eBills 101 May 2012

1. eBills 101May 2012 Presented By: Deidre Fryfogle – Product Manager

2. What is an eBill? • eBill = Claim + Attachment(s) Historical recap of eBill • EDI submission of medical bills has been around for 30+ years in the Group/Commercial claims segments • There have been several small pilots of Property &Casualty eBilling – mainly bills-only since early 1990’s • First real “eBilling” solutions for payers came about in 1999/2000 – Internet enabled

3. So, why eBills? • Acceptance that other industries have tamed the “paper beast” – embracing HIPAA standards • Attachments needed for specific claims types: Work Comp, and Auto Medical (Property & Casualty) • Government Mandates!! The government is transitioning to an all electronic billing system for claim and eBill submissions.

4. States with Mandated eBills • Currently, 2 states have already mandated electronic eBills: Minnesota, and Texas • California is set to mandate this in October of 2012. • Georgia is running pilot programs and will mandate likely in 2012. • Illinois passed a mandate for this in May-June of 2012, but are not yet allowing implementation.

5. Benefits of eBilling • Replacing paper bills and attachments with EDI transactions using a clearinghouse your providers currently utilize (One-stop-shop) • Minimizing rejections by allowing the WC claim to pass through front end edits to catch errors • Increasing cash flow by eliminating mail submissions and freeing up time within the workplace for other functions

6. Benefits of eBilling • Reducing your bill (claim) submission costs by over 55%! • Cost to submit paper bills: $6.63 X 6,200 = $41,106.00 • Cost to submit electronic bills: $2.90 X 6,200 = $17,980.00 • Annual savings per physician from automating Bill (claims) submission: $23,126* * Based on annual average of 6,200 claims submitted for a single physician. Source: Milliman, Inc., ‘Electronic Transaction Savings Opportunities for Physician Practices.” Technology and Operations Solutions. Revised: Jan, 2006. Pulled from ama-assn.org

7. Sample Key Connected Payers • National Payers – all bills, all states • Gallagher-Bassett • Travelers • Liberty Mutual • Safeco • ESIS • Heritage Group • Texas specific payers • Texas Mutual Insurance • Texas Association of School Boards • Texas Municipal League • Texas A&M

8. Practice Insight Solution Creating eBills the EASY WAY! • 1) Send the WC Claim (same method as non WC Claim) - claim will be invalid until the attachment arrives • 2) Send unlimited Attachments (electronically or manually) - Send Electronic ANSI 275 File - Send Image File Electronically - Upload the Image directly on the claim. • If the Claim is VALID, the eBill will be READY to go!** **The Claim is sent in an ANSI 837 transaction and it is followed by an ANSI 275 transaction containing the attachment.

9. Practice Insight Solution • Upload your claim like you normally would. • The claim will be INVALID, missing an attachment. The “!” field will be blank.

10. Practice Insight Solution • Double click on the red tester rejection, and you will be taken to the Attachments screen. • Click on ATTACH Electronic to attach your electronic attachment to the claim.

11. Practice Insight Solution • The system will ask you which file you want to upload. Once you select your file, and hit OPEN the file will upload. • You will then get the Report Type screen and will be asked to enter what type of attachment this is.

12. Practice Insight Solution • Once you select your Report Type and click on the Save icon, you will see your attachment line details in the Attachments screen. • To view your attachment, click on the VIEW button.

13. Practice Insight Solution • Your attachment will come up in the Attachment viewer web-browser. • It will be populated with all of the information that is included on the original report.

14. Practice Insight Solution • Once you save your claim, the claim will re-test as VALID, and the “!” field will become populated with a paperclip, indicating that the claim now contains an electronic attachment. • The claim can be set to READY!

15. Practice Insight Solution Benefits • Easy to Track the Claim and Attachment • Statuses of the Claim and Attachment get tied back to the Claim • The Attachment remains attached and viewable from the claim • Receive ERAs from some of the W/C carriers! • You can identify your WC claims easily through use of our Task Manager product

16. Getting started with eBills • Sign the Contract Amendment • PI will load Work Comp/Auto Medical payers in to your database • Assign customer Permissions and Fee Records • Focus efforts on mandated states • Upload Claims! • No Enrollment for sending eBills is required

17. Specialties to focus on • Orthopedic Surgery  • Physical Therapist • Physical Medicine & Rehabilitation • Hand Surgery • Occupational Therapist • Sports Medicine • Diagnostic Radiology • Orthopedic Surgery of the Spine • Physician Assistant • Chiropractor • Family Practice • General Practice

18. Additional eBill Information • We are live with Professional claims. • Interested in testing Institutional claims? Email Martha Johnson at mjohnson@practiceinsight.net

19. Questions?