eclaimlink Claims Management Awareness Workshop 1 March 25, 2012 (11:00 am 1:00 pm) Rashid Medical Library Rashid Hospital, Dubai

Transcription

1 eclaimlink Claims Management Awareness Workshop 1 March 25, 2012 (11:00 am 1:00 pm) Rashid Medical Library Rashid Hospital, Dubai

2 Workshop Outline Purpose An awareness workshop to guide Dubai health facilities and professionals on how to proceed with the needed changes for the new electronic claiming solution. 1. eclaimlink Overview 2. Introduction to Dubai Health Data Dictionary (DHD) Main Transactions Master Code Lists Business and Validation Rules 3. Claims Cycle & Management 4. Dubai Health Post Office (DHPO) web services 5. Questions and Clarifications

3 A DHC Enterprise Project in Dubai Connecting Payers, Providers, Patients, Supporting Systems and Authorities Unified Standard Healthcare Language Unified Communication Structure Organize, Monitor, Strategize and Intervene Centralized Data Tracking System Serving healthcare entities 12,000+ clinician

4 Providers, Payers, DHA and Patients Applications. Used for Generating and managing transactions. Dubai Health Post Office, the transfer hub for eclaim transactions. eclaimlink Gateway The Data dictionary for eclaim transactions, including codes, lists, Schema, documentation, data flow, standards and more. The information hub for system guides, registrations, news, notifications and other issues. Dashboards for users to monitor performance, outcomes, Communicate alerts for clinicians, facilities and DHA. Training material and registration, audiovisual aids, ticketing system and messenger system.

5 Utilizing the Providers and payers can utilize the online portal applications that are provided by the DHA for free. Advantages Web portal running through a web browser and requires no desktop installation. The main portal can be accessed by any IP that is granted access to the internet through the link 24/7 technical support through DHC Call center. Recommended Hardware and Software Specifications Browser: Internet Explorer 7.0, 8.0 or higher Platform: Windows Operating System (XP, Vista and 7) Processor: 2.2 GHz or higher Memory: 2 GB RAM or higher Screen Resolution: 1024 x 768 and higher Internet Access: 1 mbps or higher Network Bandwidth: T1 at 1.54Mbps with 50% availability Network Latency: Under 60ms Ports: Http port 80

6 Implementation Timeline Release of DataDictionary Start of Pilot 1 Start of Awareness Workshops Launch eclaims for Enaya (Mandatory) Launch eclaims for all health plans (Voluntarily) Launch eclaims for All payers (Mandatory) Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Start Training on System Start Registration on System Start Training on Medical Coding Start of Pilot 2 eclaim solutions will be provided free of charge for the essential system to do eclaims for both payers and providers. Providers and payers can build their own systems or procure any system to generate and manage eclaims. All eclaims need to go through the post office (including PBM). Payers and providers can voluntarily start eclaims in June (Enaya is mandatory), through mutual agreement. Dual coding with standard codes and non-standard service codes are allowed till end of Dec 2012, but cannot use the non-standard codes alone in eclaims. Basic training on medical coding and eclaim system shall be provided free of charge. The Mandate All claim transactions to become electronic (eclaims) in the Emirate of Dubai by January 1, 2013 for all providers and payers Enaya program to start in June 1, 2012 Dubai shall speak a unified health language communicated in a unified communication structure

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8 Claims Cycle High Level Claim Cycle 1 PriorRequest 2 PriorRequest PriorAuthorization 4 PriorAuthorization 3 5 ClaimSubmission 6 ClaimSubmission Provider DHPO Payer 8 7 RemittanceAdvice RemittanceAdvice

9 Claims Management Possible Claim Management eclaimlink Applications Free of Charge Data entry Generate claimsubmission file (XML) Send claimsubmission file (XML) to DHPO Fetch remittanceadvice file (XML) from DHPO Review remittanceadvice and prepare resubmission file (XML). Legacy System Manual Export and Import Data entry on legacy system. Export of claims data from legacy system (excel format). Import claims data into the eclaimlink system. Generate claimsubmission file (XML) Send claimsubmission file (XML) to DHPO Fetch remittanceadvice file (XML) from DHPO Review remittanceadvice and prepare resubmission file (XML). Legacy System integration with DHPO Legacy system direct integration with DHPO through standard web services to: Send claimsubmissions Fetch remittanceadvice.

10 Questions and Clarifications