Emdeon continues to guide our customers successfully through the migration to the X12 5010 and NCPDP D.0 versions of the HIPAA transaction standards. We have enhanced our 5010 systems and products to support the Errata versions HIPAA transactions. The Errata versions of the gap analysis documents are available at the HIPAA Simplified website under downloads.
We strive to provide you with the most updated and accurate information regarding our readiness for HIPAA 5010. Please see below answers to the most commonly asked questions regarding HIPAA 5010.
What is Emdeon’s current state and plans for HIPAA 5010 testing?
Emdeon is currently testing and implementing 5010 with submitters and payers while already in production with some payers and submitters. The late release of the Errata changes to the 5010 transaction standards further constricted the already narrow 5010 testing and conversion window. Nevertheless, as you can see in the list below, Emdeon has initiated submitter and payer testing on all 5010 transactions.
Errata testing/production in process:
• 837 Professional claims
• 837 Institutional claims
• 837 Dental claims
• 835 ERAs
• 270/271 Eligibility verification
Emdeon is also testing and implementing the Final Rule version with submitters and payers for the HIPAA X12 transactions that were not included in the Errata revisions:
• 276/277 Claim Status
• 278 Referral/Authorization
How can my organization initiate testing with Emdeon?
Emdeon has created HIPAA 5010 conversion tools to help automate the conversion for your convenience. To begin this process, please initiate testing through your Emdeon ON24/7 account. Please refer to the Submitter Claim Quick Reference Guide to guide you further. Detailed instructions are also available on Emdeon ON24/7.
How will my organization be notified of any product updates if required?
Emdeon has created a global communications plan for our clients. In addition, HIPAA 5010 Product fact sheets are available and being distributed for each product line. Remember to frequently visit Emdeon’s hipaasimplified.com website which has been recently updated and reorganized to contain new valuable content like product fact sheets and product specific testing information.
What is the timeline(s) of events?
The compliance date of HIPAA 5010 conversion is January 1st, 2012*. All Emdeon products and services have been remediated for 5010; we are in testing phase with many submitters and payers while already in production with some submitters and payers.
Is 5010 delayed until March 2012?
No, the compliance date for 5010 standards remains January 1, 2012, however on November 17th , 2011, CMS announced that the Office of E-Health Standards and Services (OESS) would not initiate enforcement action until March 31, 2012. Emdeon strongly encourages its clients to meet the January 1, 2012 compliance deadline if possible. Customers should not view this announcement as a 90 day extension of the compliance date and should continue testing earnestly with their trading partners to meet the end of the year deadline.
http://www.cms.gov/ICD10/Downloads/CMSStatement5010EnforcementDiscretion111711.pdf
Did Emdeon participate in the CMS National version 5010 Testing Days?
Yes, Emdeon did participate in the CMS National version 5010 day on June 14th and also in the subsequent testing week (August 22nd to August 26th). Emdeon sent test files to all Medicare Administrative Contractors (MACs) during both these testing periods.
How can I obtain additional information about HIPAA 5010?
Emdeon has created a valuable web resource available to all industry stakeholders titled HIPAA Simplified, which may be found at www.hipaasimplified.com. HIPAA Simplified is a one-stop online resource that features gap analysis, business level documentation, webinars, timelines for the transition and testing information for our customers.
Thanks for trusting Emdeon as your source for HIPAA readiness. We are working diligently to deliver solutions that enable our customers to seamlessly meet these industry regulatory requirements.
*The compliance date for 5010 standards remains January 1, 2012, however on November 17th, 2011; CMS announced that the Office of E-Health Standards and Services (OESS) would not initiate enforcement action until March 31, 2012. Emdeon strongly encourages its clients to meet the January 1, 2012 compliance deadline if possible.
HIPAA Update for Channel Partners
Change for the Best: Tips for Helping Healthcare Organizations Manage Change
Today, the healthcare industry is facing a barrage of changes. Mandates and technology updates, including ICD-10 conversion, are intimidating and can affect how an organization functions. While most believe that to some extent conforming to these new standards will “do good” in the long term, they certainly make navigating the present a difficult task.
So as a general guide we’ve compiled some useful tips that can help your organization and providers manage change. We use ICD-10 as an example here, but these ideas are helpful in dealing with any industry wide transition.
Be Ready for Change
“The only sustainable competitive advantage today is the ability to change, adapt, and evolve—and to do it better than the competition.” 1
“Change management” isn’t about minimizing fall-out and problems in times of transition; it’s about proactively leading organizations into new chapters for best outcomes. Through preparedness and concentrated programs for responding to change, healthcare organizations may not only make transitions successfully but thrive in a competitive marketplace, as well.
People’s natural reaction to change is resistance, because we generally fear the unknown. However, top-down management that cultivates an internal mindset to accept change as progress and then supports that mindset with people-focused processes will more likely get the buy-in of employees.
How can this specifically apply to the current healthcare environment?
Assess the scope. Determine how widespread the changes are, and identify all departments and employees that will be affected. From there, a workable plan can be developed. To use an example here, the scope and intricacy of the ICD-10 transition is significant. The ICD-10 transition will have a major impact throughout the healthcare industry and will be a major commission for providers, payers and channel partners and hence require prompt readiness.
- Position a senior leadership team to front the change. Studies confirm that change management works best when persons of authority show active support.
- Keep lines of communications open. Communications should not come to the forefront only in times of crisis. Healthcare organizations should function on a foundation of sound, internal communications to always be ready when change comes.
Lead Change
“The most common barrier to success was lack of change management. They fell short when managing the people side of change...” 2
Change is a powerful force that must be harnessed through effective administration and implementation, and a key component of the effort is the focus on the people side of change. It’s essential to keep all constituencies in mind as detailed plans are created at this point in the change process. 3
If you look at that from an ICD-10 perspective, your organization can achieve a critical strategic advantage by proper planning, fully utilizing your ICD-10 investments and moving beyond sheer compliance.
It’s essential to realize that most people’s overriding question during seasons of change is “How will this affect me?” A good plan for change will provide clear answers to this question. Likewise, true leadership of change will consistently allocate needed resources and support for success, and plans will alter responsively throughout the course.
Become the Change
“An organization that...uses effective change management...with each new initiative may experience a fundamental shift in its operations and the behavior of its employees. ...The organization has become ready and able to embrace change...” 4
When change is repeatedly administered well, healthcare organizations are able to weave these effective approaches into the fiber of their operations and truly be poised for competitive success. In essence, executives and employees “become the change” they wish to achieve in their organization.
Remember any major change requires planning, persistence and leadership but benefits for being adequately prepared are countless.
1- From “Managing Change in Healthcare”, Rashid Khalfan Al-Abri, 2007
2, 4- From “Change Management - The People Side of Change”, Hiatt & Creasey, 2003
3- From “Getting Ahead of the Change Curve”, Nancy Fagan-Coburn, 2006
Emdeon EHR Lite Simplifies ePrescribing for Physicians
Emdeon offers a quick to market EHR Lite solution that includes ePrescribing functionality as well as electronic lab orders and reports management. Emdeon Clinician, part of the Emdeon Office Suite, is also a certified EHR Lite that meets Stage 1 Meaningful Use criteria and can help eligible providers qualify for government incentives.* This solution is available to Emdeon channel partners to co-brand or implement into their existing software offering. Visit Emdeon’s Meaningful use topic center to view a short video about Meaningful Use and Emdeon Clinician.
