A Deep Dive into the rollout of Eligibility and integration with ETM University of Alabama & Centricity™ EDI Services April 30, 2015

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. 2

 Introductions  Overview of University of Alabama  Eligibility Decisions  ETM Integration Design  Q&A 3

 University of Alabama at Birmingham  Debbie Rickett - Application Specialist   Roberta White – Lead System Analyst   GE Healthcare IT EDI Services  Cindy Pope – Software engineer  4

 Billing for 950 providers  ~120,000 visits per month  Verification percentage: 75%  $100M in charges, $27M in payments/month  150,000 claims per month  Clean claim rates of 95%

6

7

 Increased flexibility and efficiency when verifying and updating insurance information in GE Healthcare.  Ability to customize results screens and file data eligibility data back into the applications  To receive more benefit information, and in a more meaningful format. 8

9

 Centralized insurance verification team  Grouped Eligibility Request Definition (GERD)  Real Time Requests On demand  Ability to request and verify eligibility on primary, secondary and tertiary insurance.  Automated Filing of Patient Insurance Data and Outcome  Customer defined “needs review” criteria enables work-by- exceptions  TES, AVM and ETM integrated workflows 10

11

 GERD Setup  Results Screens  Needs Review Dictionary 12

 UAB created fifteen payer GERDs.  Appointment GERDs check eligibility before the visit creates to ensure the eligibility response information is correct upon visit.  Visit GERDs verify visits not created by an appointment. 13

 Result Screens can be customized by payer category. 14

15

16

17

 Eligibility was enhanced to allow the customer to create the Needs Review reasons in an Enterprise Dictionary (48957). 18

19

 The new functionality allows the users to easily view the specific NR Flag with the use of the ‘NR Review’ Action Code.  These indicators serve as a guide to what steps the user needs to take. 20

21

 GE has a standard starter set for Eligibility sent and Eligibility received task definitions 22

 We do not create tasks for real time verification  Our initial set up was for appointments and visits only  The eligibility sent was compared to the eligibility received to look for missing responses  Tasks were also created based on the eligibility status looking for rejected or inactive verifications 23

24

25

26

27

 DBMS GERDS were created to give further flexibility.  DBMS Queries written with specific criteria enables sending requests on a daily, weekly or monthly GERD. 28

 Queries allow incredible flexibility ◦ Medicaid appointments for the 1-10 th day of the month are not verified until the first day of the month as Medicaid eligibility is monthly, a query is used to pull the appointments and a GERD is used to verify ◦ Alpha splits can be used to match our credit letter cycles ◦ We use the queries to meet individual team needs and associate a GERD to the query 29

30  Example of charity care GERD query  Some fields such as MRN, name, SS# may be required to submit to your carrier

 Query for self pay patient to validate against Medicare. 31

 We have TES edits related to IMS questions populated by the eligibility response. Results of inactive or rejected with TES charges keyed to them are routed to the insurance verification team.  Blank verification IMS questions create a separate TES edit which is routed to a IT analyst workfile. These edit results are used in a query and verified via a GERD. ◦ A D19 field is used to indicate which FSCs are included in the GE Ecommerce Eligibility process and only those FSCs are included in the edit. 32

33

34

35

36

 With the GERDs we had a need to create tasks for active results in specific scenarios, anything but active in some, and based on the status and needs review flag results in others.  The analysts were monitoring the no response results through the GERDs not through the ETM views 37

 We were creating many tasks which either remained unused or required an agent to resolve or resolving tasks needed in our new workflow  Our new design created the tasks based on the specific needs of the GERD 38

39

40

41

42

43

44

45

46

47

48

49 GERD name and NR Reason columns

 An alert exists if the visit eligibility fields are blank  Previously we had alerts for rejected and inactive, these are now replaced by the eligibility tasks  The pre-arrival team works these alerts from ETM 50

Questions?

Thank you for attending Please take a minute to fill out a survey 52