TCS Compliance Plan Template

Document Sample
TCS Compliance Plan Template Powered By Docstoc
					CA Department of Alcohol and Drug Programs                                              EXHIBIT
HIPAA Compliance Project



                        DMC Compliance Plan Template

Your responses are not limited to the space provided. Please feel free to use additional pages as
necessary.

Organization
County Name: ____________________________________
     or
Provider Name: ___________________________________

Contacts
Please include the primary points-of-contact within your organization who are
working with ADP on HIPAA compliance for Drug Medi-Cal (DMC) claims. Be
sure to identify the one person in your contact list who will be considered the
Single-Point-of-Contact (SPOC) for ADP.
SPOC Name:                       Role/Title:                      Phone:
Organizational Unit:                                              Fax:
                                                                  e-Mail:
Name:                            Role/Title:                      Phone:
Organizational Unit:                                              Fax:
                                                                  e-Mail:
Name:                            Role/Title:                      Phone:
Organizational Unit:                                              Fax:
                                                                  e-Mail:

Approach
Please identify the 837P transaction compliance approach that your organization
is planning to use. Provide us with comments, as necessary, to further describe
your planned compliance approach. If you plan to have more than one solution
type, indicate this by using multiple tables, or specifying in the comments.
                                     Vendor Name
Solution Source                       (if applicable)
                                                                               Comments
Internally developed
Vendor provided
Clearinghouse
Other (specify)

Please also identify the providers who will use this solution for DMC billing.
                                                            Expected Production
         Name                       Provider ID
                                                                    Date




                                          Page 1 of 2
CA Department of Alcohol and Drug Programs                                             EXHIBIT
HIPAA Compliance Project




Constraints
Please describe the barriers you currently face, or that you anticipate facing, as
you work towards achieving compliance. What is the impact of this constraint
and what steps will you take to remove these barriers?
                                                                   Steps to Remove
        Description                      Impact
                                                                       Barriers




Assumptions
Please describe the assumptions you are making as you prepare for achieving
compliance. If your assumptions prove to be invalid, what will be the impact and
how will that change your plans?

        Description                      Impact                       Backup Plan
                                (if assumption proves invalid)   (if assumption proves invalid)




Schedule
Please identify the schedule of key activities and milestones for achieving
compliance. Installation/Production refers to the anticipated date to begin
sending HIPAA-compliant 837P transactions.
         Activity or                       Start                       Completion
         Milestone                         Date                           Date
Procurement (if applicable)

Design and Development
Testing (with ADP) and
Certification
Installation/Production                                                      N/A


If you have any questions regarding the completion of this Compliance Plan,
please contact cphoenix@adp.ca.gov.




                                        Page 2 of 2

				
DOCUMENT INFO
Shared By:
Categories:
Tags:
Stats:
views:15
posted:10/1/2012
language:English
pages:2