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

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4. Centricity EDI Services

5. 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.

6. 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

7. Meridian Medical Management

8. 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.

9. About Meridian, the Company
Previously Owned by IDX
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

10. Meridian Medical Management Services

11. 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

12. 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
Review Paper EOBs into office for ERA possibilities

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

14. 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

15. Centricity EDI Services

16. 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.

17. 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

18. 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.

19. 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

20. 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