eCAMS HealthCare Engine (HCE)
The diffusion of health IT remains a major thrust of American health policy. With costs and quality control taking central roles in healthcare, greater attention is being directed towards IT to drive healthcare transformation. Initiatives stemming from the American Recovery and Reinvestment Act of 2009 (Recovery Act) authorize CMS to provide reimbursement incentives for eligible professionals and hospitals, who are successful in showcasing "meaningful use" of certified Electronic Health Record (EHR) technology.
Health information exchange and health care modernization is resulting in tremendous amount of medical encounter data collection from providers. While different states and agencies differ to some degree in Medicaid or other payment reimbursement policies or qualification rules, many commonalities remain in the form of CMS-mandated rule sets and other policies and procedures.
CNSI's business-driven health IT solutions, which are based on the principles of visibility and transparency, are designed to enable government and commercial payers to improve the efficiency and quality of healthcare delivery. The centerpiece of our solutions, eCAMS HealthCare Engine (HCE), is a services based integration infrastructure that includes a health care rules engine (RuleIT®) which provides out-of-the-box CMS-mandated rule sets for claims adjudication and a business dictionary to configure state-specific policies and rules.
eCAMS HCE uses an industry standard Enterprise Service Bus (ESB), to manage data exchange and service interactions between different systems and applications. In addition, HCE provides a robust interface service repository that features a standard management framework with complete auditing, traceability, and exception handling. This functionality allows masking the integration complexity of the different components and provides a more seamless business process experience with visibility across the process life cycle for all its stakeholders
For state Medicaid agencies, this ESB can then be utilized to act as an exchange infrastructure within the state’s healthcare agencies. The Medicaid Information Technology Architecture (MITA) provides some guiding principles on how this should be accomplished.
Learn more how eCAMS HCE is also powering the CMS Encounter Data Processing System analyze Medicare Advantage (MA) encounter data for establishing risk adjustment models based on MA cost and utilization.
