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Under the Affordable Care Act (ACA) Medi-Cal billers are required to include the NPI ID of Ordering, Referring, and Prescribing (ORP) providers when submitting a bill to Medi-Cal. Sabot has been contracted to manage a portfolio of ORP related projects with the objective of ensuring that Medi-Cal is compliant with ACA ORP legislation without negatively impacting beneficiaries access to care. Sabot will be responsible for working with DHCS programs to define the business rules and requirements to implement ORP, taking care to account for California statutes and legislation and access to care exceptions. Sabot has also been tasked with developing and executing a comprehensive transition strategy to enroll providers that generate orders, referrals, or prescriptions for Medi-Cal beneficiaries.

The CA Department of Health Care Services has embarked on a project to implement a new system to manage provider enrollment for the Medicaid system. The PAVE system will significantly reduce enrollment submission errors by providing real-time feedback on the application requirements and progress, which will significantly reduce the amount of time needed to complete an enrollment. Sabot’s testing coordinator is responsible for planning, defining, and executing user acceptance testing and monitoring vendor testing of PAVE. This role will facilitate the technical level interaction between the PAVE system and the rest of MMIS, as well as, verify that the PAVE system satisfies the architectural concepts set forth by the Department.

Missouri Employers Mutual (MEM) has re-engaged Sabot to assist with further operationalizing its Enterprise Architecture (EA) program. Sabot’s engagement includes refining MEM’s corporate, technology, and architecture governance processes, as well as, developing a roadmap to further governance and EA maturity in support of several key upcoming initiatives.

California Department of Health Care Services, Office of HIPAA Compliance, selects Sabot Consulting to provide functional architecture and project management services to assist State staff in the management of the Capitation Payment Management System (CAPMAN) upgrade effort. The CAPMAN 820/834 system supports federal regulations that require the State to maintain member benefit enrollment and accounting for all capitated payments made to managed health care plans. California has over 9 million Medi-Cal beneficiaries enrolled in 148 managed care plans, with annual payments approaching $30 billion, all managed in CAPMAN.