Confidential | Copyright © 2014 TriZetto Corporation 1

2 Executing Your Plan for QicLink™ 5.0 Presented by: Ron Gripon, Rodney DeClerk and Stephen Weir

Confidential | Copyright © 2014 TriZetto Corporation 3 Why 5.0 ?  Compliance  Efficiency  Compatibility  Future Considerations  Services

Confidential | Copyright © 2014 TriZetto Corporation 4 Compliance  ICD-10 Code sets  Full 5010 Transaction integration  CAQH/CORE Transactions  X12-270/271, X12-276/277  X  EFT transactions

Confidential | Copyright © 2014 TriZetto Corporation 5 ICD-10 Setup Checklist  ICCLOAD – Load ICD Code Sets  ICMSM – Establish Mapping Set ID  ICMLOAD – Load Code Mappings  MM/MMCAT – Update/Add CBX Categories  ICMM – Establish/Maintain Code Mappings  SN-3 – Add ICD-10 Date and Mapping Set ID  PlanBuilder – Mapping Set to Override SN-3  Optional  CEPM routing controls

Confidential | Copyright © 2014 TriZetto Corporation 6 Load & Manage ICD Codes / Mappings  ICD Code Load (ICCLOAD)  Load both ICD-9 and ICD-10 Diagnosis and Procedure codes  ICD Mapping Set Maintenance (ICMSM)  Establish and maintain mapping set IDs  ICD Code Mapping Load (ICMLOAD)  Load mappings of  ICD-9 codes to ICD-10 codes  ICD-10 codes to ICD-9 codes  ICD Code Mapping Maintenance (ICMM)  Establish and maintain code mappings  ICD Code Translation (ICT)  Inquiry of mappings New ICD Programs

Confidential | Copyright © 2014 TriZetto Corporation 7 ICD Code Mappings  No industry standard crosswalk map  CMS adopted GEMS  QicLink used GEMS for crosswalk solution testing  95% of codes mapped  Bi-directional mappings  From ICD-9 to ICD-10  From ICD-10 to ICD-9  Includes one to one, one to many, and many to one mappings

Confidential | Copyright © 2014 TriZetto Corporation 8 Efficiency  ICD-10 setup, load, and mapping programs  Full 5010 Transaction integration  835 segment conformity with EFT re-association compliance  CAGC, CARC and RARC code set mapping and integration  Real-time incoming 270 and 276 transactions  Real-time response 271 and 277 transactions

Confidential | Copyright © 2014 TriZetto Corporation 9 Efficiency  Performance enhancements 5.0  Check cycles  Load programs, pmload, emload  Reporting programs  Web Customer Service Module  Normalization of QicLink data  Current and future Microsoft products/platforms  Windows 2008 and SQL2012 .Net framework 4.0 and Fujitsu Cobol 4.1  Windows Connection Foundation (WCF) transport layer

Confidential | Copyright © 2014 TriZetto Corporation 10 CAQH CORE

Confidential | Copyright © 2014 TriZetto Corporation 11 What is CAQH CORE?  The Council for Affordable Quality Healthcare (CAQH) is an American non-profit organization that collaborates with healthcare providers, trade associations, and insurers. The organization is based in Washington, DC  The Committee on Operating Rules for Information Exchange (CORE) is a multi-stakeholder membership group organized and facilitated by CAQH.

Confidential | Copyright © 2014 TriZetto Corporation 12 Types of CAQH CORE Transactions Phase I and II  270/271 – Eligibility (real time)  276/277 – Claim (real time) Phase III  Electronic Funds Transfer (EFT)  835 Remittance Advice (ERA)  QicLink™ 5.X supports Phase I, II and III transactions.

Confidential | Copyright © 2014 TriZetto Corporation 13 Types of CAQH CORE Transactions Requests/Inquiries  QicLink™  Without HIPAA Gateway  With HIPAA Gateway  Web Service (Real time or Batch)  Without HIPAA Gateway  With HIPAA Gateway

Confidential | Copyright © 2014 TriZetto Corporation 14 CAQH_CORE Web Requests Compliance Checker In 270/276 Out 271/277

Confidential | Copyright © 2014 TriZetto Corporation Processing  Executing HIP835C  HIP835C will continue to do what it does today for both Gateway and non-Gateway  New with CAQH CORE  Whether you are Gateway or Non-Gateway a new table called QL835Trans will also house the transaction data  (ETL) extract, transform, and load process  A SQL job moves the 835 records to the CAQH CORE DB.  This ETL process also moves the claims and eligibility data for 270 and 276 requests.

Confidential | Copyright © 2014 TriZetto Corporation / 276 Web Request  Submitted via HTTP/Soap request to QCC Services  Elements needed by QCC Services  Correct Login  Correct Password  Correct File Layout  QCC Services replies with an 271 / 277

Confidential | Copyright © 2014 TriZetto Corporation 17 Repository Inquiry Tool

Confidential | Copyright © 2014 TriZetto Corporation 18 Inquiry tool: Criteria screen

Confidential | Copyright © 2014 TriZetto Corporation 19 Inquiry tool: Display results

Confidential | Copyright © 2014 TriZetto Corporation 20 Compatibility

Confidential | Copyright © 2014 TriZetto Corporation 21 Compatibility  QicLink™ 5.0 is the platform for future functionality enhancements and Regulatory requirement enhancements  3 rd party software  Maintain compatibility of current versions  Trading Partner Compatibility  Minimize step-up/step-down issues  Current data file formats for data exchanges (ECISF, 834)  QicLink 4.20 Core enhancement and performance enhancements limited

Confidential | Copyright © 2014 TriZetto Corporation 22 Compliancy

Confidential | Copyright © 2014 TriZetto Corporation 23 Future Considerations?

Confidential | Copyright © 2014 TriZetto Corporation 24 Resources  Centers for Medicare & Medicaid Services d10  2014 ICD-10-CM and GEMS  2014 ICD-10 PCS and GEMS  Customer Exchange  How to Corner:  QicLink™ e2 Corner  Did You Know?  ICD-10 Corner  835 setup  QicLink 5.00 Documentation

Confidential | Copyright © 2014 TriZetto Corporation 25 Services  TriZetto Services  QicLink™ 5.X Technical Consulting  Project Management  Automation / Operational Reviews  ICD-10 Implementation  835 Implementation  CAQH CORE Implementation  Custom Development

Confidential | Copyright © 2014 TriZetto Corporation 26 Workshop Survey We would like to extend you an opportunity to provide candid feedback. During the workshop you should have received an notification for you to take an on-line survey. If you could take a few minutes to complete at this time, we would greatly value your feedback. For your convenience, the survey will be available throughout the remainder of the conference should you not be able to complete immediately.

Confidential | Copyright © 2014 TriZetto Corporation 27 Thank You!