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

2. 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

3. 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:

4. 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)

5. 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)

6. 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.

7. Clinical Information Exchange
Some Helpful Resources
Helpful Websites:
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) or (412)
Conference Passcode: #

8. 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

9. Florida Collaborative
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