HIPAA 5010 Current State

January 1, 2012, the HIPAA-mandated implementation deadline for ASC X12 version 5010, has come and gone. With the CMS enforcement date of March 31, 2012, approaching, it is time to assess the current state of the industry and Emdeon relating to 5010 preparedness and conversion.

The Industry
Most key industry partners have experienced challenges related to the 5010 conversion. Those issues range from payers unable to accept 5010 transactions to concerns involving the effective processing of 5010 transactions and lastly the distributions of claims status reports. These issues are compounded by overwhelmed help desks across the industry. However, despite these issues, progress continues steadily. Industry partners are benefiting from shared lessons learned surrounding the most common challenges.

The conversion to the 5010 format in the commercial sector has been relatively smooth. Furthermore, Emdeon has worked closely with Medicare Administrative Contractors (MACs) as transition issues in their systems are uncovered. We will continue to work with our government payer partners in this area.

It is Emdeon’s experience that most payers are transitioning to 5010 in a sequential manner, beginning with claims transactions, moving on to electronic remittance advice (ERA) and then eligibility transactions. Therefore, transition timelines vary not only by payer but also by transaction type. Here is a summary of the current transaction status at Emdeon.

Institutional/Professional/Dental Claims (837)
Ninety five percent (95%) of Emdeon’s Institutional, Professional and Dental claim submitters have been certified and are authorized to submit claims in the 5010 format. Of those submitters, 62 percent submitted claims in the 5010 format in January 2012.

Emdeon converted 100 percent of outbound Medicare Part A and B claims to the 5010 format prior to the January 1, 2012, compliance date. New York and Connecticut Medicare Part A claims were backed out to 4010 due to contractor processing delays. Emdeon expects to re-convert these two payers to 5010 in February.

In the Medicaid sector, Emdeon has completed conversion of outbound claims to 53 percent of Medicaid payers. This percentage represents 55 percent of Emdeon’s total Medicaid volume.

Most large commercial payers have completed the transition to 5010. This represents 70 percent of Emdeon’s total outbound commercial claim volume.

ERA (835)
Of the payers that return electronic remittance advice (ERA) transactions to Emdeon, 29 percent have converted to the 5010 format.

Eligibility (270/271)
Of the payers that return real-time eligibility responses, 13 percent have converted to the 5010 format, constituting 73 percent of Emdeon’s eligibility volume. This volume includes Medicare, a mix of large commercial, Blue Cross Blue Shield and state Medicaid payers.

Emdeon has created a global communications plan for all of our clients and will continue to disseminate 5010 specific information via customer service announcements and through your online portal. In addition, HIPAA 5010 product fact sheets are available and being distributed for each product line. Remember to frequently visit Emdeon’s website www.hipaasimplified.com, which has been recently updated and reorganized to contain new valuable content like the product fact sheets and product specific testing information.

Thank you for trusting Emdeon as your source for HIPAA readiness. We work diligently to deliver solutions that enable our customers to seamlessly meet these industry regulatory requirements.

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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!

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Look What is New in Emdeon Office Suite!

Emdeon Office Suite’s Reporting & Analytics tool is a robust, online claims management reporting tool—specifically tailored for you and your practice. Utilizing today’s leading information and communications technologies, this solution organizes and translates digital data about claims into understandable and actionable information. You can readily access details regarding all your customers’ claims and manage their claims in a quick, efficient manner with Reporting and Analytics.

We understand you need clear, concise information to better serve your customers. You have been asking for these enhancements to Emdeon Office Suite and we listened. Emdeon has been working hard to introduce these new enhancements to you:

• Customizable Alerts – Within the preferences section of Reporting and Analytics, you can now set options and thresholds for the types of email alerts you want to receive related to claims activity. These alerts will give you even more visibility into claim rejections and other key metrics.

• Standardized Payer Messages – We’ve standardized payer claim status response messages to be specific, actionable and more user-friendly.

• Eligibility & Claim Status Check – You can check eligibility on a rejected claim or submit a payer claim status request for an individual claim from the claim detail screen within Reporting and Analytics.

• Claim Correct and Re-file – You can now view and edit a claim from the claim detail screen and re-submit the claim to the payer.

• Secondary Claims – From the claim detail screen, you are able to create a secondary claim from a primary claim, allowing you to make changes and create the secondary claim to the payer.

• 5010 Indicator – An indicator has been added on the claim detail page that indicates if the claim was sent inbound in the 5010 format.

• Export to Excel – 1000 Row Expansion – By expanding the number of Excel rows that can be exported, you will now be able to download all data from the query in a way that allows you to sort and manipulate it into information you can use.

Learn more about Emdeon Office Suite’s enhanced Reporting and Analytics tool at www.emdeon.com/reporting

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NEW OFFERING: Accelerate Revenue, Reduce Costs with the new Emdeon Patient Pay Online Express

Emdeon Patient Pay Online Express is a self-service application that provides comprehensive and secure online billing and payment management. This solution allows patients to securely pay invoices by credit or debit card over the internet whenever and wherever it is convenient to them. Once their payment is submitted online, it is automatically deposited into your bank account of choice. Use of Emdeon Patient Pay Online Express can yield faster collection of patient-owed amounts, improved cash flow, and reduced billing costs, all with less effort and paperwork. There is no additional software, hardware, maintenance, or custom programming expense needed.

