An HPID Update: What You Need to Know

For health plans and other entities that perform healthcare functions, the Department of Health and Human Services (HHS) will soon have their numbers...their identification numbers, that is. The assignment of Health Plan Identification Numbers (HPID) is among the many aspects of the coming ICD-10 implementation and something we’ve known was on the horizon since the Affordable Care Act (ACA) decreed it so a few years ago.

While health plans bear the responsibility of applying for new, standardized identification numbers in advance of deadlines, providers like you also carry an important role in this process. You must be ready to use the HPID numbers in claims submission in compliance with these new regulations. Large health plans must obtain their HPIDs by November 5, 2014, small plans must get new numbers by November 5, 2015 and all HPIDs must be in use for the standard transactions by November 7, 2016. Applications for HPIDs are already being accepted and time will move fast as we head toward the 2016 deadline.

The ultimate goal in all of this is to make the healthcare system more efficient. Common, standardized numbers across the healthcare system will help all of us communicate and share information more easily. According to HHS, this will address current problems such as improper transaction routing, rejected claims and confusion about patient eligibility. HHS has stated the transition could result in a $1 to $4.6 billion savings over 10 years based on material cost savings gained from moving to electronic implementation and decreasing administrative time spent by providers interacting with health plans. In other words, new numbers should ultimately mean good news for providers who are always looking to make claims management more simple, accurate and effective in securing reimbursements.

Emdeon: Count On Us as New Numbers Come Into Play
Though the intended outcome is ease of information sharing, the transition to HPID may not be quick or easy. A new enumeration system is a foundational change for our industry, so we’ve stepped up to lead and are investing early to make this transition as smooth as possible for providers and payers.

We have team members involved in Workgroups for Electronic Data Interchange (WEDI) in order to provide our expert knowledge and guide decisions to ensure HPIDs can be properly interpreted by all parties involved in data exchange. Emdeon participants include Debbi Meisner, Vice President of Regulatory Strategy, Kelly Butler, Manager of Regulatory Strategy,

Rest assured, we’re on the case. We should be fully compliant with these changes up to 16 months in advance of required deadlines. That means your Emdeon claims management solutions will be ready to transmit these IDs, keeping you steps ahead of this major industry change.

Stay connected with Emdeon for ongoing news and updates related to HPIDs and ICD-10. Bookmark this page to reference the key facts you need to know:


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An Update on ICD-10: What You Need to Know

Remember when the acronym “Y2K” evoked fear and trembling in computer programmers? Today, “ICD-10” is having a similar effect on those of us who work in the business of healthcare.

On October 1, 2014 , the industry will shift to ICD-10, the 10th edition of the International Classification of Diseases (ICD). ICD-10 is vastly different from ICD-9; it expands the number of available codes from 24,000 to 155,000 . The intention of the expansion is to improve patient care through the offering of more specific, accurate codes for diseases that can be shared throughout our healthcare system.

Where do you stand on ICD-10 preparedness?
If that question evokes aforementioned fear and trembling, you’re not alone. Sure, you’re not alone in the sense that all providers and payers are also facing the daunting changes that ICD-10 requires. We’re working to help you prepare for the October 1st of 2014 compliance date.

Rest assured, we’re focused on doing all we can to help you get prepared and avoid losing reimbursements in the vortex of noncompliance.

Here are specific ways Emdeon is on the case:
• We’ve devoted expert, multi-disciplinary staff and resources to ICD-10. Not only do we have an Executive Steering Committee to oversee ICD-10, but we also have a Functional Steering Committee comprised of leaders across our organization to ensure a synergistic approach across all impacted areas. Under the guidance of these leadership bodies, we have an ICD-10 Program Office Team facilitating day-to-day activities and delivering educational materials for our customers.

• We have readiness materials available for your reference; access them by clicking here: These quick-read documents are handy for pinpointing key changes, deadlines and other information relevant to your organization.

• We have a stated, specific timeframe for testing and implementation, and we’re not selling a tool kit for compliance. All the efforts and resources we’re devoting to ICD-10 are offered to our customers and partners at no additional charge. We consider our preparedness and our support for your preparedness an extension of our services and part of our leadership role within the industry, not an opportunity to generate revenue in your hour of need.

