Florida Collaborative:

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Presentation transcript:

Florida Collaborative: Focusing on Administrative Simplification Sharon Paquin & George Vancore Florida Blue November 3, 2017

Florida Collaborative 2017 Focus Administrative, Financial and Clinical tools are either being enhanced, developed or deployed working with our providers, EMR vendors, Availity®1 and Florida Blue Here are some examples of the work for this year… 1 Availity, L.L.C. is a multi-payer joint venture company. For more information or to register, visit Availity’s website at www.availity.com

Florida Collaborative Administrative Provider Data Management CMS Quarterly Validation of Data Provider Data Maintenance Request to Join the Florida Blue Networks Request for Participation in Network Advance Claim Edits Electronic Appeals (PASSPORT) Training needed: AlexSanJuan@floridablue.com

Florida Collaborative Financial Florida Blue Payer Spaces Quality Efficiency Reports (QERP) New Claims Status (replacing CRT) Overpayment Recovery Automation (pilot) Claims Medical Records Attachment (controlled deployment)

Florida Collaborative Care E&B Care Reminders – all members E Census – PCP - BlueMedicare HMO & myBlue Comprehensive Quality & Risk Health Assessment Forms (closing coding gaps) Quality Clinical Attestation Forms (closing care gaps -HEDIS)

Clinical Information Exchange (CIE) Florida Blue and Availity connected to the State Health Information Exchange (HIE) this year. This provides over 200 hospitals admit and discharge data in real time daily. On-going hospital connections; to date the following hospitals are in production: UF Shands, Martin Memorial, Tampa General, HCA Memorial Jacksonville Lakeland Regional, ORL Health, Baycare, St. Vincent's. Testing and work in progress with HCA Trinity (Tampa), Adventist Systems. Consolidated Clinical Document Architecture (CCDA) continued work to connect with providers for clinical documentation. Pilot with GE with 3 provider sites in FL. Tampa General in discussions on sharing clinical data for authorizations that pend.

Clinical Information Exchange Some Helpful Resources Helpful Websites: www.cms.gov www.hl7.org www.healthit.gov www.availity.com www.connectinghealthcare.com CIE Open-Line Friday: Clinical Information Exchange Edition What: An Interactive Information Exchange Session for Florida Blue’s CIE Users Group and Other Interested Parties When: 3rd Friday of every month from 9:30am to 10:30am EST Dial Toll-Free: (800) 882-3610 or (412) 380-2000 Conference Passcode: 6829655#

Florida Collaborative 2018 Focus Transition to Availity Provider Data Management (PDM) New Claim Status on-going Enhancements Over Payment Recovery Tool Deployment Continue Advance Claims Edits at Availity Gateway Possible Chat feature added to some Self-Service Tools Improving Clinical Data Exchange Between Providers and Florida Blue

Florida Collaborative sharon.paquin@floridablue.com (904-905-5728) george.vancore@floridablue.com (904-905-0176)