Organizations submit claims to either FNS or C&F Regional Claims Center Organizations submit claims to either FNS or C&F Regional Claims Center C&F current goal is to reduce the input at the Claims Center C&F current goal is to reduce the input at the Claims Center All required data elements are not captured during initial contact All required data elements are not captured during initial contact

After receiving submissions, FNS constructs: Standard ANSI X.12 EDI Transaction set Standard ANSI X.12 EDI Transaction set 148 Report of Injury (version 3050) 148 Report of Injury (version 3050) These files are then sent to the Gentran EDI server at E-SYNC (Wiltek)

Gentran server translates the EDI file to a flat file that is processed and loaded into a SQL database, NOL Gentran server translates the EDI file to a flat file that is processed and loaded into a SQL database, NOL Claims that are submitted to the claims center are either input into NOL or may be sent to FNS for processing Claims that are submitted to the claims center are either input into NOL or may be sent to FNS for processing NOL does not contain all of the required data elements for state reporting nor is it a transactional database NOL does not contain all of the required data elements for state reporting nor is it a transactional database

Vendors submit information to MMP; MMP is utilized for SROI Vendors submit information to MMP; MMP is utilized for SROI Users cannot access MMP for FROI/SROI, because it is an online application Users cannot access MMP for FROI/SROI, because it is an online application Data elements required to produce a complete SROI, and elements from HCFA 1500 and UB 92 requirements, are missing from MMP Data elements required to produce a complete SROI, and elements from HCFA 1500 and UB 92 requirements, are missing from MMP ACS has the wrong injury codes required for state reporting ACS has the wrong injury codes required for state reporting MMP and ACS are not transactional databases MMP and ACS are not transactional databases

Claim centers manually key information from paper claim files into Celerity Claim centers manually key information from paper claim files into Celerity Certain Information that is keyed into Celerity is never placed into the NOL/ACS systems Certain Information that is keyed into Celerity is never placed into the NOL/ACS systems Celerity server: Celerity server: – submits reports to states – receives acknowledgements and rejections SROI is now paper based SROI is now paper based No Current business process to deal with rejections No Current business process to deal with rejections

Non-transactional architectureNon-transactional architecture Duplicate system entryDuplicate system entry Systems do not cross-populate informationSystems do not cross-populate information No electronic entry from agents or insuredsNo electronic entry from agents or insureds Multiple Celerity systemsMultiple Celerity systems – Expensive – Management strain No automated tracking of State submissionsNo automated tracking of State submissions Multiple systems limit mining of statistical information for future analysisMultiple systems limit mining of statistical information for future analysis

Single entry – no duplicationSingle entry – no duplication Transaction based architectureTransaction based architecture Automated State submittalAutomated State submittal Browser based point of entryBrowser based point of entry Access level securityAccess level security CentralizedCentralized Data mining friendlyData mining friendly Productivity increasesProductivity increases Transaction cost reducedTransaction cost reduced