HIPAA Simplified Update

Anatomy of a patient-friendly bill
One of the major discussions this summer has revolved around the Errata for some of the HIPAA 5010 Implementation Guides (TR3s). X12N released the Errata for publication on August 5, and they are now being considered for adoption as a part of a standard by Centers for Medicare and Medicaid Services (CMS). Even though the Errata have not yet been adopted by the Department of Health and Human Services (HHS), many Covered Entities are nonetheless preparing to update their gap analyses accordingly if and when the Errata are adopted.

In simple terms, the Errata are supplemental information that contain modifications to some of the TR3s. Not only must senders adopt the Errata, but so also must receivers if they are to perform a successful exchange of information.

To help our clients with HIPAA readiness, Emdeon is publishing updated gap analyses for the transaction code sets to reflect the Errata once they are adopted by CMS. Like all of our other documentation on HIPAA Simplified, these updated gap analyses will be available to download for free. Visitors only need to type in their email addresses, and they’ll be able to pick from our vast library of documentation.

For visitors who search for new documentation on HIPAA Simplified, we have good news: we’re currently updating our Frequently Asked Questions (FAQ) to incorporate new questions we’ve answered since publishing the first FAQ.

Additionally, our Pharmacy team has been working on new NCPDP D.0 gap analyses. As always, we’ll update our Downloads page to highlight the new or updated documentation for quick access and easy download.

We’re also excited to announce that Emdeon will be launching a new regulatory e-newsletter later this year, which we’ll use not only to communicate updates to HIPAA Simplified, but also to keep our clients up-to-date on industry news that will impact them. We’ll also use the e-newsletter to announce the publication of new documentation. Check HIPAA Simplified over the next few weeks as we share more information about how to stay in the loop concerning the ongoing transition to HIPAA 5010.

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Employ the View, Tame the Claims: Rejections Become the Exception with Emdeon Vision for Claim Management

Nobody likes rejection.

That’s especially true for those in the business of providing healthcare. For providers, rejection —in the form of returned claims— means payment for services rendered will be delayed or, worse yet, denied. Every claim that must be corrected and resubmitted costs providers valuable time and money.

Your business strives to help providers get paid in a fast and efficient manner so they can focus on providing best care for their patients. To serve that purpose, thankfully, Emdeon shares your vision.

Emdeon Vision for Claim Management is a robust, online claims management reporting tool—with specially tailored versions for providers, channel partners, payers and Emdeon support. Utilizing today’s leading information and communications technologies, Emdeon Vision organizes and translates digital data about claims into understandable, actionable information. You can readily access details regarding all your customers’ claims, and manage their claims in a quick, efficient manner with Vision’s 20/20 insights and 360° perspectives.

Get the unobstructed view of customer claims.
We understand you need clear, unveiled information to better serve your customers. That’s why we made customizable alert reporting a core offering of Emdeon Vision. We’ve made it simple to set preferred criteria for searches. Query by customer, claims or dollars rejected (amount or percentage) and generate online reports (no need for printing) to identify struggling providers and address their most common rejection issues.

Additionally, you can track provider usage of Emdeon Vision, noting frequency of use and reports generated. Emdeon’s recent market research proves that providers who regularly utilize Emdeon Vision reduce rejected claims, experience measurable gains and are able to resolve many support issues internally. Thus, your knowledge of use will help pinpoint and respond to areas of opportunities within your customer base, instead of fielding productivity-inhibiting support calls.

Emdeon Vision for Vendors features
• claims search options: quantity rejection or dollar amount percentage
• alert reporting: quick view of claims issues requiring action
• utilization reporting: detailed insights into usage by customer

A clear view lets providers become insiders
Providers directly benefit from the transparent view offered by Emdeon Vision. This tool takes providers from the ‘outside looking in’ to the ‘inside looking out,’ giving them timely intelligence and empowering them to substantively improve the claims process. As one provider recently stated, Emdeon Vision is like having “...a snapshot of the health of the practice.”

Emdeon Vision for Providers features
- landing page metrics: top items requiring attention, including rejected or unworked claims and a File Summary Status matrix
- flexible work flow options: multiple search options and filters
- dashboard analytics: easy-to-read views for trend and issue identification
- mobile option: essential information formatted for smartphone viewing

Results from a recent user poll reveal the effectiveness of Emdeon Vision in practical application. The majority of respondents indicated that use of Vision has reduced outstanding accounts receivable. Most noted they no longer require text-based reports thanks to the immediate results of the online reporting tool. Likewise, many providers have reduced or ceased calls for support regarding claim status, as Vision provides direct access to that essential information. Nearly 90% of the respondents indicated that Emdeon Vision exceeds their expectations.