• We’re on target to provide a standard testing exchange by the third quarter of this year. The most common questions that customers ask us relate to how and when they can test transactions, so our expedited timeframe for offering a testing platform is welcome news. The standard testing exchange creates a pathway for providers to send us test codes and receive clearinghouse feedback that confirms whether or not the claims are valid. The testing process will be manual, but it will be immensely helpful and illuminating to participants preparing for the compliance date.

• We will store and share testing findings with providers. As an extension of our testing, we will be storing information found and sharing that data with payers to aid them in preparedness, as well. This kind of feedback will be very helpful for payers as they get up to speed.

• We will create full testing transaction and claims scenarios for providers and payers. In accordance with our predefined compliance timeline, we are on track to work with all entities to test claims submissions, transmittance through Emdeon’s system, payer pick-up and payment systems. At this level of testing, we’ll identify concerns and make modifications as needed.

• We have developed statements and strategies for handling a range of scenarios post-compliance date. For ICD-9 coded claims sent after the compliance date, our goal is to not stymie such claims from reaching payers but rather to pass them so that payers may make the determination whether to apply rejections. In those cases, we will apply rejection messaging so that providers know the payers require ICD-10 in order to adjudicate the claims. This is just one of a range of specific tactics we’ll be ready to implement to help providers and payers flesh out a full transition.

Just as this is a priority for you and your team, it’s a priority for us, as well. If you need more details about our testing processes or other ICD-10 approaches, contact us today! Or visit us online to learn more.

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An Update on ACA-Mandated Operating Rules: What You Need to Know

Operating Rules (n): the necessary business rules and guidelines for the electronic exchange of information that are not defined by a standard or its implementation specifications.
- Patient Protection and Affordable Care Act (ACA)

The ACA’s definition of “operating rules” may seem a bit complex, but the intention is all about simplification. In short, operating rules make electronic transactions in healthcare more consistent and predictable, no matter what technology is used. The rules help all entities interoperate more smoothly by advancing or building on the standards we already have in place. According to the group that developed the rules, the Center for Affordable Quality Healthcare (CAQH) Committee on Operating Rules for Information Exchange (CORE), the endeavor to improve interoperability will not only reduce costs and administrative hassles, but it will also “foster trust among all participants.”1

We probably had your attention with “reduce costs and administrative hassles.” The U.S. Department of Health and Human Services (HHS) estimates these operating rules to save providers, health plans and government $12 billion over the coming ten years.2 Though the onus of implementation of operating rules falls to payers, providers are directly impacted, and if all goes as intended, those impacts will be positive ones.

CAQH CORE states that all rules build on applicable HIPAA requirements and other standards and address a range of factors that must be clearly defined to make interoperability successful. These factors include but aren’t limited to security, rights and responsibilities of all parties, transmission standards and formats, response time standards, liabilities, error resolution, and exception processing. In other words, the rules are thorough and will benefit payers, providers and, ultimately, patients as well.

The path to implementation of the operating rules is being carried out in three phases. Here’s a quick look at each, with clarification regarding why providers should take notice.

Phases I & II: Eligibility and Claim Status
Deadline for payer compliance was January 1, 2013, and payers covering more than 30 million lives are reported in compliance to date. What does this mean for you? Thanks to standards for electronic eligibility and claims status, providers should be able to more easily connect to payers electronically to verify patient eligibility, even prior to and during patient visits. This connectivity accommodates the creation of cleaner claims, eliminates manual eligibility checks and improves ability to monitor claims status, resulting in cleaner claims, more responsive denial corrections, faster payments, and reduced staff time on administration functions.

Phase III: Electronic Funds Transfer (EFT) and Electronic Remittance Advice (ERA)
Deadline for payer compliance with these rules is January 1, 2014. These mandates require payers to include trace numbers with EFT payments. This bodes well for providers, as the trace numbers will simplify payment and remittance reconciliation by helping to match payments with the associated Electronic Remittance Advice (ERA), greatly cutting administrative time and effort. A more streamlined EFT process ensures providers get paid faster.

Emdeon: Ready to Operate!
Emdeon is at the core of operating rule creation. We’re keenly in tune with the very technical aspects required to create rules and codes that will interoperate. You’ll find us at the center of the work groups that determine best solutions—testing, coding, disproving and proving what works.

