Roadmap To HIPAA Conformance: Is CORE Certification Right .

CAQH CORE Voluntary Certification National Webinar:Roadmap to HIPAA Conformance:Is CORE Certification Right for your Organization?An EHR Vendor PerspectiveJune 25th, 20152:00 – 3:00pm ET

Session Topics2 Welcome & Introduction Voluntary CORE Certification: Entities that Can Become CORE-Certified MEDITECH: CORE Certification Phase I & II Voluntary CORE Certification: Getting Started Edifecs Conformance Testing Portal Q&A 2015 CAQH. All rights reserved.

Participating in Today’s Session Download a copy of today’s presentation onthe CAQH.org website The phones will be muted upon entry andduring the presentation portion of the session At any time throughout the session, you maycommunicate a question via the web –Submit your questions on-line at any time byentering them into the Q&A panel on the righthand side of the GoToWebinar desktop–On-line questions will be addressed firstThere will be an opportunity today to submitquestions using the telephone–3Navigate to the CAQH CORE Education Eventspage and access a pdf version of today’spresentation under the list for today’s eventWhen directed by the moderator, press the“raise hand” button to join the queue for audioquestions 2015 CAQH. All rights reserved.

Voluntary CORECertification: Entities that CanBecome CORE-Certified4 2015 CAQH. All rights reserved. 2015 CAQH. All rights reserved.

Why Certify? In an environment of heightened enforcement, healthcare organizations areconcerned about having systems that are compliant with governmentrequirements and having trading partners and vendors with compliantsystems.* Examples of evolving enforcement:– ACA-mandated HHS Health Plan Certification (proposed)– ACA-mandated Audits– New CMS Division: Division of Administrative Simplification Compliance Administrative time and cost savings: Smoother ongoing use and industrytransition to new federally mandated standards and operating rules results inmore immediate and widespread cost savings– Many in industry attribute implementation difficulties to a lack of a consistenttesting process or framework***65% of Practice Management Buyers are looking to replace existing medical software. The most common reason for replacing existing practice management or billing systems was that they weren’tconfident their current systems achieved regulatory compliance. (Medical Practice Management Software Buyer View 2014).** See the September 21, 2012 letter to HHS from NCVHS: ”Re: Findings from NCVHS Hearings on Administrative Simplification in June 2012 – an update on Heath Care Administrative CareAdministrative Transactions.” See also, “Transaction Compliance and Certification: A White Paper Describing the Recommended Solutions for Compliance Testing and Certificationof the HIPAA Transactions,” prepared by the Workgroup for Electronic Data Interchange (WEDI) Transactions Workgroup, March 10, 2010.5 2015 CAQH. All rights reserved.

What is Voluntary CORE Certification? CORE Certification is the most robust and widely recognized industryprogram of its kind. It employs a multi-faceted, independent approach todemonstrating conformance with CAQH CORE Operating Rules– Requirements developed by broad, multi-stakeholder representation through atransparent discussion and polling process– Requires conformance testing by independent third party testing vendors that areexperts in EDI and testing– CAQH CORE serves as a neutral, non-commercial administrator: Authorizes the conformance testing vendors Reviews applications and conformance test reports before Certification is awarded Award and display of a CORE Certification Seal– Allows entities to publicly communicate their conformance to their trading partners,their customers, and the broader healthcare industry, while promotingadministrative simplification– All CORE-certified entities know what to expect of other CORE-certified entities– Is proposed by HHS as a Document of Compliance in ACA-mandated Certificationof Compliance Proposed Rule6 2015 CAQH. All rights reserved.

Entities that Can Become CORE-CertifiedHealth PlanStakeholder TypesProvider StakeholderTypesClearinghouseStakeholder TypesVendor Solutions orProductsHIPAA-coveredHealth PlanHIPAA-coveredProviderClearinghouse asdefined by HIPAAHealth Plan vendorserviceThird PartyAdministratorsPhysiciansClearinghouse (notcovered by HIPAA)Health Plan vendorproductHealth Insurance IssuerHospitalsHealth InformationExchangeProvider vendor serviceGovernment Payers,including MedicaidPlansProvider’s agentHealth InsuranceMarketplaces orExchangesProvider vendor planGroup Health PlanIndependent PhysicianAssociationFinancial InstitutionHealth Plan Agent7 2015 CAQH. All rights reserved.

Why Entities Get CORE-CertifiedHealth Plan StakeholderTypes8Provider rSolutions orProducts Give assurance of theirconformance with federallymandated operating rules Inventory whether theirsystems, and thesystems of theirbusiness associates,are conformant Add value for current customersand attract new ones Position themselves asleaders in administrativeefficiencies Expedite a betterpatient experience andincrease patientsatisfaction Meet a trading partner contractexpectation; being asked of byboth health plans and providers Lower cost within their claimprocessing system Ensure their revenuecycle is the most costeffective Message to their clients ofcommitment to effective claimsprocessing and/or revenue cyclemanagement 2015 CAQH. All rights reserved.

CORE Certifications Awarded by Stakeholder Type Major national entities that have achieved CORE Certification include:Health PlanStakeholder Types9Provider StakeholderTypesClearinghouseStakeholder Types 2015 CAQH. All rights reserved.Vendor Solutions orProducts

Certification of Vendor Products: The “Slipstream” EffectA Vendor’s Customers can “Draft” behind a Vendor Product’s CORE Certifications:When a non-HIPAA covered EHR/PMS company obtains CORE Certification for itsproduct It gives its customers assurance that the product is conformant with the federallymandated operating rules, AND It gives its customers the opportunity to leverage that Certification and becomeCORE-certified as well10 2015 CAQH. All rights reserved.