Emdeon has recently expanded its Emdeon Office Suite™ to enable providers to participate in ePrescribing and to assist those providers to qualify for monetary incentives as outlined in the HITECH Act. Emdeon Office Suite offers electronic health record (EHR) capabilities compliant with Stage 1 Meaningful Use criteria. Emdeon Clinician™, part of the Emdeon Office Suite, is a certified EHR Lite* that combines day-to-day administrative health information exchange with electronic lab ordering, results distribution and ePrescribing. Read the press release.
Worth viewing or passing to your providers:
Emdeon Clinician EHR Lite Demo
**This Complete EHR is 2011/2012 compliant and has been certified by an ONC-ATCB in accordance with the applicable certification criteria adopted by the Secretary of Health and Human Services. This certification does not represent an endorsement by the U.S. Department of Health and Human Services or guarantee the receipt of incentive payments. Emdeon Inc, 10/22/10, Emdeon Clinician 7.4, 1014201030691,NQF0064/PQRI128, NQF0041/PQRI110, NQF0024, NQF0028, NQF0038, NQF0059/PQRI1,NQF0064/PQRI2, NQF0061/PQRI3.Emdeon Clinician is not currently certified for Stages 2 and 3 and we do not promise that users will qualify for any particular amount of enhanced payments.
Discover new ways to simplify your business when you connect with Emdeon
Find us online to learn about innovative new solutions and special offers or to provide feedback on Emdeon products and services you use. Emdeon regularly posts updates and offers valuable resources to keep you on top of industry trends and current information, including healthcare reform, emerging technology, best practices and more. Use your computer or mobile device to receive Emdeon updates on free webinars, new product launches, important news articles and upcoming tradeshows. You can also visit our YouTube channel to watch inspiring customer testimonials and insightful product videos, or join Emdeon on LinkedIn to connect with colleagues. Click the icons below and get social with Emdeon today!
Read More >>
New Payer Transactions Added Recently
The Emdeon network of payers continues to grow. New transactions added recently:
Claims
Assurant Health, Payer ID: 39065
Cenpatico Kentucky, Payer ID: 68068
Christian Brothers Services, Payer ID: 38308
Global Excel Management, Payer ID: GEM01
HealthEdge Administrators, Payer ID: 95213
Healthlink HMO, Payer ID: 96475
Hometown Health Providers, Payer ID: 88537
John Alden Life Insurance Co., Payer ID: 41099
Kentucky Spirit Health Plan, Payer ID: 68067
LIFE Pittsburgh, Payer ID: 25181
LifePath Hospice Inc, Payer ID: 76870
Sendero Health, Payer ID: 36426
Time Insurance Company, Payer ID: 39065
CBHNP- HealthChoices, Payer ID: 65391
ME Medicare Part B (J14-NHIC), Payer ID: SMME0
MN Medicare Part B (J6), Payer ID: SMMN0
PR Medicare Part B (J9-First Coast), Payer ID: SMPR0
Eligibility Inquiry And Response:
Key Benefit Administrators-Indianapolis, Payer ID: KEYIN
Nippon Life Benefits, Payer ID: NIPON
Optima Health, Payer ID: OPTMA
Ohio Medicaid, Payer ID: AID09
Claim Satus And Response:
Key Benefit Administrators-Indianapolis, Payer ID: KEYIN
Nippon Life Benefits, Payer ID: NIPON
For a complete list of the payers in our network, visit our website at www.emdeon.com/payerlists/
2011 MGMA Annual Conference
Are you planning to attend the 2011 MGMA Annual Conference in Las Vegas on October 23-26? Please make sure you stop by booth 1301 to learn about our new capabilities and how we can help improve your healthcare business. While you’re there, you can enter for a chance to win one of two $2,500 travel vouchers to the destination of your choice! We’ll also give you a personalized, colorful, aluminum luggage tag to make it easy to identify your bag on your next trip. 
HIPAA Update for Channel Partners
Emdeon continues to guide our customers successfully through the migration to the X12 5010 and NCPDP D.0 versions of the HIPAA transaction standards. We have enhanced our 5010 systems and products to support the Errata versions HIPAA transactions. The Errata versions of the gap analysis documents are available at the HIPAA Simplified website under 'downloads'.
We strive to provide you with the most updated and accurate information regarding our readiness for HIPAA 5010. Please see below answers to the most commonly asked questions regarding HIPAA 5010.
What is Emdeon’s current state and plans for HIPAA 5010 testing?
Emdeon is currently testing and implementing 5010 with submitters and payers while already in production with some payers and submitters. The late release of the Errata changes to the 5010 transaction standards further constricted the already narrow 5010 testing and conversion window. Nevertheless, as you can see in the list below, Emdeon has initiated submitter and payer testing on all 5010 transactions.
Errata testing/production in process:
• 837 Professional claims
• 837 Institutional claims
• 837 Dental claims
• 835 ERAs
• 270/271 Eligibility verification
Emdeon is also testing and implementing the Final Rule version with submitters and payers for the HIPAA X12 transactions that were not included in the Errata revisions:
• 276/277 Claim Status
• 278 Referral/Authorization
How can my organization initiate testing with Emdeon?
Emdeon has created HIPAA 5010 conversion tools to help automate the conversion for your convenience. To begin this process, please initiate testing through your Emdeon ON24/7 account. Please refer to the Submitter Claim Quick Reference Guide to guide you further. Detailed instructions are also available on Emdeon ON24/7.
How will my organization be notified of any product updates if required?
Emdeon has created a global communications plan for our clients. In addition, HIPAA 5010 Product fact sheets are available and being distributed for each product line. Remember to frequently visit Emdeon’s hipaasimplified.com website which has been recently updated and reorganized to contain new valuable content like product fact sheets and product specific testing information.
What is the timeline(s) of events?
The compliance date of HIPAA 5010 conversion is January 1st, 2012. All Emdeon products and services have been remediated for 5010; we are in testing phase with many submitters and payers while already in production with some submitters and payers.
Did Emdeon participate in the CMS National version 5010 Testing Days?
Yes, Emdeon did participate in the CMS National version 5010 day on June 14th and also in the subsequent testing week (August 22nd to August 26th). Emdeon sent test files to all Medicare Administrative Contractors (MACs) during both these testing periods.
How can I obtain additional information about HIPAA 5010?
Emdeon has created a valuable web resource available to all industry stakeholders titled HIPAA Simplified, which may be found at www.hipaasimplified.com. HIPAA Simplified is a one-stop online resource that features gap analysis, business level documentation, webinars, timelines for the transition and testing information for our customers.
Thanks for trusting Emdeon as your source for HIPAA readiness. We are working diligently to deliver solutions that enable our customers to seamlessly meet these industry regulatory requirements.
Ready, (Code) Set, GO...What You Need to Know About the Approaching ICD-10 Conversion
October 1, 2013.
For those of us in the healthcare industry, that’s the date that was announced back in January 2009 as the appointed day when ICD-10 conversion will occur. From that October 1st, 2013, we can never look back at ICD-9, plead for grace or vie for more time for implementation. At that time, everyone must be compliant without exception if they hope to be paid by public and private health plans.
As a part of the healthcare industry, you know very well that this date is how close and important. The two years that remain to prepare for a conversion of this magnitude are a blip on the screen. There’s much to know, consider and do to be ready, for you and your clients.
