Post on 03-Apr-2018
Automate Your EDI Transactions
for Significant SavingsAutomate your EDI transactions and achieve significant savings through
reduced investment in management and support
KEY TAKEAWAYS FROM TODAY’S SESSION
What does EDI automation mean? What is Administrative
Simplification?
Why does it matter and where can
it be applied?
What are the easiest ways to
achieve automation?
How do you put it all together to reduce EDI administrative effort, improve
operations and lower transaction costs?
EMPOWERING THE BUSINESS OF HEALTHCARE.
Dean Hill 25 years in healthcare
systems
Leads client delivery
team for EDI
transactions
Over > 450 X-12 client
implementations
Responsible for
conceptualizing and
tailoring EDI workflow
optimization for clients
Greg Sparhawk 27 years in IT Systems
Architecture/Management
14 Years in IT/EDI
Operations
Bob Kraus 24 years in info-security
and availability and
enterprise platform
Jamie Chesak 20 years of designing,
developing, and
supporting database
applications
Devotes professional
time to the architecture
of an integrated X-12
transaction engine for
healthcare PLEXIS
EDI Specialist Team
PLEXIS is trusted and built on partnership
EMPOWERING THE BUSINESS OF HEALTHCARE.
With years of experience developing and implementing EDI
solutions – we understand you and your business
KEY TAKEAWAYS FROM TODAY’S SESSION
What does EDI automation mean? What is Administrative
Simplification?
Why does it matter and where can
it be applied?
What are the easiest ways to
achieve automation?
How do you put it all together to reduce EDI administrative effort, improve
operations and lower transaction costs?
Let’s first start with
Administrative Simplification
then move to EDI automation
1
EMPOWERING THE BUSINESS OF HEALTHCARE.
WHAT IS ADMINISTRATIVE SIMPLIFICATION + WHY DOES IT
MATTER?
HIPAA was enacted in part to
reduce administrative overhead 1 2 EDI was the driver to achieve
savings
3Savings is realized by
completing all of the steps Implementing EDI
Defining the complete EDI workflow
process
Optimization: Identifying and removal of
bottlenecks
Automating Processes
Managing the exceptions and responses
4Automation is lifecycle process
workflow from beginning to end Accurate and consistent information
Faster error identification and remediation
Improved availability of systems
Increased usage and scalability
Measuring performance and results
Service Levels met or exceeded
Continuous process improvement
ROI/Cost
Savings for
automation of
EDI workflow
EMPOWERING THE BUSINESS OF HEALTHCARE.
1. End-to-end digitizing of the value chain
2. Eliminating paper across the whole system
to reduce errors and cost
3. Significantly speed up transaction
processing throughout the entire system
4. Cost transfer/reduction from full time
employee to platform automation
5. Deflection of customer support calls to
web-based self-service
6. Increased service levels to 24x7 via web-
based self-service
7. Reduce current EDI processing cost by
30-40%
EMPOWERING THE BUSINESS OF HEALTHCARE.
WHAT DOES EDI AUTOMATION REALLY MEAN?
Defined work flows
– cannot automate what is not defined
Technology Discipline
Communication - EDI is a two-way
Street
Performance Monitoring / Management
Code Files, Business Rule Maintenance
Visualization of the workflow
– cannot manage what you cannot see Rapid recovery of anomalies in the process
Automated Workflow
Secure FTP
Correct/Resubmit Encounter Data
Run ReportsAdmin Portal
Plexis Data and
Transaction Repository
Plexis EDI Transaction
Rules Engine
EDI X12 Encounter Data
Plexis ScheduledCMS Extract
CMS (Medicare)EDI Processing
Engine
EDI X12 Pended Encounter Data
CMS Accepted Encounter Data
CMS Accepts Encounter
Data?
Plexis CMS Job: Process
Encounter Data
Secure FTP
Payer
Update Database
EDI X12 Success Response
Secure FTP
CMS Encounter Data Processing
YesNo
Pend Encounter DataReply to Plexis
Accept Encounter DataReply to Plexis
MAO Reports
+
EMPOWERING THE BUSINESS OF HEALTHCARE.
WHAT DOES EDI AUTOMATION REALLY MEAN?
Defined work flows – cannot
automate what is not defined
Visualization of the workflow –
cannot manage what you cannot
see
Technology Discipline
Communication - EDI is a two-way
Street
Performance Monitoring
Maintenance of Code Files,
Business Rules
Automated Workflow
Secure FTP
Correct/Resubmit Encounter Data
Run ReportsAdmin Portal
Plexis Data and
Transaction Repository
Plexis EDI Transaction
Rules Engine
EDI X12 Encounter Data
Plexis ScheduledCMS Extract
CMS (Medicare)EDI Processing
Engine
EDI X12 Pended Encounter Data
CMS Accepted Encounter Data
CMS Accepts Encounter
Data?
Plexis CMS Job: Process
Encounter Data
Secure FTP
Payer
Update Database
EDI X12 Success Response
Secure FTP
CMS Encounter Data Processing
YesNo
Pend Encounter DataReply to Plexis
Accept Encounter DataReply to Plexis
MAO Reports
+
Workflow Scenario: Encounter Data
Automated Workflow
Automated Workflow
Secure FTP
Correct/Resubmit Encounter Data
Run ReportsAdmin Portal
Plexis Data and
Transaction Repository
Plexis EDI Transaction
Rules Engine
EDI X12 Encounter Data
Plexis ScheduledCMS Extract
Plexis CMS Job: Process
Encounter DataResponse
Secure FTP
Payer
Update Database
CMS Encounter Data Processing
Yes
EDI 999, 277, Other
Response Files
CMS Accepted Encounter Data
CMS Accepts Encounter
Data?No
Pend Encounter Data
Accept Encounter Data
CMS (Medicare)EDI Processing
Engine
Send Report File
Job #1: Scheduled Extract @ 1:00am. Log Event Start, Stop, Outcome
Job #2: File verification Run communication scripts to send file Log event Start, Stop, Outcome
Job #3: Monitor above, log reports and exceptions (check)
Job #4: Fine tune process based on results (adjust/improve)
3 HIGH IMPACT AREAS FOR
ACHIEVING EDI AUTOMATION
Customer
Service
EDI
DepartmentMonitoring
+
Reporting
EMPOWERING THE BUSINESS OF HEALTHCARE.
AUTOMATE CUSTOMER SERVICE
Implement workflow to support
automated portals – using X12
Example: Provider Portal
visibility to X12 Transactions
Main Ingredients Submit - Claims
Inquire - Claim Status
Verify - Eligibility and Benefits
Submit/Change - Authorization
for Service
Receive/Lookup - payment files
EMPOWERING THE BUSINESS OF HEALTHCARE.
AUTOMATE CUSTOMER SERVICE
Implement workflow to support
automated portals – using X12
Example: Provider Portal
visibility to X12 Transactions
Main Ingredients Submit - Claims
Inquire - Claim Status
Verify - Eligibility and Benefits
Submit/Change - Authorization
for Service
Receive/Lookup - payment files
Benefits of Automation:
Show workflow for automation of steps to
pull out Claims, Payments, Enrollment,
Messages
Provider Portals Automate a phone call
for status to customer service versus EDI
Identify the top 10 calls to customer
service
Transfer FTE expense to automation
investment
Portals: Provider; Member; Employer
EMPOWERING THE BUSINESS OF HEALTHCARE.
AUTOMATE YOUR EDI DEPARTMENT
Focus on highest impact transaction
volume - Encounter Data
Automate your external interfaces
for exchanging files
Show Workflow on Encounter Data
Submission and response handling
Introduce the EDI Gateway Solution
for automating EDI workflow
EMPOWERING THE BUSINESS OF HEALTHCARE.
AUTOMATE MONITORING +
REPORTING
Describe the specific tools that
need to be monitored in an
automated environment. Why it is
different.
Notification Management
Visual monitoring and remediation
of the response
Enabling the ability to see and track
submittals and response
Real-time and batch measurement
of EDI workflow
EMPOWERING THE BUSINESS OF HEALTHCARE.
AUTOMATE MONITORING +
REPORTING
Describe the specific tools that
need to be monitored in an
automated environment. Why it is
different.
Notification Management
Visual monitoring and
remediation of the response
Enabling the ability to see and
track submittals and response
Real-time and batch
measurement of EDI workflow
EMPOWERING THE BUSINESS OF HEALTHCARE.
Key Questions to Ask:1. How confident are you in understanding your EDI workflow?
2. Have you defined your complete workflows and documented them?
3. Do you utilize a solution to visualize EDI data workflow?
4. Have you identified your efficiencies or obstacles to full automation?
5. What is your fall-out on transactions submitted?
6. Do you have a performance management process?
7. Do you have additional questions or want to explore some ideas?
8. Would you be interested in follow-up 1:1 session with our subject matter
experts from today’s call?
AUTOMATING EDI: KEY QUESTIONS TO ASK
EMPOWERING THE BUSINESS OF HEALTHCARE.
FREE ASSESSMENTLet our EDI Specialists at PLEXIS help identify roadblocks
with your EDI workflows. Our free assessment includes:
Identifying common
symptoms of process
deficiencies
Prescribing best practices
for maximizing the value of
your data