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Public Health Lab Billing System Health & Social Services Dept, Public Health Laboratory Business Requirements Document
| Document Overview |
| Project Overview |
Project Id
Procure a modern, secure laboratory billing SaaS solution to replace the outdated LabBilSys, by BATTechnologies, addressing security vulnerabilities and complying with the 2023 Solano County Grandy Jury’s regulatory requirements.
| Prepared By |
| Gina Downing, BSA |
| Project Sponsor |
| Bela Matyas, PH Officer |
| Created On |
| August 1, 2024 |
Last Updated On
Document Scope This document captures both business and functional requirements for above mentioned project. Please refer to “Table of Content” for details.
Table of Contents
| Document Scope | 1 | |
| Table of Contents | 2 | |
| Terms and Acronyms | 3 | |
| Related Documents | 3 | |
| Revision History | 3 | |
| Background | 3 | |
| Open Issues | 3 | |
| Solution Stakeholders | 4 | |
| Budget / Funding Source | 5 | |
| Business Objectives | 5 | |
| Regulatory and Mandated Requirements | 5 | |
| In Scope | 5 | |
| Out of Scope | 5 | |
| Project Requirements | 6 | |
| 1) | Functional Requirements | 6 |
| 2) | Non-Functional Requirements | 7 |
| Data Migration | 7 | |
| Data Flow Diagram As-Is LabBilSys | 8 | |
| As-Is Business Diagram | 9 | |
Terms and Acronyms
| # |
| Term / Acronyms |
| Description |
| 1 |
| BRD |
| Business Requirements Document |
| 2 |
| LIMS |
| Laboratory Information Management System |
| 3 |
| LabBilSys |
| PH Labs current lab billing system |
| 5 |
| PHP |
| Partnership Health Plan |
Related Documents List of attachments and links to documents/information that might be useful to someone trying to understand the requirements.
1) Customer Automated Improvement Request Document
2) Final Grand Jury Report PH Lab
3) Health & Social Services Department Public Health Lab Response Letter to the Grandy Jury Public Health Laboratory Systems Review Report
4) Partnership Healthplan’s Top 19 Clearinghouse Updated Revision History
| Version |
| Date |
| Author |
| Summary of Changes |
| 1.0 |
| 8/1/24 |
| Gina Downing |
| Initial Draft |
Background The Solano County Public Health Laboratory has been utilizing the antiquated on-premise billing software, LabBilSys by BAT Technologies, to process billing. The “Mom and Pop” vendor has provided PH Lab billing support for decades but has failed to update the system architecture to meet modern technology and security standards. This vulnerability poses significant risks, including unauthorized access to sensitive data and potential breaches. Subsequently, in 2023, a Grand Jury report highlighted these security deficiencies and issued a directive to replace the outdated system and included the requirement of accepting credit card payments via electronic funds transfer (EFT). Furthermore, the report outlines a completion date for finalizing the acquisition of the upgrade no later than June 20, 2025.
Open Issues List of key open questions or issues to be resolved before these requirements can be considered complete.
| Id |
| Open Question/Issue |
| Status Notes |
| 1 |
| Partnership Health Plan (PHP) electronic billing requirements to include understanding the use of a clearing house for billing submission. |
| 2 |
| What to do with LabBilSys historical data |
| Pending response from PHL |
Solution Stakeholders
| HSS |
| Dr. Bela Matyas, Health Officer |
As the Public Health Officer, Dr. Matyas has a high interest in staff procuring a new, secure and compliant lab billing system.
| HSS |
| Beatrix Kapusinszky, PH Lab Director |
| As the Public Health Laboratory Director, Beatrix has a high interest in Department procuring a new, secure and compliant lab billing system. |
| HSS |
| Kristy Thompson, Accounting Clerk, II |
| Subject Matter Expert |
| HSS |
| Madeline Peligrino, Office Assistant, III |
| Subject Matter Expert |
| Department of Information Technology |
| Jaime Fontelera, Security Officer |
| Security oversight |
| Department of Information Technology |
| Laura San Nicolas, Data Services Manager |
| System and Data oversight |
| Health & Social Services Dept (HSS), Compliance |
| Lavona |
Hamilton Privacy, security and compliance oversight
Budget / Funding Source
· Budget - 7807
· Funding Source - Realignment
Business Objectives Replace the current LabBilSys application with a secure and modern application:
· Enhance data privacy and security decreasing the risk of malware and/or data breach
· Enhance operational efficiency for the Public Health Lab staff by acquiring a full-cycle revenue billing system
· Meet CLIA compliance regulations
· Provide advance data reporting and analytics
· Increase transparency and accountability with tools that offer clear audit reports and reporting capabilities
· Research, evaluate and procure a SaaS lab billing system solution that meets the requirements of the Solano County Public Health Laboratory
Regulatory and Mandated Requirements
· Clinical Laboratory Improvement Amendments (CLIA).