Here are some key points that will help you be prepared in your business and be the go-to resource clients need at this juncture.
1. ICD-10 code sets hold real promise.
It’s helpful to remember the intention of this mass conversion while we’re mired in the preparation. This 10th incarnation of the World Health Organization’s ICD (International Classification of Diseases) will be more specific with enhanced clinical information integrated, making it far more than just a revision of the existing ICD-9 codes. When ICD-10 code sets are the standard, our industry will likely see reduced payment errors, quicker reimbursements and significantly improved data sharing worldwide. Ultimately, we will all benefit from ICD-10’s more globally unified, meaningful reporting of diagnoses—a fact that, perhaps, makes the preparation for conversion more tolerable.
2. The HIPAA 5010 update is a looming milestone in the journey to ICD-10 compliance.
By January 1, 2012, all healthcare organizations must upgrade to the 5010 version of the Electronic Data Interchange (EDI). This is a necessary action because the current 4010/4010A1 versions are unable to accommodate ICD-10 codes and will be obsolete at the point of conversion. The disparity between dates of the 5010 transition and ICD-10 conversion exists to allow ample time for testing and trouble-shooting. Of course, this requirement is relevant to any technology or service business in a role of support for providers, payers and other entities covered by HIPAA; Emdeon is well ahead of the game in terms of readiness for the 5010 switch.
3. The ICD-10 conversion date is immovable industry wide.
No matter the size, scope or function of an organization, it must be in compliance on (or before) October 1st, 2013. The long-established conversion date is firm for providers of all types and stripes, public and private payers and industry support services such as clearinghouses and technology vendors. There is simply no delaying ICD-10, thus we need every day between now and then to finish getting ready.
4. ICD-10 conversion affects the business of healthcare from the inside out.
This conversion is about so much more than revised code sets. As the Centers for Medicare & Medicaid Services (CMS) website reminds us, this ICD-10 conversion (along with the 5010 transition) demands organizations to alter many aspects of operations. Software must be updated and installed, personnel must be educated and trained, workflows must be revised, and manuals and other materials must be rewritten and produced anew in time for implementation. That’s why the industry allotted more than four years for the process and why the two years remaining before implementation are so critical.
5. You play an important role in conversion as a partner to your clients.
ICD-10 conversion runs deep into the fiber of any healthcare organization, ultimately impacting workflows, workforce and system wide processes. Though conversion is too comprehensive and intricate for an organization to completely outsource, you can bring automated, compliant technology to lighten your clients’ loads. With Emdeon’s advanced solutions and leading edge knowledge in your toolkit, you can help your clients clear the path for ICD-10 compliance by the October 1st, 2013 deadline.
Stay in touch for ICD-10 updates at hipaasimplified.com!
What's Next for eRx and What Your Providers Need to do Now
The buzzer has sounded.
All “eligible professionals” who did not prove themselves to be “successful electronic prescribers” during January 1st through June 30th of this year are now subject to Medicare payment adjustments (translation: a 1 percent deduction on Medicare Part B reimbursement) come 2012, according to Section 132 of the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA).
What’s done is done, and whether your providers are left to nurse their wounds or breathe a sigh of relief, there’s always more eRx activity just around the corner. Here’s the latest, for your knowledge.
Comment by July 25th or Forever Hold Your Peace…
As of June 1st of this year, the 2011 eRx Proposed Rule is published in the Federal Register, providing updates to the existing eRx program. Specifics of the updates include modifications to quality measures, provisions for hardship exemption for the aforementioned 2012 payment adjustments, as well as extensions of deadlines for request of hardship exemptions. You may review details at http://ofr.gov/inspection.aspx and select file code CMS-3248-P.
Providers have until July 25th to submit comments to the rule.
Overview of Incentives—and Penalties—for eRx Going Forward
There’s still benefit to get going with eRx in 2011. Providers who prove to be a “successful electronic prescriber” during the first six months of this year, will avoid the penalty for 2012. However, providers must submit an additional 25 Medicare claims by December 31, 2011 to be eligible for the one percent incentive payment this year and to avoid penalty in 2013. As stated above, noncompliant “eligible professionals” will take a one percent deduction from the Medicare Physician Fee Schedule in 2012, 1.5 percent deduction in 2013 and two percent in 2014.
For the CMS’ specifics regarding “eligible professionals,” visit the website at http://iren.es/mDF4jA. An overview of the entire program may be accessed via http://www.cms.gov/ERxIncentive/.
Be sure to Crack the Code - Reporting the eRx G-Code
Successful reporting for the eRx Incentive Program requires a single G-code, a quality-data code adhering to parameters stated in the CMS document viewable at http://iren.es/lOmvNP. This reference offers guidelines for claims-based reporting.
Important to Know: ePrescribing and Meaningful Use
Did you know providers cannot qualify for both Medicare Meaningful Use incentives and electronic prescribing MIPPA incentives?
2011 is the first year that physicians can demonstrate Meaningful Use of a certified electronic health record (EHR) under the American Recovery and Reinvestment Act of 2009 (ARRA). Eligible professionals who meet Meaningful Use can begin to receive up to $44,000 from Medicare or up to $64,000 from Medicaid over five years. Whether Providers seek eRx incentives or focus on Meaningful Use of EHRs, ePrescribing is an essential and important initiative they must adopt. Emdeon offers an EHR Lite solution with integrated eRx functionality for ease of use and seamless system integration.
Emdeon is on the forefront of knowledge acquisition on eRx issues so that we can bring you practical solutions. Contact us anytime for answers to your specific questions or concerns about ePrescribing.
Look what is new in Emdeon 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, all leveraging the same data. 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 Emdeon Vision’s 360° views of claims.
Discover these new enhancements to Emeon Vision:
We understand you need clear, unveiled information to better serve your customers. You and your providers have been asking for the following enhancements to Emdeon Vision and we listened. Now we’re excited to introduce these great features to you and your providers:
• 5010 Indicator—In Emdeon Vision, an indicator has been added on the claim detail page that indicates if the claim was sent inbound in the 5010 format.
• Service Enrollment Matrix—Available from the Emdeon Vision landing page, this feature displays all of the provider services available by payer to alert providers to features they may not be taking advantage of, for each of their contracted payers.
• Customizable Alerts—Within the preferences section of Emdeon Vision, providers can now set options and thresholds for the types of email alerts they get related to claims activity. These alerts will give them even more visibility into claim rejections and other key metrics.
• Eligibility & Claim Status Check—Providers are now able to check eligibility on a rejected claim or submit a payer claim status request for an individual claim from the claim detail screen within Emdeon Vision.
• Standardized Payer Messages—We’ve standardized payer claim status response messages for the provider version of Emdeon Vision to be specific, actionable and more user-friendly.
• Secondary Claims—From the Emdeon Vision claim detail screen, providers will be able create a secondary claim from a primary claim. This will allow them to make changes and create the secondary claim to the payer.
• Export to Excel—1,000 Row Expansion—In Emdeon Vision, the claim summary only displays 1,000 rows. This feature will allow users to download ALL the data from their query in a way that allows them to sort and manipulate it.
Coming Soon!
• Claim Correct and Re-file—Providers will be able to view and edit a claim from the claim detail screen. This will allow them to make changes and re-submit the claim to the payer.
