caqh®core™phase ii certification testing status report...certification testing status report herb...

Edifecs confidential © 2002-2008

CAQH® CORE™ Phase II Certification Testing Status Report

Herb Larsen, SVP Alliances


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Edifecs Corporate Summary:

Leader in Compliance, Quality & Interoperability Solutions for Improving Business Performance

Partners

• Data Quality and Compliance Adaptors: Improve the quality of

transactional data, and ensure compliance with government, industry and community standards• Healthcare Transaction Gateway: Healthcare-centric, real-time, standards independent, multi-channel port that manages all transactional data

Solutions

Global Markets: Over 1,100 top-tier accounts in banking, insurance, securities, utilities, and high tech.

Healthcare: Over 350 clients

Customers

Bellevue, WashingtonHeadquarters

1996 (12 years), Privately HeldEstablished

Headcount ~100 (75 in Products & Engineering)


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Edifecs Healthcare Market Leadership: 350+ Customers/Partners

ACSAmisys-SynertechAvaility

CAQH/CORECSCClaimsnetCNSIEDSEmdeonEnCoreENSFox SystemsIBMInmediataMedAvant/ProxymedMicrosoftMSIOAO HealthcareOraclePerotPost-N-TrackQuovadxSunTIBCOUnisys

Blue Plans

Total Client Base: 24

BCBS AssociationBCBS AlabamaBCBS ArizonaBCBS ColoradoBCBS FloridaBCBS GeorgiaBC IdahoBS IdahoBCBS Kansas CityBCBS LouisianaBCBS MinnesotaBCBS MissouriBCBS Northeastern NYBCBS NevadaBCBS New JerseyBCBS North CarolinaBCBS North DakotaBCBS OregonBC NE PennsylvaniaBCBS NevadaBCBS TennesseeBCBS UtahBCBS W NYBS WashingtonCarefirst BCBS

Total Client Base: 30+

CMS Enforcement

CMS Eligibility Alaska MedicaidCalifornia Medicaid

CalOHIColorado Medicaid

DC MedicaidFlorida Medicaid

Georgia MedicaidKentucky MedicaidMaine Medicaid

Maryland MedicaidMichigan Medicaid

Minnesota MedicaidMississippi MedicaidNebraska Medicaid

New HampshireNew Jersey Medicaid

New Mexico MedicaidNew York Medicaid

North Dakota MedicaidOregon MedicaidSouth Carolina Medicaid

Tennessee MedicaidTexas Medicaid

Washington MedicaidWest Virginia MedicaidWyoming Medicaid

TriCare

Government


Providers / Hospitals

Abbott LaboratoriesACMAllina Hospitals and ClinicsBanner Health SystemsBaylor HealthCaremark InternationalClinical Labs of HawaiiFairview Health SystemFreseniusGambroIndian Health ServiceJohn Muir/Mt. Diablo Health System (JMMD)Mass Eye & EarMeridian HealthcareMethodist HospitalMilitary Health (DoD)New England MedicalNovasysPark NicolletPharMericaScott & White MemorialTMCMedVeterans Affairs


Commercial / Others

BMC HealthNet

CansecoCigna

Delta Dental of CAGHI

Great West LifeGroup Health CooperativeHealthPartners

Health NetHarvard Pilgrim

HealthPartnersKaiser PermanenteLA Care

MagellanMatria

MedicaMolina Healthcare

MedAvant/ ProxyMedPayformanceTMG Health

Tufts Health PlanUnicare

United HealthcareValueOptionsViPS

WEA TrustWellcare

WorkscapeWPS


Edifecs is the Market Leader24 Blue Plans

30+ Government100+ Payers

100+ Provider100+ Partners/Vendors

Edifecs is the Market Leader24 Blue Plans

30+ Government100+ Payers

100+ Provider100+ Partners/Vendors

Clearinghouses / Vendors And Partners


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Stakeholders Who Have Tested CORE Phase I with Edif ecs – 93%

� ACS EDI Gateway

� Aetna

� AthenaHealth

� Anthem/WellPoint

� AultCare

� Availity

� BCBS of North Carolina

� BCBS of Tennessee

� CSC Consulting

� Emdeon

� EmergingHealth

� GE Healthcare

� HMS

� Mayo Clinic

� MD On-Line

� MedAvant

� MedData

� Medical Information Engineering

� Montefiore Medical Center

� NaviMedix

� NoMoreClipboard

� Passport OneSource

� Post-N-Track

� RelayHealth

� SSI

� SureScripts-RxHub

� VisionShare


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Edifecs Invests in its Relationship with CAQH-CORE

� No-Cost Product Access and Development Effort

� No-cost Access to CORE Testing Portal powered by Ed ifecs Ramp Management for Stakeholders

� No-cost Access to Edifecs SpecBuilder rules develop ment tool for CAQH and its consultants

� Phase II Deliverables:

• Active participation in all rule development confer ence calls

• Ongoing Alpha and Beta support

• Over 1000 developer & business analyst hours for Ph ase II to date

• Enhanced product functionality to meet all CAQH-COR E Phase II-specific requirements

• Connectivity (Client and Server sides)

• Dynamic test data generation

• Dedicated Support for Phase II testing entities

• Visual/Manual inspection by Analyst for Uploaded Ve rification Artifacts

� Currently in Alpha Testing, Beta Completion in Octo ber

� Production Anticipated in November, based on Beta feedback

� Edifecs is Committed to Continue Supporting CAQH


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Edifecs Product Overview

TRANSACTION GATEWAY SOLUTIONS

� Transaction Management� Visibility, Accountability, Alerts, Reporting, Trading

Partner Management/Maintenance

� Claims Correction� Business-Friendly Views, with Facilitated Error

Correction by non-technical Partner Staff

� Ramp Management� Trading Partner Testing and Enablement

� USED FOR CORE TESTING

DATA QUALITY & COMPLIANCE SOLUTIONS

� SpecBuilder� Rules and Edits Management, test data generation,

desktop testing and guideline publishing

� USED FOR CORE TESTING

� XEngine� Runtime Validation, splitting, routing and error

reporting


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Edifecs Phase II Demonstration

caqh®core™phase ii certification testing status report...certification testing status report herb...

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