· Any laboratory that performs tests on human specimens for the purpose of diagnosis, prevention or treatment must be CLIA certified.
· Health Insurance Portability and Accountabiilty Act (HIPAA)
· US law designed to protect patients’ privacy and secure their medical information.
In Scope
· Research and evaluate full cycle revenue lab billing systems
· Assess system functionality and capabilities that meet government regulations and user requirements, including the integration with the existing Orchard Harvest Lab Information Management System (LIMS) Out of Scope
· Non-related PH Lab or Orchard LIMS training
· Integration with external Healthcare or Government Systems
· Hardware procurement such as servers
· Sample collection and tracking including logistics and sample tracking or maintaining chain of custody
Project Requirements This section provides details of Project requirements. It is assumed any items not noted in this section are not part of this project and will be considered future enhancements.
1) Functional Requirements
| ID |
| Requirement Description |
| Requested By |
| Priority |
| 1 |
| The system must be compatible and integrated with the Orchard Harvest Lab Information Management System (LIMS) |
| 1.2 |
| The system must support integration with and utilize standard Current Procedural Terminology (CPT) coding |
| 1.3 |
| The System must be capable of sending ANSI X12 837 Professional or Institutional file format (5010 version) electronic claim files to the insurance carrier Partnership Healthplan (PHP) |
| 1.4 |
| The System must be capable of utilizing one of Partnership Healthplan’s qualified clearinghouses for electronic claims submissions |
| 1.5 |
| The system must be capable of sending and receiving HL7 (Health Level Seven) formatted billing containing data such as patient demographics, insurance details, billing codes, and claim information |
| PHL |
| Mandatory |
| 1.6 |
| The system must be capable of generating customer billing statements electronically, allowing lab staff to easily print in either Word or PDF format. |
| PHL |
| Mandatory |
| 1.7 |
| The system must be capable of receiving and processing electronic remittance files from the PHP insurance carrier |
| PHL |
| Mandatory |
| 1.8 |
| The system must support multiple pricing models, including standard charges, negotiated rates and insurance-specific rates |
| PHL |
| Mandatory |
| 1.9 |
| The system must provide functionality for authorized users to update the fee schedule for procedure codes and adjust costs as needed. |
| PHL |
| Mandatory |
| 1.9.1 |
| The system must be capable of integrating with the County’s standard JP Morgan payment processing vendor for processing credit cards |
| Grand Jury |
| Mandatory |
| 1.9.2 |
| The system should allow for generating EFT payment reports for credit card transactions. |
| Grand Jury |
| Mandatory |
| 1.9.3 |
| The solution must be able to produce a readable electronic report for tracking and processing claim denials |
| PHL |
| Mandatory |
| 1.9.4 |
| The system should allow for generating EFT payment reports for credit card transactions. |
| Grand Jury |
| Mandatory |
| 1.9.5 |
| The solution must be able to produce a readable electronic report for tracking and processing claim denials |
| PHL |
| Mandatory |
2) Non-Functional Requirements
| ID |
| Requirement Description |
| Requested By |
| Priority |
| 2.1 |
| The solution must comply with the Health Insurance Portability and Accountability (HIPAA) Act to ensure patient privacy and data security. |
| 2.2 |
| The solution must be in compliance with any Clinical Laboratory Improvement Amendments (CLIA) |
· Accurate Coding and Billing – ensure all tests are billed using correct Current Procedural Terminology (CPT) codes and ICD-10 diagnosis codes.
| 2.3 |
| The solution must support integration with access identity management solutions that comply with Security Assertion Markup Language (SAML) 2.0 or OpenID Connect (ODIC) standards. |
| IT |
| Mandatory |
| 2.4 |
| The solution must be capable of multifactor authentication (MFA) |
| IT |
| Mandatory |
| 2.5 |
| The solution must have robust user access control system with role-based access permissions (RBAC) |
| IT |
| Mandatory |
| 2.6 |
| The solution must provide a seamless and efficient integration with Power BI to enable real-time reporting and the dashboards. |
| PHL |
| Mandatory |
| 2.7 |
| The solution must support an intuitive and user-friendly interface to ensure ease of use with a minimal learning curve and training. |
| PHL |
| Mandatory |
| 2.8 |
| The solution must support full cycle revenue billing for laboratory services ensuring efficient processing, tracking and reporting of financial transactions. |
| PHL |
| Mandatory |
Data Migration The LabBilSys billing data will be migrated to an on-prem SQL database server for historical reference by the PH Lab staff with a retention of six (6) years.
Data Flow Diagram As-Is LabBilSys
As-Is Business Diagram
I have reviewed the information and requirements outlined in the BRD and approve.
Beatrix Kapusinszky, PH Lab Director Requestor Name and Signature:
Bela Matyas, Public Health Officer Sponsor Name and Signature:
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