Section 111 Reporting: What You Need to Know - IVANS · Section 111 Reporting: What You Need to...
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1 Section 111 Reporting: What You Need to Know Michael Schramm, Group Vice President Michele Hendy, Section 111 Project Manager
Transcript of Section 111 Reporting: What You Need to Know - IVANS · Section 111 Reporting: What You Need to...
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Section 111 Reporting:What You Need to Know
Michael Schramm,Group Vice President
Michele Hendy,Section 111 Project Manager
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Agenda
• IVANS role in the P&C / healthcare intersection
• Key requirements and critical CMS deadlines
• Common challenges
• Workflow-based model solution
• How IVANS Can Help
• Question and Answer
Section 111 Requires Knowledge of Two Industries
IVANS is Entrenched in : P&C and Healthcare
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IVANS Has Worked with Insurance Carriers for Over 25 Years
• Supporting hundreds of insurance carriers and 30,000 agents today
• Active participant in industry organizations
• Expertise in key industry standards (e.g. AL3, XML X12, ACORD XML)
• Solutions that integrate with nearly 40 agency management systems
• Millions of transactions managed each month
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IVANS Has Unique Knowledge of the Medicare Workflow
• Operate the largest healthcare network providing access to the Medicare Data Communications Network (MDCN)
• Provide networking and Medicare Access services to over 200 payers and 135,000 providers across the United States
• Active participant in industry organizations– Workgroup for Electronic Data Interchange (WEDI)– National Plan Automation Group (NPAG)– Committee on Operating Rules for Information Exchange
(CORE)– Centers for Medicare and Medicaid
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New CMS Regulation Requires Carriers to Report to the Centers for Medicare & Medicaid Services
• New Reporting Requirements– Section 111 is part of the Medicare, Medicaid, and SCHIP
Extension Act (MMSEA) of 2007– Focus is Medicare Secondary Payer Mandatory Reporting– Section 111 is intended to help CMS more accurately pay for
covered services to its beneficiaries
• Carriers providing coverage used to pay for medical claims may be affected. This includes:
• Worker’s compensation insurance• Liability insurance • No fault insurance
• Carriers that offer Automobile, Homeowners, and Commercial plans are likely to be affected.
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Section 111 Workflow
1. Insurers can submit a query file (in the ANSI X12 270/271 transaction) to CMS to determine Medicare eligible claimants
2. CMS returns a response file indicating Medicare eligible claimants3. The insurer submits an electronic quarterly report to CMS of all eligible
claimants after the claim is resolved4. CMS returns a claim response file with errors and corrections
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CMS Continues to Update and Clarify Reporting Requirements
• Version 2.0 of NGHP User Guide posted on July 31, 2009.
• Changes vary from basic code updates to defining complex scenarios that may require monthly monitoring– Reporting of multiple TPOC Amounts– Updated Claim Input Auxiliary Record– Updated Claim Response file layout– Addition of Reporting thresholds
• Additional changes may require non-standard processing
• Importance of solution that can change to meet future requirements
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All Carriers Need to Register by September 30 to Avoid Steep Fines
• Updated implementation dates– All insurance carriers that are Required Reporting Entities
must register the Coordination of Benefits Contractor (COBC) at CMS by September 30, 2009.
– Query testing for Registered RRE can begin on July 1, 2009. – Claim Input File testing period is January 1, 2010 through
March 31, 2010.– Production Claim Input file must be submitted in second
quarter 2010.
• Required Reporting Entities that incorrectly identify a claimant’s entitlement status and/or do not report to CMS are subject to a steep penalty of $1,000 per day, per claim.
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IVANS Encourages Carriers to Implement a Solution to Ensure Successful Reporting in 2010
• Process to define reporting structure and perform role assignment must take place prior to registering with COBC
• Data gap analysis critical component to understanding the impact to claims workflow
• Carrier must be prepared to capture and collect section 111 specific data elements prior to production deadline
• Testing process will entail more than just extracting sample data from claims system
• Today’s claims are impacted
Section 111: IVANS Workflow Solution
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Phased Approach and Workflow Solution Allows Carriers to Meet Deadlines and Requirements
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IVANS Solution was Designed with the Carrier and CMS Workflow in Mind
• Design – IVANS will design the most efficient process for reporting your data to CMS.
• Data Translation – This ensures appropriate data translation between your systems and CMS’ systems.
• Certification and Implementation – IVANS will conduct testing on query/response files, perform certification testing with the Coordination of Benefits Contractor, and set up production reports.
• Report Transmission – IVANS will ensure quarterly, automated transmission of your reportable data to CMS.
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IVANS Solution Ensures You Will Meet CMS Section 111 Requirements
• Core processes combined with logical path functionality handles non-standard workflow processes
• Facilitates rapid modification to specific workflow(s) with little impact on the other processes to meet new CMS requirements
• Provides full integration with Microsoft based products, such asthe reading, writing and creating of:– excel documents– word documents– PDF documents
• Also, supports the reading, writing to Microsoft Sharepoint
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Flexibility and Rule Application Provides Ability to Capture Supplemental Data and Task Management
• Multiple methods to initiate defined workflows provides ability to work with solutions your team is familiar with.
• Supplemental workflow processes provides ability to collect datanot captured in your current claim system
• Rules applications ensure thresholds are met while performing matching process
• Task Management provides dashboard insight to claims missing required data points with full escalation procedures
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Full Audit Capabilities and Business Activity Monitoring
Section 111: IVANS Will Ensure Your Project is a Success
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IVANS Helps you Meet Compliance Requirements with Minimal Effort
• Over 25 years of insurance data translation and reporting solutions for property-casualty companies.
• 20 years experience in delivering Medicare access and eligibility solutions to the healthcare community
• Understand the importance of accurate, compliance reporting to help avoid fines and damage to your business.
• We understand that building a new compliance solution is necessary, but probably not a core focus of your business.
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IVANS Experience Ensures a Sound Solution
For Section 111 reporting, IVANS solution handles:
• Fast track compliance – By taking advantage of IVANS experience, you can easily complete the project within the reporting deadlines.
• Reduce risk – Because we have expertise in data translation and Medicare, we can design a solution that supports compliance needs.
• Minimize resource constraints - IVANS can handle the majority of the project workload, minimizing the time required of your resources.
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Contact IVANS to Get Started Quickly with Section 111 Reporting
Sales Contacts:Neal Quiros, Solutions ExecutivePhone:407-464-1000E-mail: [email protected]
Mark Gordon, VP SalesPhone: 813-288-3227E-mail: [email protected]
Chat Online:www.ivans.com
Call:1-800-548-2690
E-Mail:[email protected]
Get More Info:www.ivans.com/Section111
