WebMD Envoy HIPAA Solutions

1
WebMD EnvoyHIPAA Solutions
Angie White HIPAA Communications May 7, 2004
2
WebMD Envoy Overview

• 200K Providers
• 1.1K Payer Connections
• 2.6 Billion Healthcare Transactions
• 370 Billion in Annual Submitted Charges

3
WebMD Envoy
Pre-Adjudication Services
Paper, Scanned, Electronic Claims Eligibility
Verification Claims Status Remittance Advice and
Checks EFT and Automated AR Posting Post-Adjudicat
ion Reconciliation
Providers
EDI Clearinghouse
Reimbursement Cycle Management
Payers
Claims Communication Services
4
The HIPAA Ideal
HEALTH PLANS
PROVIDERS
5
HIPAA Challenges for the Health Care EDI Industry

• New transaction and code sets required by HIPAA
  simultaneously implemented across thousands of
  payers, physicians, hospitals, and clearinghouses
• Hundreds of variations of the definitions of the
  standards
• Multiple payer Companion Guides
• Complex Implementation Guides
• Multitude of undocumented payer requirements that
  only emerge during actual transaction testing or
  live production
• No rational transition plan
• HIPAA standards themselves continuing to evolve

6
HIPAA Readiness
Clearinghouse Capacity To Translate Legacy
Transactions To HIPAA Standards Illustrates The
Important Role In HIPAA Transition
Clearinghouse
90 Submitted Transactions Not HIPAA Standard
VENDOR FORMATS
VENDOR FORMATS
VENDOR FORMATS
VENDOR FORMATS
440 to 1,000 Unique Companion Guides
75 of Transactions Communicated to Payers ARE
HIPAA Standard
PAYER VERSION
PAYER VERSION
PAYER VERSION
PAYER VERSION
7
WebMD HIPAA Commitment

• WebMD the healthcare leader in HIPAA
  implementation
• Processing more claims in HIPAA standard format
  than any healthcare clearinghouse
• Working with all partners to to help them rapidly
  establish HIPAA standard connections
• WebMD has invested more than 20 Million to meet
  the HIPAA challenge
• Dedicated Team of IT Professionals and Customer
  Support Resources
• 92 FTEs devoted solely to HIPAA Implementation
  efforts
• Continuous system upgrades
• Increased speed, capacity, responsiveness and
  tracking ability

8
WebMD Envoy HIPAA Support and Solutions

• Providing All Payer-All Transactions Solutions
• Access to all HIPAA mandated transactions to all
  payers (Govt./BCBS/Commercial)
• Claims Encounters, Payment and Remittance
  Advice, Eligibility, Claim Status, Referrals,
  Pre-Certifications and Authorizations
• Providing Testing and Implementation Services
• Testing for format implementation
• Providing Translation and Editing Services
• Translating legacy format transactions to HIPAA
  Standards
• Providing Communication and Education
• Helpful guides and resources at
  www.webmdenvoy.com
• Submitter Support Services

9
Next Steps Healthcare Industry

• WebMD will continue to actively promote a Win-Win
  
• environment for all Participants
• WebMD
• Facilitate translation processes
• Coordinate provider and payer readiness
• Accelerate implementation of the remaining HIPAA
  Transactions
• Payer Community
• Continued migration from legacy to HIPAA
  compatible systems
• Monitoring of rejects, data quality
• Evolving migration to additional transactions
• Provider Community
• Continued migration from legacy systems to
  HIPAA-compatible systems
• Education on data gaps, and content needs to meet
  adjudication standards