Discover new ways to simplify your business when you connect with Emdeon
Find us online to learn about innovative new solutions and special offers or to provide feedback on Emdeon products and services you use. Emdeon regularly posts updates and offers valuable resources to keep you on top of industry trends and current information, including healthcare reform, emerging technology, best practices and more. Use your computer or mobile device to receive Emdeon updates on free webinars, new product launches, important news articles and upcoming tradeshows. You can also visit our YouTube channel to watch inspiring customer testimonials and insightful product videos, or join Emdeon on LinkedIn to connect with colleagues. Click the icons below and get social with Emdeon today!
Read More >>
New Payer Transactions Added Recently
The Emdeon network of payers continues to grow. New transactions added recently:
Claims
Alameda Alliance, Payer ID: Cx083
Anthem Hmo Colorado - Hmo-B, Payer ID: Cx083
Anthem Health Plans - Hmod & Hmog, Payer ID: Cx083
Anthem Health Plans Of Kentucky - Osb High & Low, Payer ID: Cx083
Anthem Health Plans Of Virginia - Osb High & Low, Payer ID: Cx083
Anthem Health Plans Of Virginia - Ppob & Ppod, Payer ID: Cx083
Anthem Insurance - Osb High & Low, Payer ID: Cx083
Anthem Insurance - Ppob & Ppod, Payer ID: Cx083
Blue Cross Blue Shield Of Wisconsin - Ppod, Payer ID: Cx083
Blue Cross Of California - Osb High & Low, Payer ID: Cx083
Blue Cross Of California - Ppoa, Payer ID: Cx083
Blue Cross Of California - Plan Ss10 & Ss20, Payer ID: Cx083
Cal Optimal -Onecare, Payer ID: Cx083
Care 1st Health Plan Medicare Advantage, Payer ID: Cx083
Care 1st Php La & San Bernadino County, Payer ID: Cx083
Chinese Community Health Plan, Payer ID: 94302
ClaimsbrIDge MIDatlantic, Payer ID: Call
ClaimsbrIDge MIDatlantic, Payer ID: Call
ClaimsbrIDge Nw, Payer ID: Call
ClaimsbrIDge Nw, Payer ID: Call
ClaimsbrIDge North, Payer ID: Call
ClaimsbrIDge North, Payer ID: Call
ClaimsbrIDge South, Payer ID: Call
ClaimsbrIDge South, Payer ID: Call
Community Insurance - Hmoa & Ppob, Payer ID: Cx083
Community Insurance - Ppod & Ppof, Payer ID: Cx083
Easychoice Health Plan, Payer ID: Cx083
Empirehealthchoice Assurance - Osb Low & Ppob, Payer ID: Cx083
Empirehealthchoice Hmo, Payer ID: Cx083
Good Shepherd Hospice Inc, Payer ID: 76923
Good Shepherd Hospice Inc, Payer ID: 76923
Golden State Health Plan, Payer ID: Cx083
Harrington Health - Bpo, Payer ID: 59143
Harrington Health - Bpo, Payer ID: 59143
Health Net 21 - La & Sacramento, Payer ID: Cx083
Health Net Healthy Families A B & C, Payer ID: Cx083
Health Net Los Angeles Php, Payer ID: Cx083
Health Net Sacramento Gmc, Payer ID: Cx083
Healthy Alliance Life Insurance - Ppob, Payer ID: Cx083
Iehp, Payer ID: Cx083
La Care Health Plan, Payer ID: Cx083
Liberty Dental Plan, Payer ID: Cx083
Md Care Health Plan, Payer ID: Cx083
Memorial Integrated Healthcare, Payer ID: Call
Mgm Resorts International, Payer ID: Cx083
Memorial Psn/Cms, Payer ID: Call
MID America Benefits, Payer ID: Call
MID America Benefits, Payer ID: Call
Molina Healthcare, Payer ID: Cx083
Mutual Assurance Administrators, Payer ID: 37256
Ohana Health Plan, Payer ID: Cx083
Ohio Ppo Connect, Payer ID: Call
Ozark Health Plan, Payer ID: Cx083
Palms Casino Resort, Payer ID: Cx083
Physicians United Plan-Pup, Payer ID: Cx083
Rocky Mountain Hospital & Medical Service - Osb High & High, Payer ID: Cx083
Sands Bethworks Gaming, Payer ID: Cx083
Santa Clara Family Health Plan, Payer ID: Cx083
Venetian, Payer ID: Cx083
Wellcare, Payer ID: Cx083
Highmark Blue Cross & Blue Shield Of Pennsylvania, Payer ID: Sb865
Pacificsource Medicare, Payer ID: 20377
Pacificsource Medicare, Payer ID: 20377
Eligibility Inquiry And Response:
Advantra Freedom, Payer ID: Covty00453
Advantra Savings, Payer ID: 456
Advantra Savings, Payer ID: Covty00456
Altius Health Plan, Payer ID: 364
Altius Health Plan, Payer ID: Covty00364
Chc Carelink, Payer ID: Covty00160
Chc Carelink MedicaID, Payer ID: Covty00182
Chc Carenet, Payer ID: Covty00190
Chc FlorIDa/Vista/Summit, Payer ID: 512
Chc FlorIDa/Vista/Summit, Payer ID: Covty00512
Chc Group Health Plan (Ghp), Payer ID: Covty00184
Chc Health America / Health Assurance Of Pennsylvania (Hapa), Payer ID: Covty00148
Chc Southern Health Services (Shs), Payer ID: Covty00156
Chc Of Delaware, Payer ID: Covty00166
Chc Of Georgia, Payer ID: Covty00154
Chc Of Health Care Of Usa (Hcusa), Payer ID: Covty00186
Chc Of Iowa, Payer ID: Covty00170
Chc Of Kansas, Payer ID: Covty00172
Chc Of Louisiana, Payer ID: Covty00158
Chc Of Nebraska, Payer ID: Covty00176
Chc Of The Carolinas / Wellpath, Payer ID: Covty00164
Carelink Advantra, Payer ID: 160
Carelink Health Plan, Payer ID: 160
Carelink MedicaID, Payer ID: 182
Carenet, Payer ID: 190
Coventry Advantra (Texas New Mexico Arizona), Payer ID: 504
Coventry Advantra (Texas New Mexico Arizona), Payer ID: Covty00504
Coventry Health Care Federal, Payer ID: 509
Coventry Health Care Federal, Payer ID: Covty00509
Coventry Health Care Of Delaware Inc., Payer ID: 166
Coventry Health Care Of Georgia Inc., Payer ID: 154
Coventry Health Care Of Iowa Inc., Payer ID: 170
Coventry Health Care Of Kansas Inc., Payer ID: 172
Coventry Health Care Of Louisiana Inc., Payer ID: 158
Coventry Health Care Of Nebraska Inc., Payer ID: 176
Coventry Health And Life (Oklahoma), Payer ID: 441
Coventry Health And Life (Oklahoma), Payer ID: Covty00441
Coventry Health And Life (Tennessee Only), Payer ID: 455
Coventry Health And Life (Tennessee Only), Payer ID: Covty00455
Coventry Health And Life-Nevada, Payer ID: 505
Coventry Health And Life-Nevada, Payer ID: Covty00505
Coventry Healthcare National Network, Payer ID: 250
Coventry Healthcare National Network, Payer ID: Covty00250
Coventry-Missouri, Payer ID: 507
Coventry-Missouri, Payer ID: Covty00507
Coventrycares, Payer ID: 510
Coventrycares, Payer ID: Covty00510
Coventryone, Payer ID: Covon
Coventryone, Payer ID: Covtycovon
Diamond Plan, Payer ID: 177
Diamond Plan (Md MedicaID), Payer ID: Covty00177
