Product overview of Hosted Claims Manager and Denials IQ presented by HealthCo Information Systems and GE's EDI team. Discover how these two EDI product innovations can improve your reimbursement processes and get your paid faster.

1. CEDI:
Hosted Claims Manager and Denials IQ 1

2. Centricty EDI Services

4. Today’s Presenter
Claire Wright
EDI Business Development
Claire Wright joined IDX/GE back in 2005 as an
EDI Support Engineer. After several years, she
transitioned to a Centricity Practice Solution
EDI Migration Project Manager where she
worked very closely with new EDI customers
and was a key point of contact for EDI product
demonstrations. After many years as a
Project Manager, Claire joined the EDI
Business Development team in 2014 in order
to continue her commitment to helping new
customers grow their business. She works out
of the Burlington VT office – home of the EDI
Data Center.

6. Product Overview:
Hosted Claim Manager

7. Product Overview:
Denials IQ
Powerful algorithm analyzes claims data weekly
to provide dashboards that reveal denial trends
by code, payor, physician, location and a
number of other categories, allowing the clinic to
rework denials in bulk and set rules via HCM to
prevent these denials in the future.

8. Imagination at work.
Centricity™ EDI Services
Hosted Claims Manager and DenialsIQ™

9. ©2016 General Electric Company
This does not constitute a representation or warranty or documentation regarding the
product or service featured. All illustrations are provided as fictional examples only. Your
product features and configuration may be different than those shown. Information contained
herein is proprietary to GE. No part of this publication may be reproduced for any purpose
without written permission of GE.
DESCRIPTIONS OF FUTURE FUNCTIONALITY REFLECT CURRENT PRODUCT
DIRECTION, ARE FOR INFORMATIONAL PURPOSES ONLY AND DO NOT CONSTITUTE
A COMMITMENT TO PROVIDE SPECIFIC FUNCTIONALITY. TIMING AND AVAILABILITY
REMAIN AT GE’S DISCRETION AND ARE SUBJECT TO CHANGE AND APPLICABLE
REGULATORY CLEARANCE.
* GE, the GE Monogram, Centricity and imagination at work are trademarks of General
Electric Company.
General Electric Company, by and through its GE Healthcare division.

10. Agenda
• Hosted Claims Manager Benefits
• Workflow- where does it fit in
• Demo
• Reports
• Case Study
• DenialsIQ
• Intro to DenialsIQ
• Dashboards
• Pattern Strengths
• Pattern Details

11. Hosted Claims Manager
Benefits

12. PREVENT
12
Source: The Healthcare Imperative: Lowering Costs and Improving Outcomes: Workshop Series (2009)
The best way to REDUCE clinical
rejections and denials is to
PREVENT
them before they occur!

13. Hosted Claims Manager Overview
Proven
• Proven, industry-leading clinical editing engine (including
LMRP/LCD)
• Includes over 4,000,000 pre-built rule combinations
Real time response
• Clinical edits are integrated into the approval process
Continuous improvement support model
• Regularly scheduled rejection and denial reviews are a key part
of service
Payer edits
• Edits can be created specific to your local payers guidelines
• Medicare LCD/NCD edits automatically updated bi-weekly for you
• Edits can be turned off if not needed
Submit
Correct
Scrub

14. Hosted Claims Manager: Features
Claim criteria
HCFA – 1500, Primary insurance, paper & electronic
Claim Scrubbing
Compares lines on the claim
Patient history scrubbing – current claim lines along with history
PQRS
Scrubbing will take place on measures you bill for
ICD-10 compatible
Scrubbing will take place on ICD-9 and ICD-10 codes

15. Demo

16. Hosted Claims Manager: Demo
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17. Hosted Claims Manager: Demo
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18. Hosted Claims Manager: Demo
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19. Hosted Claims Manager: Demo
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20. Hosted Claims Manager: Demo
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21. Hosted Claims Manager: Demo
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22. Hosted Claims Manager: Demo
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23. Hosted Claims Manager: Demo
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24. Hosted Claims Manager: Demo
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25. Hosted Claims Manager: Demo
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26. Clinical edits...What are they?
DLP Identifies items entered on one or more claims that have identical Dates of Services, Procedures , Modifiers,
Departments, and Providers (including previous claim history)
NPT Identifies where a new patient E&M was billed and the patient has been seen within 3 years by the same
organization and specialty
GFP Identifies an E&M that was billed during the global follow up period of an earlier procedure, has the same primary dx
and was performed by the same provider
NPD Identifies a line item that contains a diagnosis code that is not appropriate for use as a primary diagnosis code
LBI Identifies that no diagnosis on the claim line supports medical necessity for the procedure billed (as specified by
Local Medicare Guidelines)
MOD Identifies a line item that contains a modifier that is not permitted for use with a particular procedure code
MFD Identifies situations where you have exceeded the maximum allowed frequency for a given procedure within a given
date range
INJ Prompts you to add additional procedure code for if appropriate

