MPS – Multi-payer Remit Solution

Gerry Santos, Centricity™ EDI ServicesChuck Heidbrink, Meridian Medical Management

2

Track Owners: Zinc InstructionsPlease update the chart to the right before submitting the presentation into Active• Following review and approval in Active,

each presentation given by GE employees or customers at Centricity LIVE must be approved through Zinc

• Jessica Diniz will be uploading each presentation into Zinc following Active review

• Before submitting this presentation in Active for review, Track Owners must select the appropriate answer to each Legal and Regulatory question

• ALL QUESTIONS MUST BE ANSWERED

• If further substantiation is required, please email the appropriate permissions, sources, or citations to jessicadiniz@ge.com so she can upload to the Zinc Gallery

• Once the presentation is approved in Zinc, please delete this slide from the final deck before presenting at Centricity LIVE

Individual Page Use?: No

Are all Uses and Applications Discussed or Referenced in the Proposed Material on Label for the Product?: Yes

Relates to a Major new Product/Services Launch?: No

Includes Product or Service Claims, Features, Benefits or similar information?: No

Contains Competitive or Comparative Claims?: NoIncludes Return on investment (ROI), quantifiable cost of ownership, reimbursement, or meaningful use claim or reference?: NoInclude References to Market / Segment Share or Market / Segment Leadership?: No

Include identifiable Patient Information / Data?: No

If Customer Names are Used, are Necessary and Appropriate Permissions in Writing and on File?: NA – customer presentation

Include Customer Testimonials?: NA – customer presentation

If any non-GE Stock Images are Used, are Necessary and Appropriate Permissions in Writing and on File?: NA– customer presentation

Do the Proposed Materials Contain Images of GE Products?: Yes

Do all Product Images Depict the Device(s) Being Promoted in the Piece?: Yes

This is a Translation of a Previously Approved Piece in Which no Changes Have Been Made?: NoThis is a Revision of a Document Previously Approved for Ad / Promo Use?: No

3

©2015 General Electric Company – All rights reserved.

The results expressed in this document may not be applicable to a particular site or installation and individual results may vary. This document and its contents are provided to you for informational purposes only and do not constitute a representation, warranty or performance guarantee. GE disclaims liability for any loss, which may arise from reliance on or use of information, contained in this document. All illustrations are provided as fictional examples only. Your product features and configuration may be different than those shown. Information contained herein is proprietary to GE. No part of this publication may be reproduced for any purpose without written permission of GE.

DESCRIPTIONS OF FUTURE FUNCTIONALITY REFLECT CURRENT PRODUCT DIRECTION, ARE FOR INFORMATIONAL PURPOSES ONLY AND DO NOT CONSTITUTE A COMMITMENT TO PROVIDE SPECIFIC FUNCTIONALITY. TIMING AND AVAILABILITY REMAIN AT GE’S DISCRETION AND ARE SUBJECT TO CHANGE AND APPLICABLE REGULATORY CLEARANCE.

GE, the GE Monogram, Centricity, and imagination at work are trademarks of General Electric Company.

All other product names and logos are trademarks or registered trademarks of their respective companies.

General Electric Company, by and through its GE Healthcare division.

4

Centricity EDI Services

5

What is MPS?

The Multi-payer Remit Solution (MPS) is a remit exchange that is largely the same as a traditional remit exchange. Functionally it is 90% the same to the end-user with the following differences in its intended use.

Current vs. Future StateTRADITIONAL MPS

SINGLE PAYER MULTIPLE

LARGE VOLUME PAYER SMALL VOLUME PAYERS

Why? MPS can address the client’s goal to be 100% electronic. The traditional remit exchange is neither economical or manageable to serve the 10,20,30,etc. small volume payers a client want to post electronically.

6

Client ABC with MPSClient ABC with MPS

MEDICAID

MPSCommercial 2 Natl Benefit Fund,MetroPlus,Affinity Health Plan,POMCO,Pyramid,Midwest National Life,Gateway Health,WebTPA

5 Traditional2 MPS

7

Meridian Medical Management

8

The content of this presentation represents the views of the author and presenters. GE, the GE Monogram, Centricity and Imagination at Work are trademarks of General Electric Company.

