Centers for Medicare and Medicaid Services Implements Oracle Healthcare Transaction Base as Foundation for HIGLAS History System

Oracle today announced that its Oracle Healthcare Transaction Base serves as the foundation for the Centers for Medicare and Medicaid Services (CMS) HIGLAS (Healthcare Integrated General Ledger Accounting System) History System. CMS launched the HIGLAS dual entry system in 2005 to create a uniform financial management system to account for more than $600 billion in annual healthcare outlays. The HIGLAS History system, part of the overall HIGLAS initiative, provides a document-centric view of claim information to internal CMS users and allows CMS to answer queries from intermediaries and providers on individual claim status reports.

The selection of Oracle Healthcare Transaction Base for HIGLAS History builds on the successful deployment of Oracle U.S. Federal Financials as the commercial-off-the-shelf (COTS) foundation for the HIGLAS dual entry accounting system. The HIGLAS system, from 2005 through April 30, 2007, has processed more than 13.6 million Medicare benefit payments totaling $140.1 billion as well as 290.1 million claims totaling $157.2 billion. HIGLAS, through Oracle Federal Financials, enables accounts payable/accounts receivables (AP/AR) netting, which helps CMS ensure that providers pay the organization what they owe before receiving reimbursement on other claims. AP/AR netting preserved $5.72 billion in Medicare Trust Funds from May 2005 through May 2007 and earned additional interest of $36.3 million for the Medicare Trust Funds through the end of fiscal year 2006.

As the foundation for the new HIGLAS History system, Oracle Healthcare Transaction Base helps CMS facilitate customer service through automation and enables system users to trace documents from initiation to completion - tracking all related financial and non-financial activity. Leveraging Oracle Healthcare Transaction Base, CMS can more rapidly and cost-effectively answer intermediary and provider inquiries regarding individual claims, enabling faster claims resolution.

“For HIGLAS History, we needed a system that could provide a document-centric view of the data in Oracle Financials as well as help us improve overall application performance, enhance functionality and comply with federal mandates,” said Scott Beam, Director of HIGLAS Operations, CMS. “We worked closely with Oracle to configure and extend Oracle Healthcare Transaction Base and Oracle E-Business Suite Financial applications to meet and support our business requirements - allowing us to serve our constituents more effectively.”

CMS worked with Oracle and IBM to define functional requirements for HIGLAS History. The organizations worked together to tune the performance of the HIGLAS and HIGLAS History environments to meet the data volume and time-limited nightly batch window requirements of CMS’ large and complex processing environment. (CMS has 52 Medicare contractors and 45 million providers and beneficiaries, and processes approximately 4.5 million claims per night.) This collaborative effort between the three organizations culminated in the May 2007 production go live of the Oracle Healthcare Transaction Base solution for HIGLAS History for the first Medicare contractor. CMS plans to transition the remaining contractors to the Oracle Healthcare Transaction Base production solution over the next few years.

“CMS is committed to improving the quality and cost effectiveness of America’s healthcare system,” said Oracle Public Sector Senior Vice President, Mark Johnson. “Oracle is pleased to help CMS advance its mission through our expertise and solutions designed for the healthcare and public sector industries. Oracle applications and infrastructure software are at work around the globe helping public sector and healthcare organizations improve access to information, reduce costs and ensure compliance with regulatory mandates - ultimately enhancing the delivery of healthcare and government services.”

HIGLAS replaces and modernizes 52 Medicare contractor accounting systems with a single standardized system. A component of the Department of Health and Human Services (DHHS) Unified Financial Management System (UFMS), the HIGLAS solution is designed to improve accountability for Medicare’s payments to physicians, hospitals and other providers servicing Medicare beneficiaries.