For maximum benefit, you can couple our Patient Pay Online Express service with our automated patient statements solution to send personalized invoices with the click of a button. We can display the Patient Pay Online URL at the top and bottom of statements so patients know exactly where to go to pay their bill. Processing your statements through the Emdeon Office Suite can speed up the time it takes to get bills from you to your patients because you don’t have to print, fold, stuff and mail them yourself. With these solutions from Emdeon, you can collect more of what you are owed—quicker and with reduced costs.

Don’t just take our word for it. See what our customers have to say!

“In the medical profession, it is essential that we collect the out-of-pocket fees for our services. We used to spend weeks tracking these payments, but now we direct our clients to the Emdeon Patient Pay Online Express website to enter payments themselves or we simply collect our fees through the Emdeon site here in the office. Our patients love the convenience of being able to pay online and we love the convenience of knowing instantly whether a payment has been approved or declined. Thanks Emdeon!”

LaTasha A. Holloway
Office Manager

BASICS Group Practice, LLC.

Customer Case Study: Concord Integrative Health Implements Emdeon Patient Billing & Payment Solutions

Visit us online at www.emdeon.com/patientpayonlineexpress to discover how we can help improve your workflows and accelerate your patient payments.Bookmark and Share


Discover new ways to simplify your business when you connect with Emdeon

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New Payer Transactions Added Recently

New payers on board with Emdeon. Take a look at the new list
• Aetna; Hospital Claims; Payer ID: 26372
• Aetna; Medical Claims; Payer ID: 26372
• AmeriChoice of New Jersey, Inc. (Medicaid NJ); Hospital Claims; Payer ID: 86047
• AmeriChoice of New Jersey, Inc. (Medicaid NJ); Medical Claims; Payer ID: 86047
• Assurant Supplemental Cov ; ERA; Payer ID: ge; Dental Claims; Payer ID: ASHC1
• Carpenters Health and Welfare Fund of Philadelphia; Medical Claims; Payer ID: CX101
• CBHNP - HealthChoicesHospital; ERA; Payer ID: 65391
• CBHNP - HealthChoicesMedical; ERA; Payer ID: 65391
• CHOC - Children's Hospital Of Orange County Health Alliance; Hospital; ERA; Payer ID: 33065
• CHOC - Children's Hospital Of Orange County Health Alliance; Medical; ERA; Payer ID: 33065
• Comprehensive Healthcare Options.com, Inc.; Dental Claims; Payer ID: CHCP1
• Corizon Health, Inc.; Hospital Claims; Payer ID: CORIZ
• Corizon Health, Inc.; Medical Claims; Payer ID: CORIZ
• Delta Dental of Tennessee; Dental ; ERA; Payer ID: CDTN1
• Equitable Life and Casualty Insurance Company; Hospital; ERA; Payer ID: 87012
• Equitable Life and Casualty Insurance Company; Medical; ERA; Payer ID: 87012
• Florida Hospital Healthcare Systems; Hospital; ERA; Payer ID: 59321
• Florida Hospital Healthcare Systems; Medical; ERA; Payer ID: 59321
• HealthEdge Administrators (Bakersfield, CA); Dental Claims; Payer ID: 95213
• HealthSpan Network Repricing; Hospital Claims; Payer ID: HSPAN
• INETICO, INC.; Dental Claims; Payer ID: 43471
• InterCare Health Plans Inc.; Hospital Claims; Payer ID: 37227
• InterCare Health Plans Inc.; Medical Claims; Payer ID: 37227
• LIFE Pittsburgh; Medical Claims; Payer ID: 25181
• Lone Star TPA; Dental Claims; Payer ID: 45289
• Lone Star TPA; Medical Claims; Payer ID: 45289
• Medical Benefits Mutual Life Insurance Co.; Dental ; ERA; Payer ID: 74323
• Mercy Care Plan (AHCCCS); Hospital; ERA; Payer ID: 86052
• Mercy Care Plan (AHCCCS); Medical; ERA; Payer ID: 86052
• MOLINA HEALTHCARE Of WI; Hospital Claims; Payer ID: ABRI1
• MOLINA HEALTHCARE Of WI; Medical Claims; Payer ID: ABRI1
• NEW AVENUES, INC.; Hospital Claims; Payer ID: 95998
• NEW AVENUES, INC.; Medical Claims; Payer ID: 95998
• North American Benefits Network (Cleveland, OH); Dental Claims; Payer ID: 34159
• TML Intergovernmental Employee Benefit Pool; Dental; ERA; Payer ID: 74214
• Vermont Medicaid; Hospital Claims; Payer ID: 12K26
• West Suburban Health Providers; Hospital Claims; Payer ID: 80942
• West Suburban Health Providers; Medical Claims; Payer ID: 80942
• WINhealth Partners/Wyoming Health Solutions; Hospital Claims; Payer ID: 27327
• WINhealth Partners/Wyoming Health Solutions; Medical Claims; Payer ID: 27327

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