Simplify HIPAA Compliance with Mirra’s EDPS Solution

For the past few years, regulatory scrutiny has intensified in the healthcare sector to prevent data security breaches. With the increased use of technology in healthcare data management, HIPAA compliance has become a critical challenge that demands precision and diligence. That's where an efficient EDPS system can be a savior for health plans. Mirra's encounter data processing system simplifies HIPAA compliance process and enhances operational efficiency for health plans with advanced features.

In this blog post, we will share the features of Mirra's EDPS solution and why leading health plans choose Mirra to safeguard their data and optimize compliance efforts. Read on for more.

Understanding HIPAA Compliance

The Health Insurance Portability and Accountability Act (HIPAA) was enacted in 1996 to set national standards for protecting individuals' health information, known as Protected Health Information (PHI). It comprises of the following key rules:

• Privacy Rule: Sets standards for the use and disclosure of PHI.
• Security Rule: Mandates security rules for electronic PHI (ePHI).
• HIPAA Omnibus Rule: Expands upon previous rules to enhance privacy protections and extend responsibilities to business associates and subcontractors.

Compliance with HIPAA is a mandatory legal obligation for all healthcare businesses. Non-compliance will lead to penalties, including monetary fines, civil lawsuits, and even criminal charges. Financial penalties can go up to $250,000, depending on the severity of the violation.

Understanding EDPS and its Role in HIPAA Compliance

An EDPS is a specialized software solution designed to streamline the processing, submission, and reconciliation of encounter data within healthcare plans. It integrates with existing systems to manage the complexities of encounter data and ensure accuracy, compliance, and efficiency throughout the process.

For healthcare plans, especially those managing Medicare Advantage programs, an effective EDPS is essential for operational efficiency and for meeting regulatory requirements such as HIPAA. 

Read More: How Can Encounter Data Processing Revolutionize Medicare Advantage

How Mirra’s EDPS Solution Ensures HIPAA Compliance

1. Data Encryption and Security 

The core requirement for HIPAA compliance in this digital age is safeguarding electronic Protected Health Information (ePHI). 

Mirra’s encounter data management solutions incorporate robust encryption standards (e.g., AES-256) to secure data both at rest and in transit. Encryption ensures that unauthorized parties cannot access sensitive patient information, mitigating the risk of data breaches and ensuring compliance with HIPAA security rules.

2. Access Controls and Audit Trails

HIPAA mandates stringent access controls to limit who can access ePHI and under what circumstances.

Mirra’s encounter data processing system offers real-time audit trails and granular access controls. These audit trails not only identify unauthorized access but also ensure accountability and transparency in compliance audits.

3. Compliance Monitoring and Reporting

Effective HIPAA compliance requires continuous monitoring of systems and processes to detect and address potential vulnerabilities.

Mirra’s EDPS solutions include built-in compliance monitoring tools that regularly assess adherence to HIPAA standards. Automated reporting features generate detailed compliance reports, which are crucial for demonstrating compliance during audits and investigations by regulatory bodies.

4. Data Integrity and Accuracy 

Accurate and complete encounter data is essential for compliance with HIPAA regulations, particularly in the context of reimbursement and quality reporting.

Mirra’s industry-leading encounter data processing system employs validation rules and data integrity checks. These features ensure that encounter data is error-free and compliant with regulatory requirements.

By detecting and correcting errors proactively, Mirra’s EDPS solution minimizes the risk of compliance violations and facilitates timely and accurate submission of encounter data to CMS (Centers for Medicare & Medicaid Services).

5. Breach Detection and Response 

HIPAA requires covered healthcare entities to detect and respond to ePHI breaches immediately.

Mirra’s EDPS solution integrates advanced breach detection mechanisms that monitor unauthorized access or anomalies in data access patterns. In the event of a breach, EDPS solutions facilitate rapid incident response, including notification of affected individuals and regulatory authorities, as mandated by the HIPAA Breach Notification Rule.

Additional Benefits of Mirra's EDPS Solution

Mirra's encounter data processing system is designed not just to meet compliance requirements but to simplify and enhance the overall encounter data processing experience for health plans. Some of the most crucial features are as follows:

• File Splitting: Split customer input files into multiple 837 files based on CMS regulations.
• Real-Time Tracking: A real-time file status tracking system with batch scheduling helps keep track of submissions and responses.
• Unique Identifiers: Generate unique submission file IDs, encounter IDs, and file IDs for each received file, ensuring precise tracking and management.
• Automated CMS Response Processing: Automate the receiving and processing of CMS responses such as TA1, 999, 277CA, MAO002, and report file MAO004 to streamline operations.
• Customizable Dashboard and Reporting: Feature: Get actionable insights and visibility into compliance status to ensure proactive management and decision-making.
• User Management: An admin portal allows for efficient user, plan ID, and submitter ID management, ensuring controlled access and security.
• Historical Data Management: Load and store historical data to avoid duplicate file submissions and transaction set submissions, ensuring data accuracy and completeness.

Case Study: How Mirra's EDPS Solution Transformed Compliance for Health Plans

There is a potential Healthplan of membership close to 5000+. With their previous TPA they had an acceptance % of 92-95. But after Mirra took over we made the complaint encounters and currently we are at an acceptance % of 97-98

The Bottom Line

An efficient encounter data processing system is indispensable for healthcare plans to maintain HIPAA compliance while optimizing operational efficiency. Mirra's EDPS solution is a part of its Medicare Advantage in a Box solution. It is designed in a way that it not only meets the stringent requirements of HIPAA but also enhances data security, streamlines administrative processes, and provides actionable insights through advanced analytics and reporting. Partner with Mirra today to effectively maintain regulatory standards, safeguard patient information, and focus on delivering high-quality care in a secure environment. Visit our website or contact us to schedule a no-obligation demo today!