Advisory working group ebilling with ndchealth
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Advisory Working Group eBilling with NDCHealth. Begin with the end in mind. - Stephen Covey. Wednesday, 3 August 2005. Agenda. Introductions NDCHealth and EDI Processing Installation Industry Comparison Importance of eBilling and the DoD Success with DoD Installations

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Advisory Working Group eBilling with NDCHealth

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Advisory working group ebilling with ndchealth

Advisory Working GroupeBilling with NDCHealth

Begin with the end in mind.

- Stephen Covey

Wednesday, 3 August 2005

Attachment #8


Agenda

Agenda

  • Introductions

  • NDCHealth and EDI Processing

  • Installation Industry Comparison

  • Importance of eBilling and the DoD

  • Success with DoD Installations

  • Challenges with DoD Installations

    Revenue Cycle Management


Introductions

Introductions

  • [Name Redacted]:

    • Senior Director, Product Management

    • Former Manager of Technical Support

  • [Name Redacted]:

    • Manager, EDI Implementation and Programming

    • Former Trainer and Project Manager


Ndchealth and edi processing hospital applications and services

NDCHealth and EDI ProcessingHospital Applications and Services

  • Hospital Installations

  • Other Sectors

    • Retail Vision

    • Nursing Homes

    • Durable Medical Equipment

    • Renal Dialysis Centers

  • Annual Transactions

    • 150M Claims

    • 40M Remittance Transactions


Advisory working group ebilling with ndchealth

The NDCHealth Vision

An Ongoing Commitment to Excellent Customer ROI

  • Patient Quality of Life

  • Customer ROI

  • Improved Outcome

  • Real-time ‘decisioning’

  • Messaging

  • Compliance

  • Enhanced Insight/Enabling

  • Workflow enhancement/improvement

  • Deeper and more granular information

  • Unmasking transactional information

  • Information Foundation

  • Accuracy

  • Speed

  • Responsiveness

  • Claims

  • Editing

  • Fraud/Abuse

  • Adjudication

  • Systems

  • ePrescribing


Total hospital solution epremis

Total Hospital Solution: ePREMIS®

Encounter

Eligibility

Medical Necessity

Post-Service

Pre-Service

Claims Management- Medicare Direct Entry

Remittance Management

MedPrint Statements

Xchange

Claims Status

Eligibility

Medical NecessityPre-Certification/Referrals/Auth.’s

Professional Services, Claims Management Optimization Services, Services & Support

Continuum of Care/Revenue Cycle

NDCHealth Intelligent Network Transaction Delivery

NDC ePREMIS Claims Management Editing

Medical Records Registration

Claim Generation

Charge Assembly

Registration

Admissions

Encounter

NDC ePREMIS Solutions Throughout the Continuum of Care


Current hospital health system customers

Current Hospital/Health System Customers


Installation industry comparison

Installation Industry Comparison

  • Civilian Similarities to DoD Billing

    • Comparable Claim Content Requirements

    • Paper Claims @ 10% of Volume

  • Non-Government Claims

  • Streamlined Processes

    • Single System

  • Revenue Cycle Management

    • Integrated End to End Process


How d we get here

How’d We Get Here

  • Late 1980’s Industry adoption of Electronic Claim Delivery

  • Migration of Claims from Paper to Electronic

  • Advantages of Electronic Billing

    • Faster Delivery

    • Standardization & Automation

    • Delivery Confirmation


In dod terms by comparison

In DoD Terms - By Comparison

Paper Billing is to Electronic Billing

  • As Hang-Gliders are to Fighter Jets

  • As Horses are to Armored Personnel Carriers

  • As Rowboats are to Aircraft Carriers

    - Anonymous


Importance of ebilling and the dod

Importance of eBilling and the DoD

  • Streamlining of Billing Processes

  • Consistency of Data Delivery and Retrieval

  • Audit Trails

  • Security

  • Reporting

  • Automation of Workflow

  • End-User Adaptability

    More Money, Earlier


Proven deployment method

Proven Deployment Method

  • Installations

    • Over 500 ePREMIS Implementations Live

    • 150 Currently Being Implemented

  • 3 Years of ePREMIS Implementation Experience

    • Quality Driven Process

    • Continuous Self Assessment and Review of Client Feedback

  • Seasoned Implementation Team:

    • 80% from PREMIS Implementation Staff

    • 10% from PREMIS Customer Support

    • 10% from New Hires


Success with dod installations

Success with DoD Installations

  • William Beaumont – Fort Bliss:

    • ePREMIS Full Installation

    • April 2005 – On-Site Training

  • Gunther Air Force Base:

    • Multiple Sites with Signature Performance

    • July 2005 – Remote Training

  • Sites Currently Live:

    • 13 Live on ePREMIS

    • 22 Live on XChange to be upgraded to ePREMIS


Challenges with dod installations

Challenges with DoD Installations

  • Enrollments

  • Workstation Configuration

  • End-User Training

  • Process Change

    Same as Civilian


Four phases of epremis implementation

Four Phases of ePREMIS Implementation


Epremis baseline functionality

ePREMIS Baseline Functionality

  • Web-delivered claims management system

  • Interactive user interface

  • Process Driven Workflow

  • Validates claims against payer requirements

  • Handles electronic and paper claims

  • On-demand and automated reporting

  • Assists hospitals in controlling their financial performance by automating routine tasks

  • Facilitate Follow Up


Transaction flow

Transaction Flow

  • TPOCS Generates Claim File(s)

  • Claim Submission

  • Event Driven Automation

    • Error Identification

    • Create Reports

  • Error Free Claims Released to Clearinghouse

  • Payer Response & Remittance Follows


User experience

User Experience

  • Home Page with Message Delivery Center

  • Interactive Claims Screen

  • Address & Analyze Errors

  • Exception Based Intuitive Navigation within Claims

  • Graphical

  • On-Demand Reports

  • On-Line Interactive Help


User experience1

User Experience

  • Event Messaging

  • Menu Driven


Interactive claim replica

Interactive Claim Replica


Four requirements to proceed with epremis go live

Four Requirements to Proceed with ePREMIS Go-Live

  • Enrollments Finished

  • Workstations Configured

  • Claim Files Tested

  • Preliminary Training Completed


Questions and answers

Questions and Answers


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