About Meridian, the Company• Previously Owned by IDX • 2006 - IDX was acquired by GE Healthcare • 2013 – Meridian purchased by Gores Group• 2014 – Meridian expanded business

through purchase of Origin

Privately owned and operated

Service Culture Discipline Growth

Meridian Vision

Meridian Medical Management Services

Our Technology Services – Available to our clients

Claim Scrubber Charge ManagementPatient Self-Service EMR Document Image Document Repository

Centricity BusinessCentricity Group

ManagementRCM & EMR Suites

Business I ntelligence

EMRge

Electronic Medical Record and PM system

M3 Services Billing Services (Revenue Cycle Management) - Data Entry - A/R Management - Coding & Credentialing EMR Services (Electronic Medical Record) - EMR - RX Account Management and Reporting Product Management: - Technology Deployment and Support - Engineering and Server Support

Added Value Services Transcription Coding / Credentialing Project Management Consulting Engineering

Software Vendor EMRge Precision BI

Multi – Payer Statistics

11

Measures:150,000 Total EOBs per month1,500 MP EOBs per month

Increase in electronic posting 2% per month

Goals: Reach electronic posting percent of 90%+ Reduce effort, cost, inaccuracies Greater EOB access

Multi – Payer Identification

12

• Use Monthly eCommerce Emdeon Outstanding Enrollment Data list• Easy source for new payers already sending 835 to Emdeon

• Review Emdeon Payer List• https://access.emdeon.com/PayerLists/

• Review Paper EOBs into office for ERA possibilities

Multi – Payers

13

Payer Payer IDAlliant Health Plans 58234American Republic 42011Amerigroup 27514Assurant Health 39065Benefit Admin Systems 36149Gateway Health Plan 25169GEHA 44054GHI Emblem Health 13551HIP of New York 55247

Payer Payer IDMedical Mutual 29076Medico Ins Co. 23160Mutual of Omaha71412National Benefit Fund 13162POMCO 16111TransAmer/Chesapeake 59221USAA Life 75895WebTPA 75261

Multi – Payer Lessons

14

• Understand valid FSCs for each payer

• Monitor edit list for any payer/FSC combinations not posting

• Familiarize posting staff with Payer list

• Majority are secondary payers

• Timing if Medicare has not yet paid and information

crossover

15

Centricity EDI Services

16

MPS File Manager

Note for this exchange, there are files from different trading partners, i.e. FL Medicare (flr1), Georgia MS Network (gac3), Anthem (us01) & Emdeon (usc2).

This ability is ‘new’ to eCommerce File Manager.

17

MPS Specific Setup & Edits

Payer ID CrossmapDictionary 19 Fields

o PAYERID*

o Default Paycode for EDI 835 Processing

Dictionary 120 Fields

o PAYERID*

o EDI 835 Payer Id

* Used for claims processing as well.

Payer ID Edits

Missing Payer ID

Payer ID Invalid for FSC

MPS vs Payment Automation

18

Both MPS and Payment Automation/Bank remit exchanges post multiple payers. What’s the difference?

Item Payment Automation

MPS Relevance

835/ERA Created by 3rd Party Vendor **from bank deposits, paper EOBs & 837/paper claim data.

True 835 created by the payer’s adjudication system.

File content issues

File Route Routed from 3rd Party Vendor **

Routed from multiple sources: end-payer, clearinghouse and/or remit-upload.

Missing Files & Checks

Payer ID (REF~2U)

Specified by 3rd Party Vendor **

Specified by the payer & GE835 Collab.

Edit=Missing Payer ID edit

Payer ID Crossmap

F61,2,7 Bank Remit Payer ID Crossmap (D3526), D19 and D120.

D19 and D120 Edit=Payer ID Invalid for FSC** Emdeon, BOA/Healthlogic, Suntrust/Medistream, etc.

Implementation/Support – Best Practice

19

Limit each MPS exchange to 10 payers

Low volume payers (~500 claims/month)

Payers of the same type (Commercial/BCBS/Medicare/Medicaid)

All payers selected/implemented at the same time

Ensure stable exchange before transition to support (no add-on)

Be mindful of the manual payment posting processComplete EFT enrollmentStop paper

Click to edit Master title style

21