Transcript Document
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Confidential | Copyright © 2014 TriZetto Corporation
Executing Your Plan for QicLink™ 5.0
Presented by: Ron Gripon, Rodney DeClerk and Stephen Weir
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Why 5.0 ?
Compliance
Efficiency
Compatibility
Future Considerations
Services 3
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Compliance
ICD-10 Code sets
Full 5010 Transaction integration
CAQH/CORE Transactions
X12-270/271, X12-276/277 X12-835 EFT transactions
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ICD-10 Setup Checklist
ICCLOAD – Load ICD Code Sets
ICMSM – Establish Mapping Set ID
ICMLOAD – Load Code Mappings
MM/MMCAT – Update/Add CBX Categories
ICMM – Establish/Maintain Code Mappings
SN-3 – Add ICD-10 Date and Mapping Set ID
PlanBuilder – Mapping Set to Override SN-3
Optional
CEPM routing controls 5
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Load & Manage ICD Codes / Mappings New ICD Programs
ICD Code Load (ICCLOAD)
Load both ICD-9 and ICD-10 Diagnosis and Procedure codes
ICD Mapping Set Maintenance (ICMSM)
Establish and maintain mapping set IDs
ICD Code Mapping Load (ICMLOAD)
Load mappings of ICD-9 codes to ICD-10 codes ICD-10 codes to ICD-9 codes
ICD Code Mapping Maintenance (ICMM)
Establish and maintain code mappings
ICD Code Translation (ICT)
Inquiry of mappings
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ICD Code Mappings
No industry standard crosswalk map
CMS adopted GEMS
QicLink used GEMS for crosswalk solution testing 95% of codes mapped
Bi-directional mappings
From ICD-9 to ICD-10 From ICD-10 to ICD-9
Includes one to one, one to many, and many to one mappings 7
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Efficiency
ICD-10 setup, load, and mapping programs
Full 5010 Transaction integration
835 segment conformity with EFT re-association compliance CAGC, CARC and RARC code set mapping and integration
Real-time incoming 270 and 276 transactions
Real-time response 271 and 277 transactions 8
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Efficiency
Performance enhancements 5.0
Check cycles Load programs, pmload, emload Reporting programs Web Customer Service Module Normalization of QicLink data
Current and future Microsoft products/platforms
Windows 2008 and SQL2012 .Net framework 4.0 and Fujitsu Cobol 4.1
Windows Connection Foundation (WCF) transport layer
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CAQH CORE
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What is CAQH CORE?
The Council for Affordable Quality Healthcare (CAQH) is an American non-profit organization that collaborates with healthcare providers, trade associations, and insurers. The organization is based in Washington, DC The Committee on Operating Rules for Information Exchange (CORE) is a multi-stakeholder membership group organized and facilitated by CAQH.
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Types of CAQH CORE Transactions
Phase I and II
270/271 – Eligibility (real time)
276/277 – Claim (real time) Phase III
Electronic Funds Transfer (EFT)
835 Remittance Advice (ERA)
QicLink™ 5.X supports Phase I, II and III transactions. 12
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Types of CAQH CORE Transactions
Requests/Inquiries
QicLink™
Without HIPAA Gateway With HIPAA Gateway
Web Service (Real time or Batch)
Without HIPAA Gateway With HIPAA Gateway
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CAQH_CORE Web Requests
Compliance Checker
In 270/276 Out 271/277 14
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835 Processing
Executing HIP835C
HIP835C will continue to do what it does today for both Gateway and non-Gateway
New with CAQH CORE
Whether you are Gateway or Non-Gateway a new table called QL835Trans will also house the transaction data (
ETL) extract, transform, and load process
A SQL job moves the 835 records to the CAQH CORE DB. This ETL process also moves the claims and eligibility data for 270 and 276 requests.
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270 / 276 Web Request
Submitted via HTTP/Soap request to QCC Services
Elements needed by QCC Services
Correct Login Correct Password Correct File Layout
QCC Services replies with an 271 / 277 16
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Repository Inquiry Tool
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Inquiry tool: Criteria screen
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Inquiry tool: Display results
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Compatibility
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Compatibility
QicLink™ 5.0 is the platform for future functionality enhancements and Regulatory requirement enhancements 3 rd party software
Maintain compatibility of current versions
Trading Partner Compatibility
Minimize step-up/step-down issues Current data file formats for data exchanges (ECISF, 834)
QicLink 4.20 Core enhancement and performance enhancements limited 21
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Compliancy
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Future Considerations?
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Resources
Centers for Medicare & Medicaid Services
http://www.cms.gov/Medicare/Coding/ICD10/index.html?redirect=/ic d10 2014 ICD-10-CM and GEMS 2014 ICD-10 PCS and GEMS
Customer Exchange
How to Corner: https://cx.trizetto.com/sitelogic.cfm?id=1179 QicLink™ e2 Corner Did You Know?
ICD-10 Corner 835 setup QicLink 5.00 Documentation
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Services
TriZetto Services
QicLink™ 5.X Technical Consulting Project Management Automation / Operational Reviews ICD-10 Implementation 835 Implementation CAQH CORE Implementation Custom Development
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Workshop Survey We would like to extend you an opportunity to provide candid feedback.
During the workshop you should have received an e-mail notification for you to take an on-line survey.
If you could take a few minutes to complete at this time , we would greatly value your feedback. For your convenience, the survey will be available throughout the remainder of the conference should you not be able to complete immediately.
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