Texas Workers’ Compensation Stakeholder Collaborative Effort Presented by Azadeh Farahmand November 13, 2007

Workers’ Compensation eBill Implementation Issues Workers’ Compensation is a “cottage industry” Volume in TX accounts for more than 5 million claims per year The cost in TX is $25.00 per claim Mainly paper based EDI mainly proprietary for eBill (no standards) TX and CA working with key stakeholders within IAIABC to develop national standards Shortage of resources Budget constraints Human capital implications for all stakeholders Lack of knowledge and/or experience Lack of staff Lack of understanding the lifecycle of a claim Competing priorities for resources Fragmented processes and systems States are mandating EDI eBill Implementation will occur regionally (jurisdictionally)

Proposed Solutions Form regional collaboratives to address implementation issues The regional implementation organization would have members from other national and regional agencies as participants to assist in timely resolution as issues are identified Continue to work with the standards development organizations to meet the needs of the Workers’ Compensation industry

Why Collaborate? Avoid the ‘re-inventing the wheel all over again’ syndrome Healthcare has established standards under the HIPAA Transactions and Code Sets Rule Designated Standards Organizations are established to develop and maintain these standards Standards are dependent on consistent policies, practices and technology among key stakeholders Acquaint workers’ compensation and healthcare with each others’ processes and practices Successful Implementation Coordination and collaboration among key stakeholders Business cooperation, interoperability resolution, and data sharing agreements Leads to cost–efficient implementation Penetration and administrative efficiencies that provide the primary benefits of EDI Fragmented and inefficient implementation will be costly to everyone

How do we collaborate? TX should work with existing organizations within healthcare and the IAIABC Workgroup for Electronic Data Interchange (WEDI) has established regional strategic implementation process groups (SNIP) IAIABC will join and collaborate with WEDI Use infrastructures already in place Request WEDI form a workgroup for Workers’ Compensation Develop Whitepapers to address national implementation Hold conference calls to create a forum for meetings Form Listservs for keeping members informed on activities

How do we collaborate? Apply for TX/CA Regional Workers’ Compensation SNIP Address regional workers’ compensation implementation issues IAIABC will join and collaborate with WEDI

Key Elements of a Collaborative Environment Mission Trust Stakeholder commitment

Mission Provide an impartial forum for coordinating necessary dialogue among stakeholders in the workers’ compensation medical bill payment and reporting arena Establish opportunities for cooperation and collaboration, compile industry input, identify barriers success factors, and document industry "best practices" for improving business processes. Facilitate effective and efficient information exchange and information management. Support a network of regional stakeholders needed for a coordinated national implementation. Coordinate outreach to other related industry initiatives, identifying information gaps and identifying strategies to fill those gaps. Identify implementation issues and work with appropriate stakeholders to resolve them and/or to facilitate resolution of ambiguities within standards and rules. Serve as a resource, in coordination with WEDI, IAIABC and other key stakeholders to help facilitate resolution of business issues arising from implementation. Coordinate recommendations, proposals and strategies. Provide an end-to-end panoramic view of the process from medical bill to payment.

Trust Joint ownership Joint accountability No dominant player Balanced interests No hidden agendas Neutral meeting ground

Stakeholder Commitment Government Agencies Medical Community Professional, Institutional, Dental and Pharmacy Professional Associations & Societies Payers, TPAs & Professional Associations Vendors Clearinghouses & Billing Agents, GPMS Vendors & CMS Vendors Other Technology Vendors Financial Institutions

Next Steps Get involved in the Regional WEDI-SNIP Affiliation Strategic eBill Information Network www.sebin.pbwiki.com Set up first meeting 11/28/2007 at 1:00- 4:30 CT 11/29/2007 at 8:00-11:00 CT Solicit leadership Present work completed and in progress National Implementation Guide TX Companion Guides Errata Clarifications Jurisdictional Requirements Outreach to key stakeholders to participate in the process Identify core workgroup to address implementation issues and provide recommended solutions as they arise

Questions?

