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.

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.

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.

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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

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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.

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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!


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New Payer Transactions Added Recently

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

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/

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