Medi-Cal Behavioral Health

SD/MC Phase II System, an entirely new end-to-end solution with a state-of-the-art claims adjudication system combined with a fully compliant, easy to maintain HIPAA compliant system for claim submittal and remittance advice.

The new system can process claims as they are received seven days a week, 24 hours a day to replace the previous requirement to schedule time once a week for mainframe based processing. The constant flow of automated processing enables ADP and DMH accounting to distribute their workload more evenly rather than deal with once a week processing spikes. A further advantage for the State agencies is the automated authorization of claim submittals to eliminate the delays required by manual intervention to authorize each claim file submittal. Counties submit over one million claims each month for services totaling over $800 million in annual reimbursements.

Project  Stats

Clients

California Department of Health Care Services, California Department of Mental Health, and California Alcohol and Drug Program

Number of Users

100

Type of Users

State Staff, County Staff

Technologies

Microsoft .NET Framework 2.0, C#, ASP.NET, MS SQL Server, MS BizTalk, Edifecs XEngine

Database

130 million rows of data totaling 350 GB