In this webinar we cover the new and exciting product innovations from the Centricity EDI team. We also share how our customers have improved their A/R and collection rates with the use of these solutions.

1. Centricity
Clearinghouse
Overview
Presented by:
Jason Porter, HealthCo Information Systems

2. Today’s Presenter
Jason Porter
Vice President
HealthCo Information Systems

3. • National Partner for
GE Healthcare
• Support thousands of
physicians in their use of the
Centricity EMR/PM platform
• Founded in 1997
• Located in Portland,
OR
• Mission to improve
patient care and
financial performance
of independent
physician practices

4. Centricty EDI Services

7. Product Overview:
Hosted Claim Manager

8. Product Overview:
Denials IQ
Powerful algorithm analyzes claims data weekly to
provide dashboards that reveal denial trends by
code, payor, physician, location and a number of
other categories, allowing the clinic to rework
denials in bulk and set rules via HCM to prevent
these denials in the future.

9. Agenda
9
• Welcome
• Centricity EDI Services Overview
• Hosted Claims Manager and DenialsIQ™
• What is Next?
• Summary

10. Introduction to
Centricity EDI
Services

11. Switching Clearinghouse’s Is a PAIN…Right?
11
Situation: Using non-integrated CH and
experiencing reduced cash flow, higher than
desired AR and denial rates.
Fix: Converted to the CEDI platform for
Claims, Remit, Eligibility, HCM and DIQ
Results:
“The transition was beyond easy, it was a
smooth process. The HealthCo
implementation team even monitored my
first week of claims to make sure there were
no glitches.
Our collections have improved by over 20%
and the doctors are VERY HAPPY!”
Clinic Profile:
2 Ortho Surgeons
1 PT
2 locations including an ASC
Contact:
Melissa Miller, Billing Manager
mmiller@prairiespine.com

12. EDI Services integrates payer information
directly into the financial management process
$220B
Processed annually by Centricity EDI
Services
620M
Transactions processed annually by
Centricity EDI Services
10+ Years
Staff average EDI experience
Claim Submission Payer Integration
Advanced Payment
Tracking
Analytical
dashboard
Analytics
Denial & rejection
management
Auto Claim Status
Inquiry
Payment
Automation
Claim Scrubbing
Eligibility2,100+
Clients utilizing EDI Services from GE
Healthcare

13. Service model
GE Healthcare Service Model
• Single vendor solution
• We design, build, and maintain transaction setup
• GE Healthcare provides All Payer Connectivity
• 24/7 Production Control monitoring on all transactions
Proactive Monitoring & Support
• Production Control Team
• Monitoring Tools
• Performance Metrics
Integration
• Built-in to Practice Management System
• Centricity EDI is part of core workflow
Focus on Revenue Cycle:
• Payer Edits
• Claim Scrubbing
• Clean Claims
• Reduce Rejected Claims
• Reduce Denied Claims
• Reduce days to Payment
• Increased cash flow
Work Flow Efficiency:
• Automation
• Reduce Re-work
• Improve process

14. Centricity EDI
Services Overview

15. Insurance eligibility checking
15
Centricity EDI’s Eligibility
Verification allows customers
to utilize a highly automated
exception-based workflow to
quickly verify patient eligibility
• Why Eligibility:
• Improve customer’s ability to collect full or partial
payment (copay to deductible)
• Inform the patient of their financial responsibility
at the time of arrival – particularly with High-
deductible Health Plans (HDHP)
• Prevention of rejections & denials
• Reduce labor costs and improve productivity
(fewer phone calls!)

16. Centricity EDI Services: Transaction Flow
HTTPSCentricity PM
Centricity® EDI
Services Real-
time Data Center
Centricity EDI Services owns setup and
ongoing maintenance
Full integration with Centricity PM
Real-time Production Control 24/7
Store and Forward
EHNAC and CORE
Payer
Trading Partner
Payer
Payer
Payer
Payer
271 Response
270 Request
Payer
Transactions monitored for response and timeliness
Average response time is 10-20 seconds

17. Centricity Practice Solution integrated
eligibility workflow
17

18. Insurance claim submission
18
Customers utilizing GE’s claims service
enables an integrated, complete
workflow coupled with near 100%
electronic coverage
Why Electronic Claims:
• High % of electronic claims saves money
• EDI Dashboard for real-time file and claim tracking
• Extensive claim, remittance, and denial reporting
• Integrated product ensures efficient workflow and
follow-up
• Proactive monitoring reduces insurance follow-up
time
• Same day delivery of claims & acknowledgement
reduces cycle time

19. EDI Dashboard
• Real-time insight into claim and remittance tracking
• Centralized view of payer mandate updates
• Summary of top rejections and denials
• Detailed insights into payer rejections as well as suggested actions

20. Claim file tracking
20
Production Control

21. Payer Edit Integration (PEI)
21
Integration of front-end
(pre-adjudication) edits received
from clearinghouse and/or payer
Provides integration into the Claims
Tab while updating the status of
tickets
Why Payer Edit
Integration:
• Insurance follow up from Centricity Practice
Solutions
• “Root cause” reporting from Centricity Practice
Solutions
• Reduction in rejection rate
• Improves resolution time and reduce time to
completion
• Integration with Centricity Practice Solutions

22. Integrated EDI edits in Centricity Practice Solution

23. Electronic remittance advice
23
Centricity EDI Services remittance submissions
provides near 100% electronic remittance
transactions posted directly into your practice
management system
Integration enables standardized denials and
high auto-post rates
After posting, standardized analytics to help
you identify denial trends
Why Electronic
Remittance :
• A connected product supports more efficient
workflow and follow-up
• Labor savings by automatically posting and
integration
• Use of standard denial codes to drive automation
and process improvement
• Same-day delivery supports faster follow-ups
• Extensive ERA file history and check summary
reporting
• Ability to re-queue missing ERA files on the fly

24. Payment posting integration

25. ERA file history & check summary
Reconciliation and real-time file tracking made easy

26. Remit Summary – Denial Category
Customize denial reporting to identify workflow inefficiencies

27. Hosted Claims Manager
and DenialsIQ

28. Claim scrubbing
28
Hosted Claims Manager is a rules-
based, front-end clinical editing
tool that allows you to review
claims before submission
Reduce claim denials
Shorten your accounts receivable
cycle
Increase the rate of collections
• Why Hosted Claims
Manager:
• $25 average cost per claim
for rework*
• 15% industry average for
claims that are rejected or
denied*
• Clinical edits are integrated
into your approval process
• Real time response
• Rules updated bi-weekly
• Low implementation effort
* Source: Optum, 2015

29. Claim scrubbing
29
• Proven, industry-leading clinical editing engine including LMRP/NCD/LCD
• Edits can be created specific to your local payers guidelines
• Edits can be turned off if not needed
Submit
Correct
Scrub

30. Clinical edits...What are they?
 Duplicates
 Established/New Patient
 Medicare Local Coverage
Determinations/ National Coverage
Determinations (LCD/NCD)
 Correct Coding Initiative Edits
(CCI)
 Bundling Edits
 Modifier relationship to procedure
code
 Diagnosis relationship to procedure
code
 Maximum frequency
 Global periods
 Injection codes

31. DenialsIQ
31
Advanced statistical algorithms
from GE Global Research identify
patterns by root cause factors
DenialsIQ automatically surfaces
unseen patterns in denials to help
capture missed opportunities
Focus teams on resolving the denials
rather than finding the denials
• Why DenialsIQ:
• Built on Predix™, follows
Fastworks development
methodology … quick to
respond to change
• Alert and share invoice details
with staff to take necessary
action to resolve claim denial
• High cost to rework denials
• 2% denials write-offs equaled
of net patient revenue*
• *Advisory Board Revenue Cycle Benchmark Study

32. DenialsIQ
32
• Dynamic visualizations help prioritize opportunities to work denials more
quickly
• Defines pattern details and root cause to prevent future occurrences
• Advanced dashboards filter in order to monitor and report performance over
time

33. 33
DenialsIQ Dashboards

34. 34
DenialsIQ Dashboards-By Category

35. 35
DenialsIQ
Dashboard Filters

36. DenialsIQ and Hosted Claims Manager
36
Hosted Claims Manager is an ideal complementary solution to DenialsIQ, our advanced
analytics solution that uncovers unseen trends based on your claim denials.
Uncover coding patterns/denials in DenialsIQ then look to what can be resolved with Hosted
Claims Manager to prevent future denials and rework; thus creating a closed loop solution.

37. What is Next?

38. Payor Provider Connect

40. Summary

41. Benefits of Centricity EDI Services
 Clean Claims
 Improve financial performance
 Workflow Efficiency
 Reduce costs
 True Integration – built in!
 Value added services – single vendor
 Compliance

42. Pricing Overview:
Bundle #1:
Hosted Claims
Manager and
Denials IQ
Bundle #2:
CEDI Claims,
Remit,
Eligibility
43 %
Savings
13 %
Savings
Bundle #3:
Full CEDI
Program
26 %
Savings
Special Pricing Expires 3/15/17

43. >
Resources
• GE CEDI Information including case studies and brochures
lindah@healthcosystems.com
jasonp@healthcosystems.com
For product questions and
information:
For pricing details and
questions about your
current EDI tools: