1. Managing 5010 Migration: Roundtable Discussion HIPAA COW Spring Conference April 8, 2011

2. Ann Hollis, UW Hospital and Clinics Steve Cole, Epic Bob Mielke, Group Health Cooperative of South Central Wisconsin

3. UW’s EDI Volumes Average daily claims volume is 4700 claims 97% of claims electronic Direct connections with 20 payers constituting 90% of outbound claims; 7% of claims through a clearing house 87% of our payments come in on an 835 We receive the 835 from 18 different payers; only 9 send the funds via EFT. New development – Credit card payments (yuck!) 13 of our trading partners can exchange the 270/271 11 of our trading partners can exchange the 276/277 Have created web-bots to create inbound 271 from payers who cannot/do not provide one

4. Issues with 4010 7 years post implementation, we still have trading partners that cannot take an 837 or send an 835 (!!!!!) After implementing 837 & 835, many payers simply stopped further EDI deployment... until recently. Preferred payer solution seemed to be offering web sites, hence our creation of web-bots. There is no efficiency of automation in a web site. Lack of enforcement for compliance. Of all of the 835’s we get, only one payer is completely HIPAA compliant. Providers cannot reject a non-compliant file because we are rejecting our money. However, if we were to send a non-compliant 837, several of our trading partners would reject it. 835 group codes and COB – causing a number of issues.

5. Testing plans Have created post errata compliant 837 files and have sent out to 2 payers, awaiting their response. We use HIPAA validation software to check all files before sending to trading partners.

6. Why are we looking forward to 5010 The operating rules hold promise of better compliance among trading partners. Looking for greatly improved responses in the 271, more players, more information. 5010 looming over our heads seems to have sparked renewed activity among our trading partners in the 270/271 and 276/277 277CA – we are hoping this will solve some of our untimely filing denials.

7. 5010 Planning - Epic Code complete by 2/28 (including errata) Documentation on build steps Registration Interface Host monthly update calls Questions/comments/concerns Education

8. 5010 Planning - Customers Kickoff call with Customer/Clearinghouse(s)/Epic Environment strategy 5010 - testing 4010 – support Complete build Coordinate testing (Eligibility & Claims) Devote time/resources

9. Questions for 3 rd Party System Connectivity New ports? EDI conversion 4010 -> 5010 step-up? 5010 -> 4010 step-down? Timeline Is 3 rd party system ready? When will each payor be ready?

10. Group Health Cooperative of South Central WI Formed a Steering committee to oversee both ICD10 and 5010 conversions Hired a consultant firm to do an assessment and give us a “roadmap” for the project. Worked with our system Vendor (Epic) closely for timelines on their 5010 readiness. Training

11. Group Health Cooperative of South Central WI Identified all file exchanges both in and out. Purchased the new 5010 ANSI Standards Guides and errata. Selected and purchased a Mapping/validation tool to help with internal testing plus to make sure we had a method to handle both 4010 and 5010 during the transition period. Internal system testing for “proof of concept” Testing with business partners and Clearing houses.

12. The HIPAA COW EDI Workgroup has its calls on the second and fourth Tuesday of each month from 2pm to 3pm CST. If you are not on the workgroup email list, please sign up at the back of the room so that you can receive the meeting invites. THANK YOU!