Polling Question #1:Voluntary CORE CertificationDo you anticipate that your organization will become CORE-certified?1. Yes2. Unsure3. No4. Not applicable to my stakeholder type5. Already CORE-certified11 2015 CAQH. All rights reserved.

MEDITECHCORE Certification: Phase I and IIPresented by:Christine Sher, Senior Analyst for RegulatoryComplianceKyle MacLennan, Lead Software Developer forInteroperability

Founded in 1969 More than 2,300 facilities worldwide Over 3,900 employees Revenues of 517 million (2014) 38 consecutive profitable years 5A1 Dun & Bradstreet credit rating Employee owned, privately held

Timeline7/2011 - Began tracking the operating rulesoutlined in the Affordable Care Act (ACA)10/2011 - Started technical evaluation of CAQHCORE Operating Rules for Eligibility and ClaimTransactions(Certification not required. ARRA/Meaningful Use priority.)5/2013 - Received request from customers

Strategic Decision5/2013 - Received request for MEDITECH toconsider certification George Conklin, Senior VP/Chief Information Officer atCHRISTUS Health and Board Chairman for CAQH CORE MEDITECH and CHRISTUS Health partnership for over 20years 25 inpatient facilities in TX and LA using MEDITECH, totalingapproximately 4,800 beds

Strategic Decision(cont.) Collaborated with CHRISTUS Health staff toooEvaluate current interface usePrioritize project development CAQH CORE Phase I and II for “EDI EligibilityValidation – Version Client/Server 5.66” CAQH CORE Phase II for “Claim Status Inquiryand Response – Version Client/Server 5.66”(NEW) CAQH CORE Phase III for Electronic ClaimSubmission/Remittance – Version Client/Server5.66”

Benefits of Certification“We want healthcare providers to know thatwhenever they exchange administrative data theycan depend on real-time access to informationneeded to make timely and informed decisions.”Howard Messing, CEO and President of MEDITECH

Benefits of CORE Certification Ensure interfaces meet current Operating Rulestandards Allow for CHRISTUS and other customers tobecome CORE-certified Enhance interoperability between providers andpayers Ensure customers ease of use and compliance

START HERE!!!CAQH COREhttp://corecertification.caqh.org/CORE voluntary CORE Certification: A Step-By-Step Process FAQs about CORE and CORE Certification

Project Plan and Milestones1. Pre-certification Planning and Systems Evaluation - Obtain andreview testing data in order to determine MEDITECH's ability to meetrequirements and scope of project2. Signing and Submitting the CORE Pledge3. MEDITECH Project Development/Coding/Testing4. CORE Certification Testing - MEDITECH works with a CAQH COREauthorized testing vendor, Edifecs, to complete Pre-Testing, Testingand Post-Testing5. Applying for the CORE Seal - Complete necessary application and payCORE Seal Fee

ChallengesCoding: Allocation of resources with existing certificationprojects and committed release scheduleoo31 Days to update Eligibility Validation interface138 Days to design, code and test Claim StatusRequest/Claim Status Response Learning curve specifically with Connectivity

ChallengesTesting: Learning curve with testing process Conformance testing, rather than “productionreadiness” Response time for questions and issues

Kudos! Everything we needed was provided by CAQHCORE or Edifecs Testing process was at our own pace Saw an instant benefit of processing speedDefinitely our preferred way to certify!

Voluntary CORECertification:Getting Started25 2015 CAQH. All rights reserved. 2015 CAQH. All rights reserved.

Who Can get CORE-Certified and for What? Voluntary CORE Certification is offered to:– Any entities that create, transmit, or use the administrative transactions– Specific vendor products or services that enable providers, health plans orclearinghouses to carry out HIPAA-required standard transactions CORE Certification Testing is Stakeholder-Specific:– Each entity completes testing specific to their stakeholder type to become COREcertified so testing is relevant to entity’s business processes and eliminates nonapplicable requirements 186 CORE Certifications have been achieved to date. Access a list of theseorganizations HERE. Is available for the following transactions:– Eligibility (Phase I)– Eligibility and Claim Status (Phase II)– Electronic Funds Transfers (EFT) and Electronic Remittance Advice (ERA) (PhaseIII)Learn more about voluntary CORE Certification here26 2015 CAQH. All rights reserved.

Voluntary CORE Certification:A Step-by-Step ProcessStep 1:Pre-certification Planning& Systems Evaluation Understand requirements of the CAQH COREOperating Rules and scope your internal efforts toadopt and implement the CAQH CORE OperatingRules CAQH CORE has free Gap Analysis Tool Execute any necessary system changes/updatesSign and SubmitCORE Pledge Formally communicate your intent to pursueCORE Certification for a given phase ofCAQH CORE Operating RulesStep 3:CORE CertificationTesting An entity seeking CORE Certification workswith a CORE-authorized testing vendor toperform tests based upon CORE Phase I-IIItesting criteria specific to that entity’sstakeholder typeStep 4:Apply for CORECertification Seal Entities successfully achieving CORECertification will receive a CORE “Seal” fromCAQH that corresponds with the COREPhase and stakeholder-typeStep 2:NOTE: If the entity seeking CORE Certification outsources any portion of the applicable transactions to a trading partner, thenthat trading partner must become CORE-certified for that transaction in order for the seeking entity to complete the CORECertification process27 2015 CAQH. All rights reserved.