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

Slides:

Advertisements

Similar presentations

1 Capital BlueCross ICD-10 Toolkit. 2 Introduction Capital BlueCross and ICD-10 Capital BlueCross is dedicated to assisting providers transition to ICD-10.

Advertisements

1 Professional Provider Back to Basics Seminar CareFirst BlueCross BlueShield Updates AAHAM Third Party Payer Meeting March 15, /15/2013.

ADSoyerDO AAOS Practice Management Committee AAOS San Francisco February 10, 2012.

Lessons Learned from the 5010 Conversion to take into ICD-10

Ami Layman Assistant Director of Administration Getting Started & Funding Fundamentals.

Provider Perspective: Anticipated Benefits; Concerns; Alternative Approaches; Timeline and Budgeting for Implementation Jim Whicker, CPAM Intermountain.

Segment Five: Provider Communication Idaho ICD-10 Site Visit Training segments to assist the State of Idaho with the ICD-10 Implementation January 26-27,

SHELLY GUFFEY MAKING THE MOST OF YOUR REVENUE CYCLE MANAGEMENT TECHNOLOGY

Mayo Clinic/WPS Electronic Claim Attachment Project Presented at HIPAA COW Spring Conference Laurie Darst – Mayo Clinic Laurie Burckhardt - WPS April 4,

1 healthcare IT solutions Copyright Phoenix Health Systems, Inc All rights reserved. Countdown to Compliance For HIPAA Results of the Winter 2004.

RHODY HEALTH OPTIONS (RHO) IMPLEMENTATION

Electronic Data Interchange

ECommerce Project. The Team Project Sponsors: –Shelagh Holm, Director of Administrative Information Systems –Ron Ritter, Assoc Director and Treasurer,

Precision Practice Management, LLC the medical billing experts. 1 Successful Physician Practices.

Electronic Data Interchange Assessment Strategies Application Systems Trading Partners Business Associates Application Vendors The Standards Application.

Frequently Asked Questions. No, in fact DOCTUS considers itself a strategic extension of your organization. Hence, we deliver the work the way you do.

©2009 HP Confidential TUNGSTEN NETWORK AND PAPER INVOICING.

ICD-10 IMPLEMENTATION – ARE YOU WHERE YOU NEED TO BE? Maureen Doherty, CPC, CPC-H EisnerAmper Healthcare Services Group June 2012.

Washington Health Benefit Exchange S CENARIOS : SHOP E NROLLMENTS February 14, :00-3:00 PM.

ANSI 5010 Deidre Lawson Fryfogle- Product Manager.

0 Presentation to: Medical Associations and Societies - Group Meeting Presented by: Department of Community Health (DCH) Medicaid Division June 12, 2013.

Presented by Joan Kossow Data Compliance Manager The Changing Face of Claims Processing &

Case Study of a Large Provider System’s NPI Project Implementation Suzanne Stewart, EDI Coordinator Aurora Health Care Milwaukee, WI.

Strategies for Purchasing and Support Activities

Medicare Fee For Service (FFS) 5010 Troubleshooting with your contractor.

HIPAA Revisions! Section 1104 THE PATIENT PROTECTION AND AFFORDABLE CARE ACT February 17, Nachimson Advisors, LLC.

Medicare Fee For Service (FFS) 5010 Late Push For Late Implementers.

Community Health Improvement in Action (CHIA). CHIA Overview What is the CHIA project? What distinguishes funded partners from other participants? What.

© 2015 TriZetto Corporation ICD-10: Ready, Set, Go! August 27, 2015.

Health Insurance Portability and Accountability Act (HIPAA)

Preparing an ASCA Compliance Plan. Then what? HIPAA Summit IV Washington DC, April 25, 2002 Kepa Zubeldia, M.D.

Bee Wise Immunize Governor’s Child Health Advisory Committee Immunization Workgroup Topeka, KS April 29, 2011 Sue Bowden, RN, BS Director, KDHE Immunization.

1 What’s Next for Financial Management Line of Business (FMLoB)? AGA/GWSCPA 6 th Annual Conference Dianne Copeland, Director, FSIO May 8, 2007.