27. Hosted Claims Manager
Dashboard Reports

28. Flag Summary for Last Calendar Month

29. Flag Summary for Last Calendar Month

30. Case Study

31. www.CHORTHO.com
Located in
Tampa Bay Florida
Orthopaedic division at
All Children's Hospital
John Hopkins Medicine

32. Results with Hosted Claims
Manager
 Decreased claims rework by over 50%
 Reduced or eliminated clinical denials
 Helped speed payments by up to 22%
A customizable pre-claim clinical editing and proactive
claim analysis solution:
 Helps increase revenue cycle efficiencies
 Help improve claims accuracy
 Assists with regulatory compliance
Outcomes1:
1. Representative results realized by Children’s Orthopaedic and Scoliosis Surgery Associates, St.
Petersburg, FL.
Reduce rejections
before they occur

33. DenialsIQ
Overview
Title or Job Number | XX Month 201X See tutorial regarding
confidentiality disclosures.
33

34. 2% Denials write-offs
equaled of net patient
revenue
Re-working claims
cost per claim $15-25
An Advisory Board revenue cycle benchmark study reported that in 2013 76% of hospitals’, (in the report) denials write-offs to bad debt, equaled 2% of net patient
revenue.

35. How are denials impacting your
performance?
2,000 denied claims = $50,000 34,000 denied claims =
$850,000
$4m NPR = $80k $45m NPR = $900k
A
NPR = Net Patient Revenue
Re-work cost = $25 per claim

36. DenialsIQ surfaces unseen patterns to help
capture missed opportunities
36
ImproveRevenue
Reduce Cost
Our challenge was that the trends we
were working took too long to define
and usually didn’t pay off, even if we
fixed them.
Jose Rivera
Corporate Director, Physician &
Professional Services
Orlando Health
Advanced statistical
algorithms from GE Global
Research identify patterns by root
cause factors
Refined by customers
Using FastWorks methodology
with four customer partners and
built on Predix platform
GE’s revenue cycle
experience
Serving customer for over 40
years, to help improve financial
performance
Cost of rework – MGMA. Denials - The Advisory Board “Driving the Denials Management Initiative A Renewed Focus”

37. DenialsIQ identifies denials patterns through root cause factors and prioritizes
based on value, providing powerful insights that drive action, without research
37
DenialsIQ
Where are my most costly and unexpected denials patterns? How do I fix them more effectively?
A “pile” of denials, each with a reason 300 denials x 1
Trends queried based on experience, intuition
With Insights
“The stuff we don’t know
about.”
Patterns are identified automatically, can be resolved as a unit and
common themes provide context without research
DenialFactorsAlgorithm
DynamicVisualization
Invoice Count
DeniedCharges
Level of unexpectedness
<
<
Traditional denial resolution approach

38. Improving performance with insights that
translates into results
Dynamic visualizations
help prioritize
opportunities, to work
denials more quickly.
Defines pattern details and
root cause, to prevent
future occurrences.
Advanced dashboards
filter, monitor and report
performance over time

39.  Leverages Centricity™ EDI data
 Hosted by GE Healthcare
 No installation cost
 Data loads weekly
 Results for last week, last month, and
current month to date
 Requires Centricity EDI clearinghouse
DenialsIQ specifications and FAQ’s
39

40. Dynamic visualizations display patterns
Color indicates the rate of the
denials, i.e. red equals
denials that are occurring
more frequently than other
denials within the timeframe
Pattern #7
17 denials within pattern
$167k in denied charges
# of factors contributing to a
pattern; the common
reasons within the denial
pattern; i.e. location,
insurance, reason code
Tool tips display the specific
circumstances of the denial
pattern; i.e. Shelburne
Office, UHC, PR 27

41. Dynamic visualizations display patterns
#7
17/$167k
# of factors contributing to a
pattern
Algorithm results indicate
level of pattern
“unexpectedness”
Pattern #7
17 denials within pattern
$167k in denied charges

42. DenialsIQ Demo

43. Summary

44. Think about it……
44Source: The Healthcare Imperative: Lowering Costs and Improving Outcomes: Workshop Series
(2009)
$2
5
Average cost per
claim for rework

45. DenialsIQ and Hosted Claims Manager
45
Hosted Claims Manager is an ideal complementary solution to DenialsIQ, our advanced analytics
solution that uncovers unseen trends based on your claim denials.
Uncover coding patterns/denials in DenialsIQ then look to what can be resolved with Hosted Claims
Manager to prevent future denials and rework; thus creating a closed loop solution.

46. Pricing Overview:
Bundle #1:
Hosted Claims
Manager and
Denials IQ
Bundle #2:
CEDI Claims,
Remit,
Eligibility
43 %
Savings
13 %
Savings
Bundle #3:
Full CEDI
Program
26 %
Savings

47. >
Resources
• GE CEDI Information including case studies and brochures
lindah@healthcosystems.com
jasonp@healthcosystems.com
For product questions and
information:
For pricing details and
questions about your
current EDI tools: