Cloud Migration, Direct Data Feeds Enable Real-Time Beneficiary Data for Providers
A collaborative effort to modernize a legacy Medicare beneficiary data system is now providing more up-to-date eligibility information for Medicare providers.
The migration of CMS’s Common Medicare Environment (CME) from the mainframe to AWS will eliminate the data warehouse used by the HIPAA Eligibility Transaction System (HETS) to populate its data store. As a result, HETS now uses a combination of Beneficiary Information in the Cloud (BIC) and Common Working File (CWF) Host data to provide near real-time information to Medicare providers who use the information to determine the eligibility of Medicare beneficiaries for vital health care services.
“The migration allows the HETS 270/271 application to receive new beneficiary domain data from the BIC data service on an hourly basis, while processing CWF utilization data within minutes of receiving Medicare claims data directly from the nine CWF Host sites,” says Craig Mooney, Director, Division of Mid-Tier Applications Management (DMAM).
That means CWF Medicare utilization data and beneficiary domain data are received directly from the source of record. Receiving data directly from the source gives Medicare providers information 18-24 hours sooner than the previous process.
Prior to this, CMS’s legacy mainframe and server combination in the Baltimore Data Center (BDC) had provided Medicare eligibility information since 2012. With beneficiary data now stored in the cloud, CMS will be able to retire the BDC beneficiary data stores.
“The collaboration and due diligence during the migration was exceptional,” said Thomas Ohlendorf, Common Medicare Environment (CME) Product Owner and Nanda Kandala, CME Technical Advisor, who oversaw the move. “There were no problems with the transfer.”
The collaboration involved several CMS organizations and contractors that worked seamlessly together to make this modernization effort a success. A special thanks goes out to the following teams:
● The Division of Mid-Tier Applications Management (DMAM) and the Division of Shared Systems Management (DSSM) from OIT’s Applications Management Group (AMG).
● The Division of Medicare Systems Support (DMSS) from OIT’s Enterprise Systems Solutions Group (ESSG).
● The Division of Provider Communications Technology (DPCT) of the Provider Communications Group (PCG).
● The Infrastructure and User Services Group (IUSG) from OIT.
● Supporting contractors Mindfinders, Oddball, Peraton, and Sparksoft.
NOTE: A previous version of this story appeared in the News from OIT bulletin sent on November 1, 2022.