Pilot for End-to-End Testing of Compliance with Administrative Simplification

1. Pilot for End-to-End Testing of Compliance with Administrative Simplification Presented By: National Government Services February 12, 2013 10 am to 11 am, EST

2. Welcome ngs.compliancetesting@wellpoint.com

3. Agenda • Welcome/Opening Remarks Julie McBee 5 minutes • Mission-Critical Definition Review David Carrier 5 minutes • Small Provider Checklist Feedback Julie McBee5 minutes • Vendor-to-Payer Checklist Review Julie McBee • Open floor 40 Minutes • Questions Team • Closing Remarks Team • How to Contact Us Julie McBee ngs.compliancetesting@wellpoint.com

4. Industry Collaborative Partners Introductions • Aetna • American Health Insurance Plans (AHIP) • American Hospital Association (AHA) • American Medical Association (AMA) • CMS Medicaid • CMS Medicare Fee For Service • Emdeon • Healthcare Billing & Management Association (HBMA) • IVANS • Medicaid – CSG Government Solutions • Medical Group Management Association (MGMA) • Nachimson Advisors, LLC • Providence Health and Services • TIBCO Foresight • TRICARE • UNC Health Care • Walgreens • WellPoint • Veteran’s Affairs ngs.compliancetesting@wellpoint.com

5. Ground Rules • All participants will be muted upon log in for the start of the webinar. • Once the opening presentation is done, we will open it up for questions. • Please provide your name when asking a question so that we know who is speaking. • Additionally, we ask that only the primary and back-up points of contact be your designated speakers on the webinar. With the number of participants we expectto participate on our webinars, we want to give each Industry Leader ample time to contribute. • Listen to and value all contributions equally. We are trying to make sure this is a collaborative effort where all Industry leaders can be heard. • We value your time so please keep your discussion focused. • Specifically for today’s call, we will be opening the floor for each contributor up to 3 minutes to speak. We will let you know when you are at 2 and 2:30 minutes to finalize your comments. • Silence equals agreement. ngs.compliancetesting@wellpoint.com

6. Goals The goals of the pilot are: • To develop and implement a process and methodology for end-to-end testing of the transaction standards, operating rules, code sets, identifiers, and other Administrative Simplification requirements adopted by the Secretary of Health and Human Services (HHS) under the Health Insurance Portability and Accountability Act of 1996 (HIPAA) and the Patient Protection and Affordable Care Act of 2010 (ACA) based on industry feedback and participation. • To develop an industry wide “Best Practice” for end-to-end testing that lays the ground work for a more efficient and less time consuming method for health care provider testing of future standards, leading to more rapid adoption of the future standards. ngs.compliancetesting@wellpoint.com

7. Intended Outcomes The intended outcomes of the pilot are: • To provide documents and artifacts to all industry segments outlining the critical check-points needed to ensure compliance with the current mandates • To provide documents and artifacts to all industry segments outlining the critical check-points which can be used as foundations with future mandates • To provide a universal testing process and methodology that can be adopted by all industry segments • To provide a framework and common understanding around the End-To-End testing process and definitions ngs.compliancetesting@wellpoint.com

8. Overview • Phase I – Business and Gap Analysis started on September 24, 2012, and ran through December 21, 2012 (Completed) • Phase II - Development of Pilot Testing started on December 10, 2012, and will run through June 27, 2013 (approximately six months)* • Phase III - The planned start date for Phase III, Implementation and Quality Assurance, is July 1, 2013, and will run through September 23, 2013 (approximately three months)* *Actual dates are subject to change during detailed schedule development ngs.compliancetesting@wellpoint.com

9. Mission-critical Feedback • – “may result in the failure of business operations” – that’s not going to happen. Businesses are not going to shut down their operation. Suggests maybe to say, “may result in the failure of 1 or more business operations”. It needs to be toned down a little bit. Re-written definition would look like this “mission critical refers to any essential service required for day-to-day operations, whose unacceptable impact to business processes may result in the failure of one or more business operations.” • – agrees with this version of the definition. ngs.compliancetesting@wellpoint.com

10. Mission-Critical *Our revised definition: Mission-critical refers to any essential service required for day-to-day operations, whose unacceptable impact to business processes may result in the failure of one or more business operations. Business processes could include any operation of the entity, vendor, and may include interaction with external trading partners. *This is a catalyst for our initial discussions with our Industry Collaborative Partners for establishing a clearly refined definition of Mission-Critical based on Industry feedback and participation on the February 7, 2013 webinar. ngs.compliancetesting@wellpoint.com

