1. ©2010 RealMed Corporation. RealMed Overview National Committee on Vital and Health Statistics Subcommittee on Standards Sean Kilpatrick, Director of Product Management - RealMed Russ Anderson, Director of Financial Solutions - Availity December 3 rd, 2010

2. ©2010 RealMed Corporation. Availity and RealMed Overview Availity – Core Solutions Multi-payer Business Solutions –Claims –Eligibility and Benefits –Claim Status –Referrals / Authorizations –Remittances –CareCost Estimator – member liability estimation Clinical Solutions –Availity CareProfile – patient health history –Availity CarePrescribe – electronic prescribing –Clinical Messaging RealMed – RCM Solutions Revenue Cycle Management Services –Core Business Transactions (Eligibility, Claims, Claim Status, ERA) –Integrated and automated eligibility and claim status checking –Real-time, online error notification and correction –Automated remittance posting Payment Services –RealAssure SM – member liability estimation –RealBill SM – patient statements –RealPay SM – patient payments Value Added Solution Services –RealClean SM – advanced claim editing –RealLink SM – practice management integration 2 2

3. ©2010 RealMed Corporation. >150 Direct Payers >1,150 Indirect Payers >1,000 Hospitals >450 Vendor Partners - Clearinghouses - Practice Management Systems - Hospital Information Systems - Electronic Medical Record Systems >455,000 Employers >200,000 Physicians Availity ® Health Information Network RealMed Revenue Cycle Management Solutions Business Solutions Clinical Solutions Availity ® Health Information Network RealMed Revenue Cycle Management Solutions Business Solutions Clinical Solutions $ >70,000,000 Consumers Availity and RealMed: More Than One Billion Transactions Annually 3

4. ©2010 RealMed Corporation. RealMed ERA Adoption Statistics Geographic RegionRealMed ERA Adoption 1 National Average 2 Southeast95%46% Mid-Atlantic91%46% Southwest80%46% Midwest77%46% National84%46% 1 Percentage calculated by claims in ERA’s returned through RealMed vs. claims submitted through RealMed. RealMed data, October 2010. 2 National Average based on U.S. Healthcare Efficiency Index © (USHEI), Current Use of Electronic Billing and Payment Transactions, www.ushealthcareindex.com www.ushealthcareindex.com 4

5. ©2010 RealMed Corporation. RealMed EFT Adoption Statistics Payer TypeRealMed EFT Adoption 1 National Average 2 BlueCross BlueShield86%10% Medicare94%10% Medicaid93%10% National Commercial24%10% Other Commercial32%10% 1 Percentage of ERA’s returned through RealMed with EFT indicator. RealMed data, October 2010. 2 National Average based on U.S. Healthcare Efficiency Index © (USHEI), Current Use of Electronic Billing and Payment Transactions, www.ushealthcareindex.com www.ushealthcareindex.com 5

6. ©2010 RealMed Corporation. RealMed acts as an 835/ERA holding bin for providers today. –835/ERA retrieved on an as needed basis; manual today. –If EFT information / notification was provided, it could be automated and reconciled by the provider’s vendor –Clearinghouse or PM System Health Plans receive EFT information which is then included in the ERA file. They could distribute both an ERA and an ANSI 820 payment file to provider. How does RealMed fit in? 6

7. ©2010 RealMed Corporation. Where does RealMed fit in? Claim Payment / Remittance Advice Delivery Electronic delivery of ERA’s to health care providers for health plan reimbursements –8% delivered to legacy systems in non-ANSI files –92% on ANSI 4010 –90% provided a supplemental electronic human readable version –Acts as a translation and transformation engine for health care providers Electronic delivery of ERA’s information to other vendors at provider’s request Tracking and transparency of reimbursement, adjustments, write-offs –Remittance reconciliation with all claim transactions Results: RealMed’s ERA adoption is 38% higher than the national average. 7 National Average based on U.S. Healthcare Efficiency Index © (USHEI), Current Use of Electronic Billing and Payment Transactions, www.ushealthcareindex.com www.ushealthcareindex.com

8. ©2010 RealMed Corporation. Where does RealMed fit in? (continued) Facilitating Electronic EFT Enrollment Electronic delivery and enrollment of EFT “paperwork” for health plans Drives adoption of EFT enrollment No standardized electronic way of performing closed-loop registration today Results: Payer #1 - Zero to 47% adoption in less than 12 months Facilitating Adoption of EFT Mandated use of EFT / ERA on setup with RealMed Discontinued paper for provider groups (both Payment and Remittance) Payer incented the providers with a payment policy: next-day deposits Results: Payer #2 - 100% EFT adoption 8

9. ©2010 RealMed Corporation. Challenges Privacy Issues (HIPAA requirements) Combination of payment information and PHI on the same network Different rules for governing the protection of health and financial data Transaction Complexity Persists Need a standard way for electronic EFT enrollment for mass adoption Multiple layers of payment reconciliation information –Line item, claim and EFT level adjustments, calculations = lots of data Non-Standard formats –Many legacy systems require translation of ANSI/HIPAA based standards into older standards and proprietary file formats Inherently, a file-based (synchronous) model –Acknowledgment of receipt of files, balancing, reconciliation of information –Use the ANSI 820 to enable the reconciliation of deposit and ERA by clearinghouses 9

10. ©2010 RealMed Corporation. Challenges Reconciliation considerations Is there a standards problem or a process problem? Update a banking transaction - CTX format to reconcile? –Health care transactions are complex and specialized with substantial data elements; routing to multiple vendors; compliance level requirements Why invent a new format vs. use existing health care standard transactions to close the loop (ANSI 835 / ANSI 820) –Health plans, providers and vendors would require confirmations from banking partners –Banks would need to pass health plan re-association keys to provider in payment stream Health plans and physicians must go through another transaction format migration in addition to 5010, ICD-10, HIE/EMR conversions to implement 9 As RealMed has demonstrated, with collaboration between health plans and vendors, adoption levels can increase significantly even with current standards in place.