Human Services. Also, it
will combine the old Legacy system that processes claims for the Division of
Medical Assistance (DMA), the Integrated Payment and Reporting System (IPRS) used
by the Division of Mental Health, and the Purchase of Medical Care Services
(POMCS) that handles claims for both the Division of Public Health and the
Office of Rural Health and Community Care.
The new system will have the
following online capabilities:
-recipient eligibility verification
-prior approval request
-claims submissions
-secure email messaging
-electronic remittance advice reports
-view claim status in real time
While the Legacy system has some of these attributes, the NC
Tracks system is designed for improved paperless processing and a higher level
of efficiency for providers. It also claims to “streamline the claims process”
and provides the ability for online enrollment, verification, and
credentialing.
Despite the benefits reported by CSC and DHHS about NC
Tracks, not everyone is so confident. In a report recently released by State
Auditor Beth Wood’s office, multiple questions were raised about the readiness
of the new system. There is concern that the system is not prepared for the
onslaught of claims from the over 70,000 enrolled providers. The major is that
the system has not been properly tested. There were issues with a portion of
the test cases run, as well as unease that not all the testing has been
completed with barely a month left before implementation. Also causing distress
is the computer code used to write the software. CSC used an antiquated style
of code from the 1950’s that is rarely used today. Detractors of the system are
complaining that most people trained in writing the code are retired, and
programmers from India had to be brought in to develop the system.
With the July 1st deadline looming, CSC has many
promises to fulfill. After running two years over deadline and costs rising
from the projected $265 million to $484 million, faith in NC Tracks is waning.
Providers are hoping that the new system will be more user-friendly and make
providing healthcare and supplies to Medicaid recipients easier, as promised. If
NC Tracks fails to meet the demands of DHHS, this will be the mostly costly
mistake in the state’s history.