Inbound Supplier Freight Costs $1.5B Industry Cost Cost Reduction Opportunity $500M Savings No Barrier to Entry Easy to Implement No Cost or Fees.

Utah Health Information Network A Community-Based HIPAA Implementation Jan Root, Ph.D. Standards Manager UHIN uhin.

Medicare Fee For Service (FFS) EDI ACT (October 10, 2013) Leader’s Line: Conference ID:

CAHABA MAC Conversion MAY-09 Kathy Whitmire Dale Gibson Preparing for the Transition from an FI/Carrier to a Medicare Administrative Contractor (MAC)

Types of transactions. What is it? An electronic payment is any kind of non-cash payment that doesn't involve a paper check. Methods include credit cars,

Segment 6: Provider Communication California ICD-10 Site Visit Training segments to assist the State of California with the ICD-10 Implementation June.

Standard Unique Health Identifier for Health Care Providers April 9, th Annual HIPAA Summit Gail Kocher Highmark.

National HIPAA Audioconference: Analysis of the National Provider Identifier Preparing for the NPI Transition January 11, 2006.

Testing for Successful Deployment: Roundtable Discussion HIPAA COW Spring Conference April 8, 2011.

- Revenue CycleRevenue Cycle Improvement “From customer contact to cash in the bank” HIPAA Transaction Implementation Eligibility Case Study 270/ X092A1.

“Medical Identity Theft” February 9th 2016

Systems, Data and HIPAA from a Medicaid Perspective Rick Friedman, Director Division of State Systems Center for Medicare and Medicaid US Dept Health &

Electronic Data Interchange

ICD-10 Operational and Revenue Cycle Impacts Wendy Haas, MBA, RN Dell Services Healthcare Consulting.

Confidential | Copyright © 2014 TriZetto Corporation 1.

HIPAA Yesterday, Today and Tomorrow? Dianne S. Faup Office of HIPAA Standards Centers for Medicare & Medicaid Services.

Provider Perspective on Medicare’s COB Edits By George Arges.

©2010 RealMed Corporation. RealMed Overview National Committee on Vital and Health Statistics Subcommittee on Standards Sean Kilpatrick, Director of Product.

Traveling into the Future with the 5010 Implementation Timeline HIPAA COW Spring 2009 Conference Presented by Laurie Burckhardt, WPS EDI Manager.

Businessolver Implementation & Customer Service Plan

NCI CBIIT LIMS ISIG Meeting– July 2007 NCI CBIIT LIMS Consortium Interface SIG Mission: focus on an overall goal of providing a library of interfaces/adapters.

Implementing HIPAA Centers for Medicare & Medicaid Services Fourth National HIPAA Summit April 25, 2002 Jared A. Adair Director Office of Operations Management.

TUNGSTEN NETWORK AND PAPER INVOICING

Food Suppliers Implementation of EDI &PAV March 2010

Sales & Marketing Funnels

LAKELAND CARE PAYER CONFERENCE OCTOBER 18, 2017

2012 Business Guidelines for Association Membership

Paper vs. E-Invoicing November, 2015

Countdown to Compliance

HIPAA Transactions and Code Sets Implementation June 6, 2003

The Centers for Medicare & Medicaid Services

Are Stakeholders Prepared? Results from the WEDI Survey Conducted in

The Centers for Medicare & Medicaid Services

Company Overview.

The Importance of April 16, 2003: Where You Should be in HIPAA Data Code Sets/Transactions Testing and Compliance Presented by: Steven S. Lazarus, PhD,

Paper vs. E-Invoicing November, 2015

EDI Systems What They Are and Why They Matter

Presentation transcript:

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

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

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/ 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

Issues with 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.

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.

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 looming over our heads seems to have sparked renewed activity among our trading partners in the 270/271 and 276/ CA – we are hoping this will solve some of our untimely filing denials.

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

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

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

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

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.

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 list, please sign up at the back of the room so that you can receive the meeting invites. THANK YOU!