Group Health Plan - Cmr, Payer ID: 184
Health America Inc./Health Assurance/Advantra, Payer ID: 148
Healthcare Usa, Payer ID: 186
Mhnet Behavioral Health, Payer ID: 514
Mhnet Behavioral Health, Payer ID: Covty00514
Mail Handlers Benefit Plan, Payer ID: 251
Mail Handlers Benefit Plan, Payer ID: Covty00251
Omnicare, Payer ID: Covty00413
Omnicare - A Coventry Health Plan, Payer ID: 413
Personalcare/Coventry Health Of Illinois, Payer ID: 179
Personalcare/Coventry Health Of Illinois, Payer ID: Covty00179
Southern Health Services Inc., Payer ID: 156
University Of Missouri, Payer ID: Covtycovum
University Of Missouri, Payer ID: Covum
Vista (MedicaID FlorIDa Health KIDs Long Term Care Products Only), Payer ID: 508
Vista (MedicaID FlorIDa Health KIDs Long Term Care Products Only), Payer ID: Covty00508
Wellpath, Payer ID: 164
Coventry Nebraska MedicaID, Payer ID: 511
Coventry Nebraska MedicaID, Payer ID: Covty00511
Ohio MedicaID, Payer ID: AID09
Ohio MedicaID, Payer ID: Oh
Claim Satus And Response:
Advantra Freedom, Payer ID: COVTY00453
Advantra Savings, Payer ID: 456
Advantra Savings, Payer ID: COVTY00456
Altius Health Plan, Payer ID: 364
Altius Health Plan, Payer ID: COVTY00364
CHC Carelink, Payer ID: COVTY00160
CHC Carelink MedicaID, Payer ID: COVTY00182
CHC Carenet, Payer ID: COVTY00190
CHC FlorIDa/VISTA/Summit, Payer ID: 512
CHC FlorIDa/VISTA/Summit, Payer ID: COVTY00512
CHC Group Health Plan (GHP), Payer ID: COVTY00184
CHC Health America / Health Assurance Of Pennsylvania (HAPA), Payer ID: COVTY00148
CHC Southern Health Services (SHS), Payer ID: COVTY00156
CHC Of Delaware, Payer ID: COVTY00166
CHC Of Georgia, Payer ID: COVTY00154
CHC Of Health Care Of USA (HCUSA), Payer ID: COVTY00186
CHC Of Iowa, Payer ID: COVTY00170
CHC Of Kansas, Payer ID: COVTY00172
CHC Of Louisiana, Payer ID: COVTY00158
CHC Of Nebraska, Payer ID: COVTY00176
CHC Of The Carolinas / Wellpath, Payer ID: COVTY00164
Carelink Advantra, Payer ID: 160
Carelink Health Plan, Payer ID: 160
Carelink MedicaID, Payer ID: 182
Carenet, Payer ID: 190
Coventry Advantra (Texas New Mexico Arizona), Payer ID: 504
Coventry Advantra (Texas New Mexico Arizona), Payer ID: COVTY00504
Coventry Health Care Federal, Payer ID: 509
Coventry Health Care Federal, Payer ID: COVTY00509
Coventry Health Care Of Delaware Inc., Payer ID: 166
Coventry Health Care Of Georgia Inc., Payer ID: 154
Coventry Health Care Of Iowa Inc., Payer ID: 170
Coventry Health Care Of Kansas Inc., Payer ID: 172
Coventry Health Care Of Louisiana Inc., Payer ID: 158
Coventry Health Care Of Nebraska Inc., Payer ID: 176
Coventry Health And Life (Oklahoma), Payer ID: 441
Coventry Health And Life (Oklahoma), Payer ID: COVTY00441
Coventry Health And Life (Tennessee Only), Payer ID: 455
Coventry Health And Life (Tennessee Only), Payer ID: COVTY00455
Coventry Health And Life-Nevada, Payer ID: 505
Coventry Health And Life-Nevada, Payer ID: COVTY00505
Coventry Healthcare National Network, Payer ID: 250
Coventry Healthcare National Network, Payer ID: COVTY00250
Coventry-Missouri, Payer ID: 507
Coventry-Missouri, Payer ID: COVTY00507
Coventrycares, Payer ID: 510
Coventrycares, Payer ID: COVTY00510
Coventryone, Payer ID: COVON
Coventryone, Payer ID: COVTYCOVON
Diamond Plan, Payer ID: 177
Diamond Plan (MD MedicaID), Payer ID: COVTY00177
Group Health Plan - CMR, Payer ID: 184
Health America Inc./Health Assurance/Advantra, Payer ID: 148
Healthcare USA, Payer ID: 186
Mhnet Behavioral Health, Payer ID: 514
Mhnet Behavioral Health, Payer ID: COVTY00514
Mail Handlers Benefit Plan, Payer ID: 251
Mail Handlers Benefit Plan, Payer ID: COVTY00251
Medical Mutual Of Ohio, Payer ID: 211
Medical Mutual Of Ohio, Payer ID: MMO00211
Omnicare, Payer ID: COVTY00413
Omnicare - A Coventry Health Plan, Payer ID: 413
Personalcare/Coventry Health Of Illinois, Payer ID: 179
Personalcare/Coventry Health Of Illinois, Payer ID: COVTY00179
Southern Health Services Inc., Payer ID: 156
University Of Missouri, Payer ID: COVTYCOVUM
University Of Missouri, Payer ID: COVUM
VISTA (MedicaID FlorIDa Health KIDs Long Term Care Products Only), Payer ID: 508
VISTA (MedicaID FlorIDa Health KIDs Long Term Care Products Only), Payer ID: COVTY00508
Wellpath, Payer ID: 164
Coventry Nebraska MedicaID, Payer ID: 511
Coventry Nebraska MedicaID, Payer ID: COVTY00511
For a complete list of the payers in our network, visit our website at www.emdeon.com/payerlists/
Claims Submissions: A Game of Assists
Follow these tips to help us help you
In basketball, a player that passes the ball to a teammate who successfully makes a basket is credited with an “assist” for helping score those points. The more the players help each other, the better chance the team has to score points.
Emdeon is in the business of offering assists to our channel partners. We’ve created products, services and a system of support, and we pass those on to you so you can score points with your providers. Of course, an assist works best when all team members are on the same game plan and giving it their all on the court. As Emdeon aims to support you in every way, it’s helpful to make sure all our efforts are collaborative—the essence of teamwork.
Here are some pointers regarding best practices for support issues. You can apply these tips to make sure Emdeon has everything needed to offer the best assists for your business.
•Deal with unpaid claims promptly.
When your providers face claims that remain unpaid, you often turn to Emdeon for an assist in the form of timely filing letters. Though we’re on the ready to help, our timely filing letters are only effective if sent as soon as possible upon detection of nonpayment.
Much like the shot clock in basketball counts down a player’s opportunity to shoot, payers impose limits on the timeframe in which claims can be reconciled. That’s why it’s essential that you work with your provider partners to keep an eagle eye on claim status. The sooner you alert us about unpaid claims, the sooner we can offer a timely filing letter to aid in adjudication.
