Cobalt EDI And HIPAA Implementation

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Cobalt EDIAnd HIPAA Implementation

• HIPAA COW
• Green Lake, WI
• 09/26/2003

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EDI Claim Sources

• Direct e-submitters
• . Proservices Medical Claims
• . Clearinghouses Dental Claims
• . Medicare Carriers A B Crossover
• . Medicare Providers Med-A claims
• Agency Claims
• . Data Dimensions key paper to EDI file
• . GTESS OCR paper to EDI file
• . Alliance Pre-priced to EDI file

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Annual Volume of EDI Claims

• Proservices 3,600,000
• Agency Claims 1,000,000
• Medicare Crossover 1,400,000
• UGS Medicare Part A 31,000,000
• A TOTAL OF 37 MILLION CLAIMS HAD
• TO BE CONVERTED TO ANSI 837 V4010

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Other EDI Transactions

• 835 Remittance Advice
• . Directly to Submitters
• . Through Proservices
• 270/271 276/277 Inquiry . Directly from
  Providers . Directly from Clearinghouses
• 278 Pre-Cert Referrals . Directly from
  Providers . Directly from Clearinghouses
• 834 Enrollment 820 Premium Payment
• . From Employer Groups
• . From Self-Insured Groups

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We needed to get ready for HIPAA and our existing
EDI application could not do it

• Mainframe Based
• Aging technology
• A replacement system was required

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The Master Plan

• Continue Legacy EDI on mainframe system using
  current formats
• Install newer technology HIPAA compliant EDI
  system
• Conduct orderly migration of submitters to new
  system as they become compliant
• Retire old mainframe system 10/16/02

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The Challenges

• Staff limited EDI resources
• Budget high cost of a new HIPAA compliant
  system
• Time to install, develop, test, implement the
  new system and convert all our submitters
• Knowledge new EDI system AND9 ANSI
  transactions

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How Are We Going To Get This All Done ?
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The Healthcare Data Interchange Group (HDIG)
Formed by five Blue Cross Blue Shield Plans who
share a common EDI vendor.
BCBSKS BCBSNE BCBSND Noridian BCBSWI EXCELLUS
Health Plan, Inc. (Central New York division
Rochester Area Division Utica-Watertown
Division)
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HDIG Mission

• Reduce the cost of Electronic Data Interchange
• Standardize platform implementation and
  maintenance
• Develop and maintain a standard set of EDI
  applications
• Influence the vendor with regard to design and
  development
• Share knowledge and resources

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HDIG History

• Created HDIG Charter
• Developed By-laws
• Formed Steering Committee
• Core workgroup
• Business Rule workgroup
• Testing workgroup
• Jointly developed all HIPAA transactions and
  other common transactions

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HIPAA Compliance?

• On October 16, 2003 time runs out.
• Will your company be ready for HIPAA?
• HIPAA is the most sweeping national legislation
  to impact the health care industry in more than
  25 years. It will be a strategic driver forcing
  all participants in the delivery system to
  rethink the way they do business with each other.
• M2 Systems has worked closely with a consortium
  of five (5) BCBS plans, the Healthcare Data
  Interchange Group (HDIG), to establish a set of
  best practices that encapsulate HIPAA certifiable
  administrative transactions that are being used
  in real-world environments. These best practices
  consist of pre-defined workflows, trading partner
  profiles, mapping and translations, business
  rules and custom edits that are specifically
  designed to streamline an organizations HIPAA
  implementation, provide rapid certification and
  go into production on time and within budget.
  This approach has been highly successful and the
  HDIG members have been able to meet their
  deadlines with minimal business interruption.
  Formed in 1998, HDIG is committed to technical
  excellence and M2 Systems plays a vital role for
  supplying the necessary technology in support of
  the organization.
• M2 Systems is strategically committed to HIPAA
  compliance and productivity. We have worked
  closely with our business partners and healthcare
  organizations to create a complete, integrated
  HIPAA solution that covers all of the related
  HIPAA transactions. Our i24Payor HIPAA solution,
  incorporates best practices that are in
  production in the real world not theoretical
  approaches, best guesses or incomplete
  frameworks. Our solutions are processing hundreds
  of millions of healthcare transactions every year
  and they can go to work for you today.
• We will help you
• leverage your existing investment in technology
  and knowledge
• complete your compliance testing
• become operational and productive on time.
  That is our promise to you

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I Think Weve Got It Now

• Were Home Free

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Then Came The Extension

• HIPAA Compliance was extended to 10/16/03
• Mainframe was planned for retirement in early
  2003
• Applications were leaving the ship to newer
  server based technology
• The mainframe was resembling a big hotel with
  more and more vacant rooms

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Back To Square One
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The New Master Plan

• Develop the Legacy formats on the new platform
  
• Migrate the Legacy EDI processing to the new
  system
• Convert all Legacy submitters to the new
  system
• Retire the mainframe in May 03

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The M2 Environments

• Legacy Pre-HIPAA
• . Production
• . Test
• HIPAA Version 4010A1
• . Production
• . Test
• . Staging

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Status of EDI Transactions

• 837 Claims (I, P, D) . In Production with
  Institutional Claims . Professional Dental
  to follow shortly
• 835 Remittance Advice . In Production as of
  5/15/03
• 270/271 276/277 Inquiry to Eligibility Claims
  . Ready for Production
• 278 Pre-Cert Referrals . Transaction
  development complete . Application
  integration being tested
• 834 Enrollment 820 Premium Payment .
  Transaction development complete . Application
  integration being tested

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HIPAA Contingency Plan

• WE will be prepared to process HIPAA
  compliant transactions but will temporarily
  accept non-HIPAA compliant transactions from
  current submitters and will monitor those
  partners' progress in achieving compliance.
  However, providers submitting electronic
  transactions for the first time after Oct. 16
  will be required to use HIPAA-compliant formats.

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835 Electronic Remittance Advice

• It is in Production
• It is HIPAA compliant
• It balances
• We want to promote it
• So weve developed a windows-based remit print
  software program we will distribute free of
  charge to our providers

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Remit Print Software

• Translates the 835
• Allows sorting by various fields for flexibility
• Select a single claim, multiple claims or the
  entire file
• View or print the output (or both)
• Provider controls their own data
• Historical storage and inquiry capabilities
• Did I mention that it was free?

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Remit Print Software

• THE DEMO

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Questions? Comments?