Case Study

Prison Industry Authority (PIA)

COMPANY PROFILE
Prison Industry Authority (PIA) was created by Chapter 1549, Statutes of 1982 as a semiautonomous state agency to operate California's prison industries in a manner similar to the private industry. PIA provides work assignments for approximately 6,000 inmates and operates over 60 service, manufacturing, and agricultural industries at 22 prisons. These industries produce a variety of goods and services including: flags, coffee, shoes, printing services, signs, binders, eye wear, gloves, office furniture, license plates, clothing, cell equipment, and much more. PIA’s products and services are available to government entities, including Federal, State, and local governmental agencies.

THE CHALLENGE
About 3,400 dispensing optical providers statewide submit hand-written prescriptions on three-part forms and mail them with eyeglass frames to one of the four labs. After extensive screening for PHI the prescriptions along with the frames is transferred to the Lab. Once manufactured the eyeglasses are shipped to the provider and billed to Medi-Cal. Due to the manual nature of the process and associated issues many of the orders resulted in cancellation, redo, non payment due to ineligibility and calls to provider for verifying the RX , reducing the productivity and delays in the order completion.

THE SOLUTION
R Systems designed, developed and implemented an on-line solution with the following functionality:

• Provider Registration
• Medi-Cal eligibility verification and prescription ordering and monitoring
• Interface with lab system for eyeglass manufacturing using XML files
• Interface with third party Medi-Cal billing agency using XML web services
• Monitor and manage progress and status of RX
• Creation of packing slips and integration with Courier Services for package tracking
• HIPAA complying Audit trail

THE RESULT
The new system provides PIA staff and the Medi-CAL provider community with a tool that automates optical prescription ordering and billing. This has resulted in:

• Reduced total time for prescription completion and billing
• Reduced PIA's operating costs for staff overhead by reducing the manual prescription processing and reviewing tasks
• Reduced PIA's costs for denied claims research, keying of PHI, and data reports by using improved process and verifying Medi-Cal eligibility on real-time
• Reduced the number of cancelled RXs by employing on-line validation edits
• Eliminated paper movement by using workflow processes significantly reduced or eliminated PIA's risk of PHI inadvertently being seen by inmates or other unauthorized personnel by using electronic interfaces and de-identifying PHI.