Welcome to the RUG n’ Roll Midwest & Great Lakes Regional User Group for Cerner Clients Eligibility Management

1. Welcome to the RUG n’ RollMidwest & Great Lakes Regional User Group for Cerner ClientsEligibility Management Milwaukee, Wisconsin April 30 – May 2, 2007

2. Presenters: Sue Tallar – Aurora Health Care Supervisor, Patient Access Team Heather Maki – Aurora Health Care Business Application Analyst, Patient Access Team

3. In the next 50 minutes... • What is Eligibility Management • Advantages & Concerns • Set Up • Integration with ERM & Scheduling

4. Who is Aurora Health Care? • Private, non-profit, teaching organization: • - 664 employed physicians • - 3,385 physicians on staff • - 25,000 employees • - $3 billion annual revenue • - 0.5 million IP days/year • - 2.4 million OP visits/year • - 0.25 million ED visits/year • - 0.3 million Home Care visits/year • - 5.6 million retail Rx/year • Integrated Delivery Network • 13 Hospitals (60-800 beds) • 120 Outpatient Clinics • 140 Retail Pharmacies • Long Term Care • Home Health Services • Hospice Services • Laboratory Services • One of the nation’s “Most Wired” hospitals in 2004, 2005, 2006

5. Eligibility Management Facilitates the electronic processing of insurance eligibility verification through electronic data interchange. By automating these transactions, insurance eligibility can be verified in real time.

6. Eligibility and ERM Integration • Eligibility Check May be Performed at the Time of Pre Registration or Registration • Eligibility Validation Button in ERM Conversations

7. Eligibility Management • Eligibility performs a simple check on the insurance eligibility status of a patient • This allows for the verification of insurance prior to the procedure, or if desired it can be verified before a procedure is scheduled • Requests are sent directly to an insurance payer or to a third party clearinghouse

8. Eligibility Management • The payer or clearinghouse returns a response that includes eligibility info • Response may be viewed from Scheduling and Registration or in a stand alone tool

9. Advantages • Reduce number of denials due to patients having inactive coverage • Eliminates having to re-enter patient and insurance information into a separate application. Less chance of human error • History of previously ran transactions is retained, no need to re-run the eligibility check

10. Concerns • Anyone who has access to ERM pre-reg will have access to send eligibility through • When using a clearinghouse there is a charge if results are posted. If insurance is not set up in Cerner, users will not get a response back, therefore no transaction fee • No multi-facility logic supported in application. We get around this by using one facility ID for all eligibility transactions

11. Setting Up Eligibility Management • 3rd party clearinghouse or direct connection. Must have contract negotiated with payers or clearinghouse(s) for processing • 270/271 HIPAA compliant Interface • EEM Profile tool • Icons placed in ERM conversations

12. Building Profiles • Profiles need to be built for each Payer in EEM Profile tool • 270 transaction initiated in Cerner, which is then sent outbound to clearinghouse • Clearinghouse will send the EDI information to the payer that is required to process transactions

13. Submitting Transactions • Via ERM • Via Standalone • Via Scheduling

14. Submitting via ERM • After insurance info is verified in ERM, user clicks on the “Eligibility Validation” icon to open Eligibility Validation window • All insurance plans will display

15. EEM Previous History • History on previously submitted transactions is stored. Before submitting transactions, history is viewed to see if a transaction had been submitted • History on previously ran transactions is saved until purge job is ran.

16. Results window displays info on transaction that was previously ran

17. Submitting a Transaction • After insurance info in ERM is verified, user clicks on the “Eligibility Validation” icon to submit transaction. Insurance is selected and submitted to clearinghouse

18. Details that are returned vary depending on the Payer, each Payer determines what to send back. The information displayed can also be printed  Eligibility Details shows if patient has active coverage

20. Submitting via Standalone • Icon is placed on the Cerner Desktop • No encounter is needed to submit transactions • Insurance information submitted comes from what was last entered in ERM

21. Information from ERM populates, transaction is submitted

22. Eligibility Standalone – Response Info

23. Submitting via ESM • Automatic verification at • Booking • Check In • Reschedule • Manual Verification • Right click – Actions – Verify • Verify Button

24. ESM Confirm Window Eligibility Status

25. ESM Confirm Window/Eligibility Tab Eligibility Details

26. Enterprise Eligibility & ESM Icons Appointment Icons available Icon will display when check is performed

27. Enterprise Eligibility ESM History Eligibility status shows verified

28. History (cont.) Action History shows who checked Eligibility Benefit information displays

29. Questions?