The General Medical Services (Payments) Board (GMS) is an agency established under the auspices of the Irish Government Department of Health. The Board is responsible for calculating, approving and issuing payments to primary care providers for services delivered to citizens on behalf of all the area Health Boards in Ireland. The Board also compiles statistics and other information in relation to such services. In the year 2001 the Board issued payments to the value of €952m representing almost all payments for services provided in the community by General Practitioners, Community Pharmacies, Dentists and Optometrists/Ophthalmologists under the various schemes operated by GMS.
All persons who are resident in the State have eligibility for Health Services. The degree of eligibility varies by individual, based on qualifying criteria. The result is that Primary Care is delivered to qualifying residents at reduced or zero charge, and GMS in turn reimburses the health professionals responsible for delivering the services. This results in hundreds of thousands of individual claims that have to be approved annually, and at least half of the population use at least one of the services in any year.
To support the accurate and timely processing of the claims under the various schemes and to in order to increase the Board’s capability to process claims electronically, GMS identified the need for a central index of all potential claimants and an enhanced infrastructure to support electronic processing.. The project to design and implement the Central Client Eligibility Index (CCEI) and associated infrastructure was awarded to Compaq.
The project supports the key aim of GMS to remove paper and manual processes from the Board’s business operations while improving access to the Board’s IT systems for their clients – 5,000 Primary Care professionals and 10 Area Health Boards.
The initial phase of the project focussed on the creation of the CCEI and its integration with existing claim processing systems at GMS. This part of the solution has been implemented on HP Alpha Tru64 Unix platform utilising an Oracle database and is based on e*Index and e*Gate software from SeeBeyond.
E*Index, which is widely used in the health sector, is a sophisticated search engine that allows client searching not only on name and address but also on various identifiers that a Client might have e.g. Social Security Number, Hospital Reference number, etc. Clients are cross-indexed between applications using real-time matching algorithms and enabling consistent Client management. The Index is accessible from any application using standard open interfaces.
e*Gate is a market leading Interface/Integration engine which provides reliable connectivity to all interface systems that supply data to the CCEI. It offers an open architecture with proven scalability and ease of management. The CCEI currently holds almost 2.5 million individual records.
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