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Organizations submit claims to either FNS or C&F Regional Claims Center

Organizations submit claims to either FNS or C&F Regional Claims Center C&F current goal is to reduce the input at the Claims Center All required data elements are not captured during initial contact. After receiving submissions, FNS constructs: Standard ANSI X.12 EDI Transaction set

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Organizations submit claims to either FNS or C&F Regional Claims Center

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  1. Organizations submit claims to either FNS or C&F Regional Claims Center • C&F current goal is to reduce the input at the Claims Center • All required data elements are not captured during initial contact

  2. After receiving submissions, • FNS constructs: • Standard ANSI X.12 EDI Transaction set • 148 Report of Injury (version 3050) • These files are then sent to • the Gentran EDI server at • E-SYNC (Wiltek)

  3. Gentran server translates the EDI file to a flat file that is processed and loaded into a SQL database, NOL • Claims that are submitted to the claims center are either input into NOL or may be sent to FNS for processing • NOL does not contain all of the required data elements for state reporting nor is it a transactional database

  4. Vendors submit information to MMP; MMP is utilized for SROI • Users cannot access MMP for FROI/SROI, because it is an online application • Data elements required to produce a complete SROI, and elements from HCFA 1500 and UB 92 requirements, are missing from MMP • ACS has the wrong injury codes required for state reporting • MMP and ACS are not transactional databases

  5. Claim centers manually key information from paper claim files into Celerity • Certain Information that is keyed into Celerity is never placed into the NOL/ACS systems • Celerity server: • submits reports to states • receives acknowledgements and rejections • SROI is now paper based • No Current business process to deal with rejections

  6. Non-transactional architecture • Duplicate system entry • Systems do not cross-populate information • No electronic entry from agents or insureds • Multiple Celerity systems • Expensive • Management strain • No automated tracking of State submissions • Multiple systems limit mining of statistical information for future analysis

  7. Single entry – no duplication • Transaction based architecture • Automated State submittal • Browser based point of entry • Access level security • Centralized • Data mining friendly • Productivity increases • Transaction cost reduced

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