Attachments

Workgroup for Electronic Data Interchange (WEDI) CORE PURPOSE Improve the quality of healthcare through effective and efficient information exchange and management. MISSION To provide leadership and guidance to the healthcare industry on how to use and leverage the industry’s collective knowledge, expertise and information resources to improve the quality, affordability and availability of healthcare. WEDI will achieve its mission by: Providing a forum for facilitating improvements in information exchange and management including the development of strategies and tactics, definition of standards, the resolution of implementation issues, identification of best practices and the development and delivery of education and training programs; Focusing the power of the healthcare industry on achieving improvements in information exchange and management; Assisting healthcare leaders to define, prioritize, build consensus and make decisions on the critical technical and business issues that affect the implementation and value of internal and external business process improvements; Ensuring thoughtful development and implementation of healthcare industry standards, policies and regulations; Serving as the primary catalyst for the identification, communication and resolution of obstacles that impede the growth of information exchange and management within healthcare; and Informing and educating WEDI members and other healthcare stakeholders about the benefits of and strategies for improving information exchange and management. http://www.wedi.org

Membership To ensure broad representation from throughout the health care community, WEDI actively seeks membership of all key parties health care EDI. WEDI membership classes are:  Individuals and eMembership * Providers  Healthplans  Hybrid Organizations (formerly Mixed Provider/Healthplan) ** Government Organizations  Standards Organizations  Vendors  Not-for-Profit Affiliates/Regional Entities ***     * The Individual and eMembership categories are for individuals from organizations with gross healthcare revenues below $500,000 who are interested in WEDI and its activities. **Hybrid Organizations are companies that have the characteristics of HealthPlans, Vendors and/or Providers and choose not to be identified solely in one of those categories. *** The Affiliate/Regional Entities category includes organizations with fewer than 150 employees that are regional or state affiliates of, and have a formal, legal or corporate structural relationship with a national Corporate Member organization which is a member in good standing of WEDI, or they may be an approved WEDI Regional Affiliate (WRA) entity, that supports WEDI's mission and does not qualify under any of the other Membership categories.

Benefits of Membership Provide you with valuable business contacts and information resources within the WEDI network of key industry and government decision-makers. Increase your personal competency and knowledge regarding electronic commerce in healthcare. Enhance your organization's competitiveness and recognition in the marketplace. Increase your organization's overall efficiency and 'bottom line' results. Keep you and your organization fully informed of the issues, options and strategies being reviewed, thus aiding you directly in your own corporate and organizational planning. Provide you with direct input into the process for identifying, developing, and implementing the policies and standards to be selected. 

What WEDI Provides Annual Conference - Each year, WEDI convenes industry and government leaders in a national forum focused upon issue briefings, policy updates, interactive discussions and educational topics. This event is highly valued as one of the industry's key sources for becoming informed and establishing important contacts with leading corporate and governmental decision-makers and suppliers. Educational Forums - In addition to the Annual Conference, WEDI conducts regional forums on a variety of issues impacting our members and the healthcare industry. These programs provide you with an opportunity to meet and interact with key decision-makers of the healthcare EDI industry and to get your views heard. The topics focus on subjects and regulatory actions of interest and importance to our members, and have recently included sessions on NPI, Claims Attachments, Real-time Adjudication, Privacy and Security issues, Inter/Intranet opportunities and challenges and updates stemming from HIPAA '96. Government Relations - Keeping our members informed of pending legislative and regulatory issues is a priority for WEDI. Our objective is to develop and maintain a two-way flow of information between regulatory officials and our membership. With the active assistance of our members, WEDI will monitor governmental activity at the federal and state levels, advising you of legislation and regulations that may impact your organization's business interests. We will ensure that the input and concerns of our members will be communicated to the appropriate officials in a timely manner. Information Access - Providing our members with information of value and relevance, is one of our major objectives. To do this, we utilize regional forums, our Annual Conference, the website, special member bulletins, 'white papers', PAG meetings, and other communication vehicles as appropriate. Your active participation as a WEDI member will ensure that you are fully informed on key industry issues and standards developments as they occur. Website - Information is one of our most important services! As a leading advocate of electronic commerce and communications, WEDI is committed to providing its members with timely access to information of value via its website. This is a key resource for you and your organization to receive information on industry meetings, educational programs, technical reports from our Policy Advisory Groups and committees, member benefits and services and legislative/regulatory updates.

Annual Dues Structure CATEGORY DUES GROSS HEALTHCARE RELATED REVENUES eMember $150 Less than $500,000 Individual $300 Affiliate/Regional Entity $500 Not applicable Government $1,000 Not-for-profit $1,000 $2,000 Less than $2,000,000 Over $2,000,000 For-Profit $1,000 $2,000 $3,000 $4,000 $5,000 Less than $2,000,000 $2.1 to $5,000,000 $5.1 to $10,000,000 $10.1 to $25,000,000 $Over $25,000,000

Strategic National Implementation Process (SNIP) Mission As an initiative of WEDI, WEDI SNIP will: Facilitate a collaborative, industry-wide approach and readiness to health information technology (HIT), clinical initiatives, and standards including those for security, privacy, EDI transactions, code sets, and identifiers. Foster implementation of HIT, HIPAA, clinical initiatives, and standards in a manner that preserves the confidentiality, integrity and availability of health information, while enabling efficient business processing.