CAQH®CORE™Phase II Certification Testing Status Report...Certification Testing Status Report Herb...
Transcript of CAQH®CORE™Phase II Certification Testing Status Report...Certification Testing Status Report Herb...
Edifecs confidential © 2002-2008
CAQH® CORE™ Phase II Certification Testing Status Report
Herb Larsen, SVP Alliances
Edifecs confidential © 2002-2008
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Edifecs Corporate Summary:
Leader in Compliance, Quality & Interoperability Solutions for Improving Business Performance
Partners
• Data Quality and Compliance Adaptors: Improve the quality of
transactional data, and ensure compliance with government, industry and community standards• Healthcare Transaction Gateway: Healthcare-centric, real-time, standards independent, multi-channel port that manages all transactional data
Solutions
Global Markets: Over 1,100 top-tier accounts in banking, insurance, securities, utilities, and high tech.
Healthcare: Over 350 clients
Customers
Bellevue, WashingtonHeadquarters
1996 (12 years), Privately HeldEstablished
Headcount ~100 (75 in Products & Engineering)
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Edifecs Healthcare Market Leadership: 350+ Customers/Partners
ACSAmisys-SynertechAvaility
CAQH/CORECSCClaimsnetCNSIEDSEmdeonEnCoreENSFox SystemsIBMInmediataMedAvant/ProxymedMicrosoftMSIOAO HealthcareOraclePerotPost-N-TrackQuovadxSunTIBCOUnisys
Blue Plans
Total Client Base: 24
BCBS AssociationBCBS AlabamaBCBS ArizonaBCBS ColoradoBCBS FloridaBCBS GeorgiaBC IdahoBS IdahoBCBS Kansas CityBCBS LouisianaBCBS MinnesotaBCBS MissouriBCBS Northeastern NYBCBS NevadaBCBS New JerseyBCBS North CarolinaBCBS North DakotaBCBS OregonBC NE PennsylvaniaBCBS NevadaBCBS TennesseeBCBS UtahBCBS W NYBS WashingtonCarefirst BCBS
Total Client Base: 30+
CMS Enforcement
CMS Eligibility Alaska MedicaidCalifornia Medicaid
CalOHIColorado Medicaid
DC MedicaidFlorida Medicaid
Georgia MedicaidKentucky MedicaidMaine Medicaid
Maryland MedicaidMichigan Medicaid
Minnesota MedicaidMississippi MedicaidNebraska Medicaid
New HampshireNew Jersey Medicaid
New Mexico MedicaidNew York Medicaid
North Dakota MedicaidOregon MedicaidSouth Carolina Medicaid
Tennessee MedicaidTexas Medicaid
Washington MedicaidWest Virginia MedicaidWyoming Medicaid
TriCare
Government
Total Client Base: 100+
Providers / Hospitals
Abbott LaboratoriesACMAllina Hospitals and ClinicsBanner Health SystemsBaylor HealthCaremark InternationalClinical Labs of HawaiiFairview Health SystemFreseniusGambroIndian Health ServiceJohn Muir/Mt. Diablo Health System (JMMD)Mass Eye & EarMeridian HealthcareMethodist HospitalMilitary Health (DoD)New England MedicalNovasysPark NicolletPharMericaScott & White MemorialTMCMedVeterans Affairs
Total Client Base: 100+
Commercial / Others
BMC HealthNet
CansecoCigna
Delta Dental of CAGHI
Great West LifeGroup Health CooperativeHealthPartners
Health NetHarvard Pilgrim
HealthPartnersKaiser PermanenteLA Care
MagellanMatria
MedicaMolina Healthcare
MedAvant/ ProxyMedPayformanceTMG Health
Tufts Health PlanUnicare
United HealthcareValueOptionsViPS
WEA TrustWellcare
WorkscapeWPS
Total Client Base: 100+
Edifecs is the Market Leader24 Blue Plans
30+ Government100+ Payers
100+ Provider100+ Partners/Vendors
Edifecs is the Market Leader24 Blue Plans
30+ Government100+ Payers
100+ Provider100+ Partners/Vendors
Clearinghouses / Vendors And Partners
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Stakeholders Who Have Tested CORE Phase I with Edif ecs – 93%
� ACS EDI Gateway
� Aetna
� AthenaHealth
� Anthem/WellPoint
� AultCare
� Availity
� BCBS of North Carolina
� BCBS of Tennessee
� CSC Consulting
� Emdeon
� EmergingHealth
� GE Healthcare
� HMS
� Mayo Clinic
� MD On-Line
� MedAvant
� MedData
� Medical Information Engineering
� Montefiore Medical Center
� NaviMedix
� NoMoreClipboard
� Passport OneSource
� Post-N-Track
� RelayHealth
� SSI
� SureScripts-RxHub
� VisionShare
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Edifecs Invests in its Relationship with CAQH-CORE
� No-Cost Product Access and Development Effort
� No-cost Access to CORE Testing Portal powered by Ed ifecs Ramp Management for Stakeholders
� No-cost Access to Edifecs SpecBuilder rules develop ment tool for CAQH and its consultants
� Phase II Deliverables:
• Active participation in all rule development confer ence calls
• Ongoing Alpha and Beta support
• Over 1000 developer & business analyst hours for Ph ase II to date
• Enhanced product functionality to meet all CAQH-COR E Phase II-specific requirements
• Connectivity (Client and Server sides)
• Dynamic test data generation
• Dedicated Support for Phase II testing entities
• Visual/Manual inspection by Analyst for Uploaded Ve rification Artifacts
� Currently in Alpha Testing, Beta Completion in Octo ber
� Production Anticipated in November, based on Beta feedback
� Edifecs is Committed to Continue Supporting CAQH
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Edifecs Product Overview
TRANSACTION GATEWAY SOLUTIONS
� Transaction Management� Visibility, Accountability, Alerts, Reporting, Trading
Partner Management/Maintenance
� Claims Correction� Business-Friendly Views, with Facilitated Error
Correction by non-technical Partner Staff
� Ramp Management� Trading Partner Testing and Enablement
� USED FOR CORE TESTING
DATA QUALITY & COMPLIANCE SOLUTIONS
� SpecBuilder� Rules and Edits Management, test data generation,
desktop testing and guideline publishing
� USED FOR CORE TESTING
� XEngine� Runtime Validation, splitting, routing and error
reporting
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Edifecs Phase II Demonstration