With our hands-on knowledge, we are planning to be at full remediation by third quarter of this year and will be ready to test with all commerce in fourth quarter, well in time for payers meeting the next Operating Rules deadline.

Perhaps we feel at home on the leading edge of this mandated initiative because it’s so in tune with our core business. With our nimble solutions, we’ve been facilitating interoperable transactions, claims tracking and faster payments for our customers for years. Our customers won’t miss a beat as the ACA continues to progress throughout the healthcare system.

For questions or details on operating rules or other aspects of the ACA, continue to follow Emdeon through this newsletter. We’ll keep you apprised of what you need to know to be compliant and triumph in this new era of healthcare.

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The New Standard for Revenue Cycle Pros: HFMA’s Certified Revenue Cycle Representative Program

We’re actively encouraging members of our staff to complete the Certified Revenue Cycle Representative (CRCR) program created by the Healthcare Financial Management Association (HFMA) as a standard bearer for performance for revenue cycle professionals. All of the Emdeon Enterprise Representatives are among the 5,000 who’ve earned certification through this highly regarded program.

According to Emdeon Manager of Sales Support & Training Chrissie Brady, this certification is a vital way our employees can substantiate and exemplify their expertise in this challenging, ever-changing profession.

“Earning this designation equals credibility. We need to be subject matter experts in the eyes of customers, as in the eyes of vendors and colleagues,” she explains. “We even set an incentive deadline for our team to complete the program; we value it that much.”

Our team is not alone in earning certification. Since CRCR launched four years ago, approximately 5,000 revenue cycle professionals, 3,000 in the last year, from a range of job types have become certified. Participants must retest every two years to maintain CRCR certification.

Chris Burke, a director with HFMA, states that CRCR is fitting for “anybody who touches the revenue cycle.” Professionals in the following areas of focus are recommended for the program.
• Patient access
• Financial representation
• Patient accounts
• Compliance
• Managed care operations
• Decision support
• Health information management
• Case management
• Finance

“Testers should have a working knowledge of revenue cycle,” Burke emphasizes.

The program consists of an online course divided into seven chapters of study, as well as the final exam. Content for the course and exam was developed based on input from a “whole host of folks,” as Burke describes. An internal HFMA team created the core study guide and exam, then a technical team and outside consultants (including many hospital members of HFMA who are also Emdeon clients) provided invaluable input. The result is an up-to-date, highly relevant and challenging program that covers a gamut of revenue cycle knowledge.

Most participants typically finish the self-paced, online study course in 12 to 15 hours and are then ready to take the certification exam.

“The exam is comprised of 150 multiple choice questions,” Burke explains. “A participant must make a minimum of 75% to pass and earn certification.”

Stats from HFMA show that around 50% of testers pass the first exam. 70% of those who retake the exam pass on the second attempt. Most professionals who pass have three or more years of experience, but as Burke points out “work history doesn’t always equal knowledge.”

“People with over 20 years of experiences have not passed the exam,” he reports.

Brady concurs that the program is truly challenging.

“Our seasoned employees, even those who’ve been in the business before, have said they’ve learned or been refreshed in their knowledge by participating in this program. No matter experience or tenure, this program really matters.”

Burke reports that the program will be consistently updated to address the latest aspects of revenue cycle management.

“The program is expanding to deal with new regulations. We’ll be adding ICD-10 in the near future, as well as content on ACOs.”

Are you ready to pursue certification? Thanks to the flexibility of the web-based study course, you can get started anytime. For details on program parameters and fees, visit, and join your Emdeon representatives in participation in this growing, respected program!

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Thank you for joining us in Orlando! See you next year in Vegas!

As you saw at HFMA ANI, getting ready for the changes driven by healthcare reform is top of mind for everyone right now. The good news is Emdeon can help.

Given the transition to pay for performance, implementing and leveraging interoperable systems that enable patient information to be shared seamlessly across a continuum of patient care is more important than ever. Did you know that Emdeon solutions integrate directly within the workflows of many leading Health Information Systems such as Epic®? We can offer connectivity to the largest Healthcare Revenue and Payment Cycle Network in the industry all within the convenience of your unified workflow.

Learn more about Emdeon solution and services at

Epic is a registered trademark of Epic Systems Corporation.
Emdeon and Emdeon solutions are not affiliated with or endorsed by Epic Systems Corporation.

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