•Have all details ready for timely filing letters
By the time it’s necessary to submit a timely filing letter, that aforementioned shot clock is really ticking. When you come to us to request a letter, have all the pertinent details on hand so we can act as fast as possible on behalf of you and your providers. Those pertinent details include patient name, insured ID, claim amount, date(s) of service, date of submission and payer name. Armed with this key information, we’re able to move ahead.
Please bear in mind that timely filing letters serve only as confirmation to payers that Emdeon received the claim and do not guarantee payment.
•Offer key information to help find ERAs that are MIA
When a remittance goes missing, turn to Emdeon to initiate a search within our system, and have the appropriate details handy—particularly in case we need to expand the search to payers’ systems.
At Emdeon, we just need to know payer name, check number, check date and payment amount to start looking. If we can’t find the missing remittance, payers can often start searching with only this basic information, as well. However, bear in mind that other details and protocols may be required. Here are examples.- Medicare payers typically require a PTAN (Provider Transaction Access Number ) in order to offer support.
- Some payers require the NPI(National Provider Number) and/or payer-specific provider IDs.
- If payment was made via EFT, payers often ask for an EOB , Cigna requires a DDAR (Direct Deposit Activity Report).
Note that some payers will not generate an electronic remittance if they have not received and processed an electronic claim (e.g. - paper claims or claims generated via OCR/scanned claim information).
•Remember you have a stake in your provider’s claims process
While the claims submission process takes teamwork to complete successfully, it’s in the provider’s court to properly handle the initial legwork—accurate, prompt filing, diligent record keeping, etc. The smoother the provider’s claims submission process, the better payment outcomes and results will be for all involved.
Because you’re the provider’s direct link to claims submissions solutions and expert industry knowledge, it’s in your court to train and guide the providers’ processes. You can share our “How to Avoid Claims Rejection” quick-reference tool with your customers to help them navigate the challenges of claims filing.
When you play an active role in guiding providers to submit clean claims, you help ensure those claims pass the secondary evaluation by payers. We may reject claims based on our basic editing, as well as the use of some payer-specific editing. However, there are occasions in which claims pass our system yet are rejected at the payer level. If a claim does get rejected by a payer, please contact us with the Emdeon Claim Reference number or Emdeon File Reference number so we can assist in getting to the root of the problem.
•Keep track of the trace number to troubleshoot in real-time
To help you troubleshoot a real-time claim status, eligibility or referral transmission, we need the Transaction Reference Number, also known as the Trace Number. With that key bit of information, we can hit the ground running to help you help your customers.
If you don’t have this number, the next best information will be the eligibility logs 270/271 reporting, claim status logs 276/277 reporting, and referral logs 278 reporting. Make note: you can resubmit eligibility and claim status transactions to obtain the transaction or trace number, but providers should not retransmit referrals.
Remember to take advantage of the claim visibility and support tools available to you via Emdeon Vision and Emdeon ON24/7. Emdeon Vision for Claim Management provides your customer service staff with an end-to-end view into all claims from the point of submission to Emdeon through payer adjudication, while Emdeon ON24/7 provides flexible support tools that give you the service and support you need, when you need it, letting you submit requests online anytime or you can call into our office where our support staff will be happy to assist you quickly and effectively.
Follow these tips to help us help you, and together, we’ll achieve a truly winning strategy.
Introducing Emdeon's Latest Innovations:
Two New Bigger, Faster, Better Solutions to Simplify Your Business...Again!
Have you ever seen a duck gliding on a lake? The image looks so serene, as sunlight gleams on the iridescent feathers of the duck skimming smoothly, seamlessly on the glasslike water. Yet just underneath the surface, the duck’s feet paddle quickly, furiously, relentlessly—in constant, concerted effort to keep moving forward. It takes lots of work to look that effortless.
Emdeon is much like that duck; our systems are ceaselessly working, and our people are endlessly innovating bigger, faster, better ways to simplify the business of healthcare. As our partner, you enjoy the smooth reliability of the more than 100 solutions Emdeon offers. You conduct business with seamless functionality because we’re constantly below the surface—paddling nonstop to save you time, money and effort in managing the revenue and payment cycle.
But at Emdeon, ‘bigger, faster, better’ is never enough, because our goal is to give you the services and support needed to be leaders. We stay in a mode of innovation to advance our existing solutions and pinpoint new ones to enhance your ever-growing, ever-changing business. Now, we’re pleased to report that all the proverbial paddling has paid off again in the form of two major innovations.
Introducing Emdeon’s data center additions and new, best-in-class print technology.
Emdeon Data Centers
On the occasion of the opening of the second of two new data centers, we invite you to look below the surface to get a glimpse of all that goes on to not only keep the single largest financial and administrative information exchange in the U.S. healthcare system going but to take its capabilities to new heights.
Our data centers deftly, reliably and securely transmit the unbelievable number of information exchange points and transactions the business of healthcare demands at any given minute, on any given day. Yet the volume of data exchanged is not nearly as impressive—or important—as what the new centers enable us to do with the data itself.
Rather than keep data chained together through separate business rules and processes as was required in the past, the technology behind our systems allows us to create data mash-ups, combining and aggregating data making information more useful and nimble.
Here’s a quick look at the advanced capabilities our data centers can enable.
For providers:
- Get paid sooner thanks to electronic claims that are auto-corrected and/or enriched with eligibility data to increase auto-adjudication rates.
- Receive remittance advice or estimate of payment within seconds of filing an electronic claim.
- Easily obtain comprehensive, accurate patient medical and prescription history within a collaborative care community.
- Monitor patients’ adherence to disease management protocols over defined periods of time within your collaborative care community.
For payers:
- Decrease call center and other operational costs thanks to minimization of errors or omissions on claims filed by providers.
- Detect insurance fraud prior to claims payment.
- Offer preventative patient care messages to providers based on patient medical and pharmacy histories.
- Eliminate pounds of paper currently received by mail or fax.
By bringing the new data centers online, we have streamlined many of our business processes, reducing the human factor and minimizing the potential for errors. By automating these processes, we can more accurately measure performance and anticipate issues before they become a problem. As a result, since the new centers have been online, calls into our call center have steadily dropped, while customer satisfaction has increased.
Our new, massive data centers live up to their billing as ‘state-of-the-art’ in every sense of the phrase. With hundreds of miles between them, these facilities are redundant yet independent to ensure all data is secure, safe and accessible without interruption. They exchange data at lightning-speed to eliminate downtime issues and further our capabilities as the single largest financial and administrative information exchange in the U.S. healthcare system.•55,000 sq. ft. containing 2,000 servers
•2 petabytes of storage (That’s 2,000 terabytes!)
•20+ Load Balancers (10+ Redundant Clusters)
•900 Microsoft Windows Servers
•350 IBM AIX Unix Servers
•500+ VMWare Virtual Guests
•450 databases
•100% future growth potential
Unparalleled Printing Advancements
We have introduced the Pitney Bowes® IntelliJet™ 30 Printing System to herald the next generation in on-demand printing technology and patient communications production. As one of only three such systems in the world, Pitney Bowes IntelliJet™ takes the idea of “fast and high quality printing” to stratospheric levels. With amazing 1200x600 dpi output of 1,380 pages per minute, there is virtually no limit to what you can create, design and produce for your patient communications.• Advanced print quality for razor sharp, vibrant patient statements
• Full-color statements in an extremely high resolution—1200 x 600 dpi
• Capable of four-color printing on both sides of the statement
• 1,380 pages per minute (400 feet of paper per minute)
With this new printing capability, Emdeon ExpressBill now has extreme capacity to handle patient statement production responsively in whatever quantities you need. We’re able to quickly update your statement design and content and print on demand—as needed, eliminating costs and waste associated with traditional, pre-printing methods.
