SeBIN Overview Debbi Meisner, VP Compliance Emdeon Business Services November 28, 2007

Background On November 13th key stakeholders met to address implementation issues Outcome was a need to collaborate Decision was to form a regional organization under the Work Group for Electronic Data Interchange (WEDI)

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

Purpose of SeBIN Provide an impartial forum Establish opportunities for cooperation and collaboration Work closely with State Departments of Workers’ Compensation Facilitate effective and efficient information exchange and management. Support a network of regional stakeholders Coordinate outreach Identify and work through implementation issues Serve as a resource Coordinate recommendations, proposals and strategies. Provide an end-to-end panoramic view of the process from medical bill to payment. 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.

SeBIN Organization

Focus of Workgroups Attachments/Documentation Education/Outreach Identify Issues regarding the attachments needed to support eBills Work with HL7 and X12N to identify standards Propose solutions for current and future use Education/Outreach Identify educational opportunities and provide materials Propose ways to outreach to key stakeholders

Focus of Workgroups Connectivity Pharmacy Identify connectivity issues Propose testing guidelines Propose solutions Pharmacy Work with NCPDP to address issues regarding Pharmacy bills

Technology and Implementation Identify technology issues Work with X12N and HL7 to address technical issues Work with NUBC/NUCC to address content and paper form issues. Propose solutions

Goals for this meeting Identify Members Solicit volunteers for leadership Goal would be at least 2 co-chairs per workgroup Representing different stakeholders Determine Meeting Schedule Must be aggressive as end goal is January 1, 2008 Begin to identify and prioritize Issues Work toward consensus on each issue Voting within the workgroup Interim Solutions and/or long term solutions Work product of each group should be a published whitepaper addressing each issue with proposed solutions. Draft Whitepaper distributed to SeBIN and/or WEDI membership Final Whitepapers published on WEDI, IAIABC and SeBIN website and distributed to listservs.

Sample Whitepaper Issue: Data entry challenges Providers must key the data from the paper remittance into the system rather than auto posting. This may cause data entry errors. Claim adjustment reasons are often proprietary codes or text messages. This makes it difficult for the provider to send the right Claim Adjustment Reason Codes (CARC) in the secondary claim. Suggestion: As an interim step, the paper remits should move toward the use of the standard CARC to make the conversion from paper to electronics manageable. Payers should document their remittance advice codes and provide crosswalks for their providers through websites or other media.

Schedule Work Group Facilitator Time Attachments/Documentation Joseph Montoya Wednesday 3:00-3:45 Education Adam Thornsley Wednesday 3:45-4:30 Connectivity Sherry Wilson Thursday 8:00-9:00 Pharmacy Sue Thompson Thursday 9:00-10:00 Technology/Implementation Debbi Meisner Thursday 10:00-11:00

Questions??