Monday, August 6th 2008

Medical Benefits Administration

Information and Technology

Emdeon Electronic Claims.

Our contract with Emdeon has expired as of July 24th 2008, we had decided not to renew the contract due to problems with the clearinghouse and its inability to get reports back to our physicians, work with us in moving our electronic claim standards forward, and ensuring accurate data.

Our preferred Clearinghouse is Medavant which we will be offering ERA and ACH payments through hopefully within a few months.

Current Emdeon submitters can still send us claims using Emdeon or one of their sub companies but you need to change the Payer ID you are submitting to.

Old Payer ID for Emdeon: 68041

New Payer ID for Emdeon: MBA01

We may not receive claims sent to 68041 for unknown reasons, Emdeon has not sent us any claims on paper or electronically since July 24th 2008.

The MBA01 ID will go from Emdeon to Office Ally who will pre check the claims for valid information and return the report back to Emdeon, this should also alleviate previous problems with Emdeon submitters not receiving the IPA's rejection reports.

This also effects the Hospital claims, and other CHW claims - We have put in requests to change the information at CHW but it may take some time for them to update their systems.

In other IT news for MBA we are no longer contracted with Managed Care due to lack of interest.

We are currently working with EMR's from a few select vendors and hope to have more information on the EMR/EHR program at MBA soon.

For questions or concerns you may contact the Director of Information and Technology

Phone: (530) 271-3219      Email: Jon@e-mbainc.com

Monday, October 24th 2005

Medical Benefits Administration

Information and Technology

We are pleased to announce that as of Monday, August 22, 2005 we have began processing X12, 837, and 834 E-Claims

What are X12, 837 and 834 electronic files and how do they work in your benefit?

1: Cost effectiveness.

The new file formats that are widely becoming the medical standard are becoming even more cost effective, not only for the administrators, but the physician's offices as well. Although most clearing houses will continue to charge a per-claim processing fee (usually 0.25 per claim), they may already have this capacity and not realize it. Companies running Med Manager usually process through WebMD, and other applications have similar Bundles. Using this type of information exchange can greatly reduce your overhead by reducing personnel hours, computer system resources, paper, mailing and possible fees for breeches in HIPAA compliance.

(Most physician offices spend over 0.60 per claim in paper, stamps, and personnel)

2: Accuracy.

Accuracy is a must in the medical world as it determines every aspect of every business involved in the process. For example, if an inaccurate CPT cope is input in an office and processed by the payer or administrator, it may go for a month without correction before that claim is sent in as encounter data and received by the group, thus affecting everyone's Pay for Performance.

3: Speed.

The rate at which 837 files can be exported from one system and imported into another is phenomenal, and in most cases, takes none of your valuable time. Web MD, for example, receives the files for processing from your system, and submits them to the payer within 12 hours. That file is then processed by the payer within another 12 hours. On average, filing a paper claim can take upwards from 6 days, not including postal time, and an electronic EDI, although processed in 2 days, can take up to 4 days to be received by the payer if mailed by the US Postal Service.

Within the next 6 months, as we expand and work towards being one of the best Third Party Administrators and evolve our business into today's world of information and technology it is possible that paper claims will be more difficult to use and take longer to process.

4: HIPAA and CMS regulations.

HIPAA and CMS are cracking down on breaches of compliance. You may feel safe by sending a stack of paper claims, or an EDI disk via the US Postal service, but you might still be at risk for compliance if that disk or paper is lost or stolen. Recently a company lost a backup tape with patient information; the tape was in a locked room and password protected. Although they were not fined because they were believed to have taken reasonable steps to ensure security, the law required they contact every individual whose information may have been compromised and they be informed of the situation. You can prevent this from happening to you by submitting your files through a clearing house. Do know that while this will not alleviate all compliance issues, once the clearing house receives your files or retrieves it from your system, the responsibility lands on them.

For more information regarding HIPAA compliance please visit http://nvd.nist.gov

Clearing Houses Medical Benefits Administration currently has contracts with.

If you are currently with one of these clearing houses, please contact your representative for more information on processing electronically.

For those that are not set up with a clearing house I would encourage you to contact one of the above businesses and consider this service as a valuable business tool to move you ahead into the 21st century.

You may receive a call from someone at Medical Benefits Administration in the near future. We will be contacting as many people as we can to find out what clearing house you are using, if they can export 837 files directly from their systems, or if we may send information to one of our contracted Clearing Houses so they may assist you in making your decisions.

For questions or concerns you may contact the Director of Information and Technology

Phone: (530) 271-3219      Email: Jon@e-mbainc.com