Most impressively, this new printing system ensures statements enter the mail stream significantly sooner through logical presorting that combines postal codes prior to printing. This advanced capability eliminates the delays associated with the traditional USPS sorting process. Now we print your batches of statements in full color, in the presorted manner, allowing statements to hit the mail immediately upon print completion. Statements that get mailed sooner often lead to faster payment.
At Emdeon, we know we’re doing our job if you only see “the duck gliding on the water” with not so much as a worry about what must happen to keep things moving smoothly. Hopefully, this brief view beneath the surface deepens your appreciation for the innovations we’ve created. Now you can go about your business even more simply, while we keep ‘paddling’ to our next round of innovative solutions.
To learn more about Emdeon’s innovations and to view a video tour, please visit www.emdeon.com/innovation.
HIPAA Simplifed Update for Channel Partners
We are pleased to announce that Emdeon has received notification that we have met the requirements of the EHNAC 5010 Readiness Assessment Program. Emdeon received a score of 100%, which further evidences Emdeon’s commitment to ensure compliance with HIPAA 5010.
In addition to this industry recognition, Emdeon continues to guide our customers successfully through the migration to the X12 5010 and NCPDP D.0 versions of the HIPAA transaction standards. We have updated our gap analysis documents to include the recent 5010 Errata changes and we have enhanced our 5010 systems and products to support the Errata versions HIPAA transactions. The Errata versions of the gap analysis documents are available at the HIPAA Simplified website under downloads.
We strive to provide you with the most updated and accurate information regarding our readiness for HIPAA 5010. Please see below answers to the most commonly asked questions regarding HIPAA 5010.
What is Emdeon’s current state and plans for HIPAA 5010 testing?
Emdeon is currently testing and implementing 5010 with submitters and payers. The late release of the Errata changes to the 5010 transaction standards further constricted the already narrow 5010 testing and conversion window. Nevertheless, as you can see in the list below, Emdeon has initiated submitter and payer testing on all 5010 transactions.
Errata Beta testing in process:
• 837 Professional claims
• 837 Institutional claims
• 837 Dental claims
• 835 ERAs
• 270/271 Eligibility verification
Emdeon is also testing the Final Rule version with submitters and payers for the HIPAA X12 transactions that were not included in the Errata revisions:
• 276/277 Claim Status
• 278 Referral/Authorization
How can my organization initiate testing with Emdeon?
Emdeon has created HIPAA 5010 conversion tools to help automate the conversion for your convenience. To begin this process, please initiate testing through your ON24/7 account. Please refer to the Submitter Claim Quick Reference Guide to guide you further. Detailed instructions are also available on Emdeon ON24/7.
What Emdeon solutions are impacted by 5010?
5010 impacts eligibility, claim, claim status and remittance transactions. The associated Emdeon solutions impacted by 5010 include our clearinghouse and others including:
• Emdeon Office
• Emdeon Payment Manager
How will my organization be notified of any product updates if required?
Emdeon is actively working on finalizing a global plan communications we will be providing to our clients throughout the year. In addition, fact sheets will soon be available and distributed for each product line.
What is the timeline(s) of events?
Emdeon is committed to fully support 5010 standards prior to the HIPAA 5010 compliance date. The precise dates on which Emdeon will support 5010 standards will vary based on the product, transaction, payer readiness and client readiness. Our goal is to have all Emdeon products modified and testing completed by the end of the year in order to be ready for the January 1, 2012 compliance date.
Where can I obtain additional information about HIPAA 5010?
Emdeon created a valuable web resource available to all industry stakeholders titled HIPAA Simplified, which may be found at www.hipaasimplified.com. HIPAA Simplified is a one-stop online resource that features gap analysis, business level documentation, webinars, timelines for the transition and testing information for our customers.
Thanks for trusting Emdeon as your source for HIPAA readiness. We are working diligently to deliver solutions that enable our customers to seamlessly meet these industry regulatory requirements.
How to Spot a Unicorn -or- The Accountable Care Organization Identified and Explained
What You Need to Know about ACOs
In a January 2011 news report, National Public Radio journalist Jenny Gold likened accountable care organizations (ACOs) to “the elusive unicorn: everyone seems to know what it looks like, but no one has actually seen one.”
The ACO has been a relatively hot topic since it was introduced as a provision in the new health law last year. The acronym fast achieved industry buzz phrase status as many in our industry began to eagerly hunt the proverbial unicorn without benefit of details or a roadmap. Most are aware ACOs fit in context with a better model for delivering care to Medicare beneficiaries; otherwise specifics are sketchy.
Here is the key information you need to know about ACOs—the corralling of the unicorn so you can have a better view.
Accountable care organization
əˈkountəbəl | ke(ə)r | ˌôrgəniˈzā sh ən
noun1 a type of payment and delivery reform model that seeks to tie provider reimbursements to quality metrics and reductions in the total cost of care for an assigned population of patients* *—as defined on Wikipedia
2 a recognized legal entity under State law and comprised of a group of ACO participants (providers of services and suppliers) that have established a mechanism for shared governance and work together to coordinate care for Medicare fee-for-service beneficiaries*
*—as defined by the Centers for Medicare & Medicaid Services
An ACO is an organized network of healthcare providers (hospitals, physicians, specialists) and is accountable to patients and payers, specifically Medicare. Provider participants collectively share responsibility for the healthcare of a group of patients for a set period of time. Specifically under the new law, an ACO must commit to care for at least 5,000 Medicare patients for a minimum of three years. The goal of an ACO is to improve the quality of care for patients while achieving cost savings, beyond the ACO’s historic national benchmark.
The intended benefit for patients is coordinated, well-rounded and more thoughtful care. Rather than receiving disjointed snapshots of care through referrals and provider visits, patients in the fold of an ACO would be part of a broader network. It’s kind of a “why buy the ingredients when you buy the cake already baked?” approach to healthcare.
The intended benefit for providers is the ability to give more efficient, results-oriented care while achieving cost savings that may then be shared amongst provider participants. Though still earning fees for service, ACO participants have the incentive of sharing in the savings, without full-blown capitation.
The intended benefit for everyone is aligned with the goals of ACOs in general: measurably better care and lower costs. Medicare is beleaguered, lumbering and struggling as an entity; those in positions of national leadership in health reform are banking on ACOs to achieve cost reductions and enhance care now while making the system viable for the longer term.
Under the provision of ACOs, providers will continue to receive fees-for-service, and patients will be free to select physicians outside the ACO network. The latter point is a key differentiator of ACOs from HMOs or health management organizations. This structural nuance is intended to avert possible control of patient referral patterns that some see as the bane of the HMO model (e.g. adverse selection). Additionally, antitrust reviews are to be expedited and coordinated by both the Federal Trade Commission and the U.S. Justice Department to ensure that no ACO is able to wield market power that drives prices up while keeping competition down, at least in theory.
The highly anticipated proposed rules were released on March 31, 2011 with a 60 day comment period. CMS received more than 1,200 comments, many of whom found ACOs bearing too many requirements with too few rewards. At the first ACO Learning Development Session on July 21, CMS Administrator Donald Berwick acknowledged the proposed rules caused debate and discourse and believes the final rule will take into account the thoughts and opinions of those who commented. Nonetheless, ACOs are part of the health reform structure and are poised to play a major role in our healthcare system moving forward.
Some of the comments from nationally recognized healthcare opinion leaders include:
• The American Academy of Family Physicians—“…The AAFP is concerned that the Medicare ACO program as currently proposed will fail to offer the potential benefits of better care for individuals, better health for populations, lower per capita costs for Medicare beneficiaries and improved coordination among physicians…"
• The Mayo Clinic—“…it (the rule) creates a sense of mistrust toward providers in a manner that suggests that CMS would not be a trustworthy and effective partner in the innovation that is necessary for us to really make progress in reform…"
• The Medicare Payment Advisory Commission (MedPAC)—“…Providers may be reluctant to commit time and money to reorganize the delivery system to better coordinate care and improve quality, if rewards are uncertain and difficult to calculate…"
Unicorn Sightings: ACO Dates and Milestones
Implementation deadline for ACOs is January 1, 2012.
In March 31st of this year, the federal government published proposed rules to guide the operation of ACOs. These rules establish comprehensive structural and quality requirements. HHS also released information for patients and providers to lay groundwork for ACO implementation. Upon release of proposed rules, many called for immediate review and modification.
On May 17th of this year, Centers for Medicare & Medicaid Services (CMS) unveiled three ACO initiatives to guide ACO structure and approach: the Pioneer ACO Model, Accelerated Development Learning Sessions and the Advanced Payment ACO Model.
Recent and upcoming ACO deadlines include:
June 6, 2011- NPRM comments closed
June 17, 2011- Cut-off for comments about advanced payment initiative to The Innovation Center
June 20 - 22, 2011- Training for Accelerated Development Learning
Session 1 in Minneapolis, also viewable by webcast
Session 2 September (TBA); San Francisco Bay, CA area
Session 3 October (TBD); Philadelphia, PA area (tentative)
Session 4 November (TBD); Atlanta, GA area (tentative)
June 30, 2011 - Due date for Letter of Intent for organizations interested in participating in the CMS’ Pioneer ACO model
August 19, 2011 - Application deadline for the Pioneer ACO Model
January 1, 2012 - Deadline for ACO implementation
Discover new ways to simplify your business when you connect with Emdeon
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New Payer Transactions Added Recently
The Emdeon network of payers continues to grow. New transactions added recently:
•Combined Benefits Administrators; Claims; ID: 88059
•Dreyer Health; Claims; ID: DREYR
•MED PAY; Claims; ID: 88058
•MORRIS ASSOCIATES; Claims; ID: 35092
•Omnicare Medical Group (OMNI); Claims; ID: IP088
•Nebraska Medicaid; Claims; ID: SKNE0
•AIG; Claims; ID: 19402
•America First; Claims; ID: J1427
•Federated; Claims; ID: J1297
•Hartford; Claims; ID: J1422
•Liberty Mutual; Claims; ID: 33600
•Secura; Claims; ID: J1379
•Travelers; Claims; ID: 19046
•Golden Triangle Physician Alliance/SelectCare of Texas(GTPA); Claims; ID: TXNSE
•HEALTHe Exchange; Claims; ID: THEXI
•Central SeniorCare; Claims; ID: TXNSE
•Memorial Clinical Associates/SelectCare of Texas(MCA); Claims; ID: TXNSE
•Northwest Diagnostic Clinic/SelectCare of Texas(NWDC); Claims; ID: TXNSE
•Fresenius Medical Care; Eligibility Inquiry and Response; ID: FRSMC
•Generations Healthcare; Eligibility Inquiry and Response; ID: GENHC
•Katy Medical Group; Eligibility Inquiry and Response; ID: TXNSE
•Optima Health; Eligibility Inquiry and Response; ID: OPTMA
•Select Senior Clinic; Eligibility Inquiry and Response; ID: TXNSE
•Texan Plus (North Texas Area); Eligibility Inquiry and Response; ID: TXNNT
•Texan Plus (Southeast Texas Area); Eligibility Inquiry and Response; ID: TXNSE
•Today's Health; Eligibility Inquiry and Response; ID: TDHLT
•Today's Options; Eligibility Inquiry and Response; ID: TDOPT
•Tribute/SelectCare of Oklahoma; Eligibility Inquiry and Response; ID: TSCOK
•Village Family Practice; Eligibility Inquiry and Response; ID: TXNSE
•IlliniCare Health Plan; Eligibility Inquiry and Response; ID: CLINI
•Central SeniorCare; Eligibility Inquiry and Response; ID: TXNSE
•Fresenius Medical Care; Eligibility Inquiry and Response; ID: FRSMC
For a complete list of the payers in our network, visit our website at www.emdeon.com/payerlists/
HIPAA Simplified Update for Channel Partners
We are pleased to announce that Emdeon has received notification that we have met the requirements of the EHNAC 5010 Readiness Assessment Program. Emdeon received a score of 100%, which further solidifies Emdeon’s commitment to ensure compliance with HIPAA 5010.
Emdeon’s commitment is to guide our channel partners successfully through the migration to the X12 5010 and NCPDP D.0 versions of the HIPAA transaction standards. We have updated our gap analysis documents to include the recent 5010 Errata changes and we have enhanced our 5010 systems and products to support the modified HIPAA transactions. The Errata versions of the gap analysis documents are available at the HIPAA simplified website under downloads.
Testing with Emdeon:
Emdeon began testing for the original 5010 Final Rule version in the 3rd quarter of 2010, ahead of the January 1, 2010 HHS guidance date. During the June 2010 X12 meeting several Errata revisions were approved and these Errata versions were adopted by HHS as the 5010 standard in October 2010. However, as HHS did not move out the January 1, 2012 5010 compliance date, this late release of the Errata versions further constricts the already narrow testing and conversion window. As you can see in the list below, Emdeon has initiated submitter and payer beta testing on the Errata versions, in advance of the CMS April 1, 2011 date to begin Medicare Errata testing.
ERRATA Beta Testing in process:
• 837 Professional claims
• 837 Institutional claims
• 837 Dental claims
• 835 ERAs
• 270/271 Eligibility verification
Emdeon is also testing the Final Rule version with submitters and payers for the HIPAA X12 transactions that were not included in the Errata revisions:
• 276/277 Claim Status
• 278 Referral/Authorization
Emdeon Pharmacy Update
An NCPDP D.0 gap analysis is also available at the HIPAA simplified website under downloads. To help our clients with HIPAA readiness, Emdeon is continuously updating gap analysis documentation. Like all our other documentation, this gap analysis is available to download for free. Visitors only need to provide their email addresses and they will be able to download documents from our vast library. Emdeon is also currently testing in NCPDP D.O.
Take advantage of Emdeon’s HIPAA simplified website that not only communicates important 5010 updates but also keeps you aware of any industry news that will impact you and your providers. To date, the HIPAA simplified website has received 30,000 visits and over 20,000 downloads of resource materials.
