1. SeBIN Overview Debbi Meisner, VP Compliance Emdeon Business Services
November 28, 2007

2. Background
On November 13th key stakeholders met to address implementation issues
Outcome was a need to collaborate
Decision was to form a regional organization under the Work Group for Electronic Data Interchange (WEDI)

3. Why Collaborate?
Avoid the ‘re-inventing the wheel all over again’ syndrome
Healthcare has established standards under the HIPAA Transactions and Code Sets Rule
Designated Standards Organizations are established to develop and maintain these standards
Standards are dependent on consistent policies, practices and technology among key stakeholders
Acquaint workers’ compensation and healthcare with each others’ processes and practices
Successful Implementation
Coordination and collaboration among key stakeholders
Business cooperation, interoperability resolution, and data sharing agreements
Leads to cost–efficient implementation
Penetration and administrative efficiencies that provide the primary benefits of EDI
Fragmented and inefficient implementation will be costly to everyone

4. Purpose of SeBIN Provide an impartial forum
Establish opportunities for cooperation and collaboration
Work closely with State Departments of Workers’ Compensation
Facilitate effective and efficient information exchange and management.
Support a network of regional stakeholders
Coordinate outreach
Identify and work through implementation issues
Serve as a resource
Coordinate recommendations, proposals and strategies.
Provide an end-to-end panoramic view of the process from medical bill to payment.
Provide an impartial forum for coordinating necessary dialogue among stakeholders in the workers’ compensation medical bill payment and reporting arena
Establish opportunities for cooperation and collaboration, compile industry input, identify barriers success factors, and document industry "best practices" for improving business processes.
Facilitate effective and efficient information exchange and information management.
Support a network of regional stakeholders needed for a coordinated national implementation.
Coordinate outreach to other related industry initiatives, identifying information gaps and identifying strategies to fill those gaps.
Identify implementation issues and work with appropriate stakeholders to resolve them and/or to facilitate resolution of ambiguities within standards and rules.
Serve as a resource, in coordination with WEDI, IAIABC and other key stakeholders to help facilitate resolution of business issues arising from implementation.
Coordinate recommendations, proposals and strategies.
Provide an end-to-end panoramic view of the process from medical bill to payment.

5. SeBIN Organization

6. Focus of Workgroups Attachments/Documentation Education/Outreach
Identify Issues regarding the attachments needed to support eBills
Work with HL7 and X12N to identify standards
Propose solutions for current and future use
Education/Outreach
Identify educational opportunities and provide materials
Propose ways to outreach to key stakeholders

7. Focus of Workgroups Connectivity Pharmacy Identify connectivity issues
Propose testing guidelines
Propose solutions
Pharmacy
Work with NCPDP to address issues regarding Pharmacy bills

8. Technology and Implementation
Identify technology issues
Work with X12N and HL7 to address technical issues
Work with NUBC/NUCC to address content and paper form issues.
Propose solutions

9. Goals for this meeting Identify Members
Solicit volunteers for leadership
Goal would be at least 2 co-chairs per workgroup
Representing different stakeholders
Determine Meeting Schedule
Must be aggressive as end goal is January 1, 2008
Begin to identify and prioritize Issues
Work toward consensus on each issue
Voting within the workgroup
Interim Solutions and/or long term solutions
Work product of each group should be a published whitepaper addressing each issue with proposed solutions.
Draft Whitepaper distributed to SeBIN and/or WEDI membership
Final Whitepapers published on WEDI, IAIABC and SeBIN website and distributed to listservs.

10. Sample Whitepaper Issue: Data entry challenges
Providers must key the data from the paper remittance into the system rather than auto posting. This may cause data entry errors. Claim adjustment reasons are often proprietary codes or text messages. This makes it difficult for the provider to send the right Claim Adjustment Reason Codes (CARC) in the secondary claim.
Suggestion: As an interim step, the paper remits should move toward the use of the standard CARC to make the conversion from paper to electronics manageable. Payers should document their remittance advice codes and provide crosswalks for their providers through websites or other media.

11. Schedule Work Group Facilitator Time Attachments/Documentation
Joseph Montoya
Wednesday 3:00-3:45
Education
Adam Thornsley
Wednesday 3:45-4:30
Connectivity
Sherry Wilson
Thursday 8:00-9:00
Pharmacy
Sue Thompson
Thursday 9:00-10:00
Technology/Implementation
Debbi Meisner
Thursday 10:00-11:00

12. Questions??