11. Small Provider Checklist Feedback 1 • Education and Training • Suggests to change the federal register to standard (didn’t hear this comment clearly). Whether you do electronic or paper coding, it should not make a difference. It should just be generic, so we don’t get hung up on the electronic part. Everyone should just be ready. • Using federal instead of standard, ICD-10 training – type of level of training (advice to keep both) for education. • Doesn’t recommend putting training hour estimates, needs to be more generic, each institute need to decide on their own. If they base on the number of hours of training we provide them, they may go under the budget. • Specific # of training is just general. Each entity can go to the reference guide and decide their own. Object about the last comment about the ICD-10. • If we’re looking at checklist for small providers, we need to be realistic, don’t think small providers are going to create an FAQ, or having the interest doing that. Needs to be aware how communication occurs within these small providers. Remove the mention of the small provider creating the FAQ (item 2.15?) ngs.compliancetesting@wellpoint.com

12. Small Provider Checklist Feedback 2 3. Design Documentation • Would make sure these terms (implementation Guides/Companion Guide) are clearly defined.   Would also mention obtain payer policies/instructions regarding submission. • The part where it says, “create & update Implementation Guide produced by Health plan”. Instead we should to say, “identify & download IG as necessary”. Health plan creates their own Companion guide, but not their own Implementation guide. We can put both word here, IG & Companion guide. • 3.5 – develop new training material – if you’re small provider, most likely you won’t develop your own training material, so maybe to say, identify material to educate staff. • Agree with prior comment. • Companion guides – need to talk about that there needs to be both Payer Companion guide & Clearing House Companion guide (multiple Companion guide). Don’t know if others use the term “Payer facts sheet” – it is supplement to the companion guide for real time transaction. We may need to put that on the list. They’re very specific for real time transaction. (Will send more information defining “Payer Facts Sheet”). ngs.compliancetesting@wellpoint.com

13. Small Provider Checklist Feedback 3 3. Design(continued) Requirement • No comment. External Code Sets • Suggestion to add one additional step, it has a potential affecting practice management rather than practice, what software to use. Under external code sets 3.10.3, make the first step to identify which software packages use these external code sets. Stopped at “Development” ngs.compliancetesting@wellpoint.com

14. Vendor-to-Payer Checklist ngs.compliancetesting@wellpoint.com

15. Questions ? ngs.compliancetesting@wellpoint.com

16. Closing Remarks • Next ICP webinar sessions: • Thursday, February 14, 10 am to 11 am EST – Vendor–to-Provider • Tuesday, February 19, 10 am to 11 am EST – Large Provider • Thursday, February 21, 10 am to 11 am EST – Large Provider • No ICP sessions from February 26, 2013 through March 7, 2013 • End-to-End Testing web page (http://www.cms.gov/Regulations-and-Guidance/HIPAA-Administrative-Simplification/Affordable-Care-Act/End-to-End-Testing.html) • ICD-10 web page (http://www.cms.gov/Medicare/Coding/ICD10/) • Listening Sessions – On hold until after the WEDI February 28, 2013 presentation • Participants may begin listening again starting March 12, 2013 http://www.cms.gov/Regulations-and-Guidance/HIPAA-Administrative-Simplification/Affordable-Care-Act/End-to-End-Testing.html ngs.compliancetesting@wellpoint.com

17. Suggested Audience for Listening Session Definitions Small Providers includes small/medium sized organizations comprised of 99 or less physicians/staff, independent practices, dentists, durable medical suppliers, pharmacy, home health agencies/hospices, and specialty practices. Large Providers includes organizations comprised of 100 or more physicians/staff, clinical labs, hospitals, critical access hospitals, nursing homes, rehab centers, skilled nursing facilities, ambulatory surgical centers, pharmacy, and Federally Qualified Health Centers (FQHC). Payers includes organizations comprised of Commercial, Medicaid, Medicare, Pharmacy Benefit Management (PBM), and Workers Compensation Government Contractors. Vendors includes organizations comprised of Billing Services, Clearinghouses, Electronic Health Record/Electronic Medical Record Systems, Network Service Vendors, Practice Management Systems, and Value Added Networks. ngs.compliancetesting@wellpoint.com

18. How to Contact Us • All questions may be sent to ngs.compliancetesting@wellpoint.com • Our expected level of service is to acknowledge all e-mails within 24 hours • Additional Contact Resources: ngs.compliancetesting@wellpoint.com