Even with overall satisfaction so high, Emdeon continues to improve Emdeon Vision. Recently Emdeon Vision added the Emdeon payer list to the portal, integration of ERAs, as well as Customer Service alerts from Emdeon ON24/7. In the near future, this innovative tool will be enhanced with fee-based add-on features such as payment management, advanced claiming (auto and work comp), comparative community reporting and in-system refiling capabilities. We’ll offer real-time eligibility and claim status within Vision soon, as well.

Ready to improve the view for your customers and gain insights on their claims? Contact us to get started.

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Adding Value to Emdeon ExpressBill Services

The IntelliJet™ Printing System

Emdeon is pleased to announce the arrival of the next generation in printing technology, which will expand and improve the capabilities of Emdeon ExpressBill Services to accelerate patient statement printing and provide more communication opportunities, all with an exceptional level of system reliability and accuracy.

Maximize communication opportunities with custom statement messaging
Save money by communicating with your patients directly through their statements instead of paying extra for separate mailings. With this sophisticated printing technology, Emdeon can print statements that include customized messages at the batch, group or individual statement level.

Greater statement design flexibility
With this new printing system, statement information such as standard legal disclaimers or letterhead design can be quickly updated to accommodate your needs. This added flexibility in statement design also provides cost savings by eliminating the additional fees for destroying unused preprinted paper stock.

Advanced print quality for razor sharp, vibrant patient statements
The Pitney Bowes®IntelliJet™ Printing System prints full-color statements in a high resolution (1200 x 600 dpi resolution) which produces sharp logos and imagery with crystal clear text. Emdeon will also be able to accommodate nearly any request for adding four-color printing to either side of the statement to produce eye-catching patient statements.

Accelerate patient payments with expedited insertion into the mailstream
Emdeon will be able to get statements into the mailstream more quickly. Since the IntelliJet™ Printing System integrates with advanced presorting software and eliminates the need for preprinted forms, statement printing, processing and delivery is accelerated.

Closed loop processing for greater print and mail precision
The IntelliJet™ Printing System offers an unmatched level of system integrity and process control. A closed-loop workflow monitors the entire process from beginning to end, to help ensure statement accuracy. With this advanced printing system, you can also get peace of mind knowing your patient statement printing and mailing can seamlessly continue to function with enhanced reliability using our secure network of redundant back-up servers.

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Emdeon Achieves CAQH CORE Phase II Compliance

Anatomy of a patient-friendly bill
Emdeon has achieved compliance with the CAQH® Committee on Operating Rules for Information Exchange (CORE) Phase II rules. CAQH, a nonprofit alliance of health plans and trade associations, is a catalyst for industry collaboration on initiatives that simplify healthcare administration for health plans and providers, resulting in a better care experience for patients and caregivers. Emdeon achieved CORE Phase I compliance in March 2007.

CORE Phase II sets industry-wide standards that improve electronic administrative information exchange between health plans and providers. Both CORE Phase I and Phase II were designed by CAQH to resolve communication disparities created by original Health Information Portability and Accountability Act (HIPAA) regulations. Persistent ambiguity in language and code sets from payer to payer has perpetuated healthcare IT inefficiencies and made adoption of electronic solutions especially challenging, labor intensive and expensive for providers that must interact with multiple payers.

As a leading provider of electronic healthcare transaction processing, Emdeon has long provided technology solutions to manage the flow of information between healthcare payers and providers and bridged the gaps caused by disparate rules for data exchange. In achieving CORE Phase II compliance, Emdeon furthers its position as an industry leader committed to healthcare efficiency and broadens its capabilities to transact information in accordance with industry standards.

"Our CORE Phase II compliance is not only good news for the thousands of providers and payers we interact with daily, it ultimately benefits patients whose care may be improved as their healthcare providers and payers can more easily exchange essential electronic information," explains Damien Creavin, chief information officer of Emdeon.

Creavin continued, "Emdeon is dedicated to reducing costs involved in the claim lifecycle and simplifying the business of healthcare— with the goal of making the system more efficient and affordable."

CAQH launched CORE to promote interoperability between healthcare payers and providers and to improve provider access to administrative information. The CORE rules are being developed by over 115 participating organizations, representing providers, vendors, health plans, the Center for Medicare and Medicaid Services, state and federal government agencies, associations, standard-setting organizations and other healthcare organizations. More than 20 leading health plans, large provider groups and technology vendors committed to completing Phase II rules certification on or before the end of March 2010. Emdeon is among these organizations.

"The CORE Phase II rules represent a transparent, consensus-based national approach to an expanded set of operating rules for electronic administrative transactions among providers, health plans and vendors," said Robin Thomashauer, CAQH executive director. "By completing CORE Phase II certification, Emdeon is making it easier for everyone to exchange real-time administrative transactions more effectively, thereby improving efficiency and freeing up time for physicians to focus on their patients."

