MPS – Multi-payer Remit Solution Gerry Santos, Centricity™ EDI Services Chuck Heidbrink, Meridian Medical Management

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Centricity EDI Services

What is MPS? Current vs. Future State The Multi-payer Remit Solution (MPS) is a remit exchange that is largely the same as a traditional remit exchange. Functionally it is 90% the same to the end-user with the following differences in its intended use. Current vs. Future State TRADITIONAL MPS SINGLE PAYER MULTIPLE LARGE VOLUME PAYER SMALL VOLUME PAYERS Why? MPS can address the client’s goal to be 100% electronic. The traditional remit exchange is neither economical or manageable to serve the 10,20,30,etc. small volume payers a client want to post electronically.

Client ABC with MPS Client ABC with MPS 5 Traditional 2 MPS MPS Commercial 2 Natl Benefit Fund, MetroPlus, Affinity Health Plan, POMCO, Pyramid, Midwest National Life, Gateway Health, WebTPA MEDICAID 5 Traditional 2 MPS

Meridian Medical Management

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About Meridian, the Company Previously Owned by IDX 2006 - IDX was acquired by GE Healthcare 2013 – Meridian purchased by Gores Group 2014 – Meridian expanded business through purchase of Origin Privately owned and operated Meridian Vision Service Culture Discipline Growth

Meridian Medical Management Services

Multi – Payer Statistics Goals: Reach electronic posting percent of 90%+ Reduce effort, cost, inaccuracies Greater EOB access Measures: 150,000 Total EOBs per month 1,500 MP EOBs per month Increase in electronic posting 2% per month

Multi – Payer Identification Use Monthly eCommerce Emdeon Outstanding Enrollment Data list Easy source for new payers already sending 835 to Emdeon Review Emdeon Payer List https://access.emdeon.com/PayerLists/ Review Paper EOBs into office for ERA possibilities

Multi – Payers Payer Payer ID Alliant Health Plans 58234 American Republic 42011 Amerigroup 27514 Assurant Health 39065 Benefit Admin Systems 36149 Gateway Health Plan 25169 GEHA 44054 GHI Emblem Health 13551 HIP of New York 55247 Payer Payer ID Medical Mutual 29076 Medico Ins Co. 23160 Mutual of Omaha 71412 National Benefit Fund 13162 POMCO 16111 TransAmer/Chesapeake 59221 USAA Life 75895 WebTPA 75261

Multi – Payer Lessons Understand valid FSCs for each payer Monitor edit list for any payer/FSC combinations not posting Familiarize posting staff with Payer list Majority are secondary payers Timing if Medicare has not yet paid and information crossover

Centricity EDI Services

MPS File Manager Note for this exchange, there are files from different trading partners, i.e. FL Medicare (flr1), Georgia MS Network (gac3), Anthem (us01) & Emdeon (usc2). This ability is ‘new’ to eCommerce File Manager.

MPS Specific Setup & Edits Payer ID Crossmap Dictionary 19 Fields PAYERID* Default Paycode for EDI 835 Processing Dictionary 120 Fields EDI 835 Payer Id * Used for claims processing as well. Payer ID Edits Missing Payer ID Payer ID Invalid for FSC

MPS vs Payment Automation Both MPS and Payment Automation/Bank remit exchanges post multiple payers. What’s the difference? Item Payment Automation MPS Relevance 835/ERA Created by 3rd Party Vendor ** from bank deposits, paper EOBs & 837/paper claim data. True 835 created by the payer’s adjudication system. File content issues File Route Routed from 3rd Party Vendor ** Routed from multiple sources: end-payer, clearinghouse and/or remit-upload. Missing Files & Checks Payer ID (REF~2U) Specified by 3rd Party Vendor ** Specified by the payer & GE835 Collab. Edit=Missing Payer ID edit Payer ID Crossmap F61,2,7 Bank Remit Payer ID Crossmap (D3526), D19 and D120. D19 and D120 Edit=Payer ID Invalid for FSC ** Emdeon, BOA/Healthlogic, Suntrust/Medistream, etc.

Implementation/Support – Best Practice Limit each MPS exchange to 10 payers Low volume payers (~500 claims/month) Payers of the same type (Commercial/BCBS/Medicare/Medicaid) All payers selected/implemented at the same time Ensure stable exchange before transition to support (no add-on) Be mindful of the manual payment posting process Complete EFT enrollment Stop paper

Thank You Team Meridian Medical Management Chuck Heidbrink Jason Gauthier EDI Services Leyla Alnasrawi Kim Bruce Alan Buck Chris Doucette Jennifer Gardner Shannon Kennedy Kate Ketelaar Jon McKay Catherine Moller Gerry Santos Don Willer Nina Zdravev