To learn more about Emdeon, call 877.EMDEON.6 or visit us online.

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Emdeon webinar series

Anatomy of a patient-friendly bill
Emdeon offers informative webinars that will keep you in the loop regarding the latest news, views and issues related to your business. The following recorded webinars are available for you to view via the webinar section of our Resource Library from anywhere on emdeon.com.

» From Practice Management to Meaningful Use
» HIPAA 5010 for Software Vendors & Channel Partners

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New Payer Transactions

New payers. Take a look at the new list
The Emdeon network of payers continues to grow. New payers added recently:

• ADVANTICA BENEFITS- Claims, Payer ID: 59374
• Alta Bates Medical Group- Claims, Payer ID: A0701
• American Family Medicare Supplemental Administered by Am Rep- Claims, Payer ID: 56071
• AmeriChoice of New Jersey, Inc. (Medicaid NJ)- Claims, Payer ID: 86047
• ATA-FL- Claims, Payer ID: 65064
• BCBS LA- Claims, Payer ID: 23740
• Benefit & Risk Management Services- Claims, Payer ID: 99320
• Benefit Administrative Systems- ERA, Payer ID: 36149
• Blue Cross Blue Shield of Montana- ERA, Payer ID: CBMT1
• Coventry Health Care- ERA, Payer ID: 25133
• Empire Omnipro (BC NY City)- ERA, Payer ID: 12B36
• Employee Benefit Systems- Claims, Payer ID: 42149
• Employers Insurance Group- Claims, Payer ID: J1232
• Florida Health Care Plan- Claims, Payer ID: 59322
• Freedom First- Claims, Payer ID: 31313
• Healthtran- Claims, Payer ID: 31172
• Hometown Health Plan Nevada- ERA, Payer ID: 88023
• InterCare Health Plans Inc.- Claims, Payer ID: 37227
• JMH Medicare Advantage- Claims, Payer ID: 59171
• MAMSI Life and Health Insurance Co. (MLH)- ERA, Payer ID: 52148
• MBA Benefit Administrators, Inc.- Claims, Payer ID: 83028
• MD Medicare Part A (J12- Highmark)- ERA, Payer ID: 12010
• Medicaid Hawaii Waivers- Claims, Payer ID: 77059
• Medical Services Initiative- Claims, Payer ID: 12057
• Medicare Blue Private- Claims, Payer ID: SX262
• MetroPlus Health Plan- ERA, Payer ID: 13265
• Metropolitan Transit Athority- Claims, Payer ID: J1238
• MidCoast IPA- Claims, Payer ID: 77012
• National Health Insurance Company- ERA, Payer ID: 75275
• Nebraska Medicaid- ERA, Payer ID: 12K19
• New Era Employee Welfare Benefit Plan Trust- ERA, Payer ID: 76031
• NHI Billing Services, Inc- Claims, Payer ID: 14043
• North American Benefits Network (Cleveland, OH)- Claims, Payer ID: 34159
• Optum Specialty Svcs/ Americhoice of NJ- Claims, Payer ID: GP133
• PEHP (Public Employees Health Program)- ERA, Payer ID: CX080
• Pennsylvania Medicaid- ERA, Payer ID: 12008
• Providence PPO- Claims, Payer ID: SX187
• Regence UT BCBS- ERA, Payer ID: CBUT1
• Regence UT BCBS FEP- ERA, Payer ID: CBUTF
• San Louis Obispo Select- Claims, Payer ID: 33072
• Sheffield, Olson, & McQueen, Inc- ERA, Payer ID: 41143
• Southwest Airlines- Claims, Payer ID: J1233
• SRS Hilton Worldwide, Inc - Claims, Payer ID: J1237
• SuperiorSTAR Pregnant Women- Claims, Payer ID: CPPSW
• Surency Life and Health- Claims, Payer ID: CX088
• Surency Life and Health- ERA, Payer ID: CX088
• The Beacon Mutal Ins Co- Claims, Payer ID: J1234
• Tower Life Insurance Co- ERA, Payer ID: 69493
• United American Liberty National- Claims, Payer ID: 55821
• United Healthcare Ovations Insurance Solutions (AARP)- ERA, Payer ID: 36273
• University Family Care- ERA, Payer ID: 09830
• University Family Care- Healthcare Group - ERA, Payer ID: 07503
• University Family Care- Maricopa Health Plan - ERA, Payer ID: 09908
• UTICA (C1027)- Claims, Payer ID: C1027
• Valley Mental Health - Claims, Payer ID: 94293
• Wellmark BCBS- Medicare COB- Claims, Payer ID: 12B92
• Wellmark BCBS- Medicare COB- Claims, Payer ID: SB645
• Wyoming Blue Cross- ERA, Payer ID: 12B30

For a complete list of the payers in our network, visit our website at www.emdeon.com/payerlists/

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