new york data center bpo service center...bpo service center 85 w. algonquin suite 410 arlington...

© 2006-2018 WorkCompEDI, Inc.

BPO SERVICE CENTER85 W. Algonquin

Suite 410

Arlington Heights, IL 60005

NEW YORK DATA CENTER4250 Veterans Memorial Hwy

Suite 301e

Holbrook, NY 11741

(800) 297-6909


Management Team Marc Menendez (President & CEO)

Brendan Friar (Senior Vice President)

Bill Grosch (Vice President, IT/IS & Security Officer)

Scott Hefner (Vice President, Business Development)

Jennifer Jones (Sr Director, Operations & Client Support)

Marsia Nappi (Director, Operations & QA)2

Connectivity Simplified™

Corporate Facts Sheet

Company Profileo WorkCompEDI launched in 2006

• Processing EDI for over 3,000+ payors & bill review companies (2,200+ directly)

• Providing services to receivers, submitters & vendors

o Focus primarily on P&C (workers’ compensation, auto & personal injury)

o Exclusive Clearinghouse to CorVel & Conduent (Stratacare/ACS/CompIQ)

o Preferred partner to IMS Solera (HI) & Mitchell International

o All Payor Print & Mail Vendor

Grand Central Station for 2-way Communications

Clientele Market ✓ Insurance Carriers

✓ Third Party Administrators

✓ Self Insured Employers

✓ Bill Review Firms

Physicians & Hospitals

Clearinghouses

Practice Management & General Software Vendors

Billing Companies


Corporate Headquarters4250 Veterans Memorial Hwy

Suite 301E

Holbrook, NY 11741

Tel: (800) 297-6909

www.WorkCompEDI.com

Processing Facility85 West Algonquin Rd

Suite 410

Arlington Heights, IL 60005

EDI Clearinghouse(WC/Auto/PI/GH)

Custom EDI

EDI Translation

Mailroom/OCR/KFI/Paper-to-EDI

Custom Printing Services

Virtual Card/ACH/EFT

Private Label Products & Service

Custom Software Engineering

“Stop-Gap” Solutions

IMSLink® Document

Management & Workflow

Company

Information

Products and

Services

Certifications &

AccreditationsBrands

Supported


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Additional Corporate Information



4

The WorkCompEDI Value Prop

Largest Clearinghouse in P&C Market• 3,000+ electronic routes in market today

o 2,200+ direct connections to WCEDI

• Fully compliant with all state mandates (WC & Auto)

Multi-Pronged Service Provider• Submitters, Receivers & Vendors

• Consultative approach to aligned partnerships

Robust Service Offerings: Receivers• Managed Gateway Clearinghouse (1-stop shop)

• Flexible connectivity for entire industry

• Pre-adjudication processing

• Multi-route processing (iReviewEDI™)

• Adjudication system interface (ResolutionManager™)

• Electronic Payments Solution (WorkCompPay®)

• Electronic Attachments Solution (IMSLink™)

Robust Service Offerings: Vendors• 27+ years of EDI partnership experience

• Integration, Interface, or transaction exchange

• Flexible data & communication methods

• Aggregating & Non-Aggregating Services

o Billing (direct & non-direct)

o Turnkey or piecemeal services

• Private Label Offerings

Robust Service Offerings: Submitters• All-Payor clearinghouse

o Largest EDI connectivity network for P&C

o Print & mail when cannot reach electronically

• Direct processing tools & services

o Secure web billing portal (iCompEDI™)

o PMS Interfacing Software (CompLink™)

o PMS Interfacing Partnerships

o Vendor relationships (PMS, Clearinghouse)

• Advanced Transaction Services

o IntelligentMail™ Tracing & Tracking

o Secondary Party Serving

o Electronic Secondary Bill Review (appeals)

o Direct-to-Mail™ & dtmEDI™

o Proof-of-Service™

© 2006-2018 WorkCompEDI, Inc. 5

Healthcare Connectivity Simplified™

WorkCompEDI “Eco-System”

Paper

Processing

(OCR / KFI)

WorkCompEDI

“Eco-System”

Centralized gateway

coordinating

transactions from multiple

parties & products to accelerate

transactions, increase

efficiencies, and reduce

costs

Mail

Fax

Website

File Exchanges

Vendor Integrations

Historic Files



Gateway Connectivity Solutions

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iReviewEDI™Transaction Routing

System

BPO Processing

(OCR / KFI)

WorkCompEDI

Centralized gateway

coordinating

transactions from multiple

parties & products to accelerate

healthcare transactions, increase

efficiencies, and reduce

costs

Partner

Clearinghouses,

EMR/HER Vendors &

PMS Software

Vendors

Real Time & Batch Transactions

Batch Transactions

iCompEDI™Secure Web Billing

Portal

LifeEDI™

LienEDI™

dtmEDI™

eRFA™

MediHawaii™

IMSLink™ Electronic

Attachments

Business

Associates or

Joint Ventures

Insurance

Company, Bill

Review, TPA,

Employers

Subsidiaries

or Divisions

Printing Facility

ResolutionManager™Custom Integrated Adjudication

Platform Interface

CompLink™PMS Interfacing Driver

Solution

CompFax®Fax Aggregation &

Conversion Service

WorkCompPay®Payment Solutions

Receiver Solutions

Submitter Solutions


HIPAA X12:

• 837 (Bills: D, P, I & Rx) (4010A1 & 5010)

• NCPDP (Rx)

• 275 Patient Information Attachment

• 997 & 999 Syntax Validation

• 824 Standards and Jurisdiction* Validation

• 276/277 (Claims Status)

• 277U (Unsolicited Claims Status)

• 835 (Remittance Advice)

• 278 (Referrals & Prior Authorizations)

• 820 (Premium Payements)

• 834 (Enrollment & Disenrollment)

o Payor specific validations

o Claims aggregation from any source & vendors

o BPO: Paper to EDI conversion Services

o BPO: Bill / Claims Printing Services

o Proprietary formats (to & from clients / partners)

o Proprietary EOBs , reports, communications

o Proprietary rejection reports

Formats Supported

• ANSI X12 837

• NSF (multiple versions)

• Print Image

• Industry Standard

• WorkCompEDI Proprietary

• Client Proprietary

• XML

• HL7

Pre-Adjudication Validation & Scrubbing

• Claim Files

• Vendor Files

• Provider Files

• Taxonomy Codes

• State License Numbers

Advanced Transactions

• Proof of Services (POS)

• Secondary Party Serving (SPS)

• Direct to Mail (DTM)

• Claim Index Look-up

• OCR / Paper-to-EDI

• EOB-to-EDI

• Custom Printing & Fulfillment

Transactions & Methods Supported


Healthcare Connectivity Simplified™

WorkCompEDI Clearinghouse

Pro-spective Bill Flow


Bill file generated

• 837, print image, proprietary, etc.

Attachments indexed

• PWK, scan/fax with cover sheet/bard code, etc.

Receiving party generates acknowledgement response

• 997/999/Ack

Receiving party generates bill level notifications/rejections & final remittance

• 277/824/835

If using clearinghouse, bill level notifications will come from clearinghouse first, then Payor

or Bill Review company

837 PWK 999 277 835

Transaction Workflow Explained


Transmission MethodssFTP (File Transfer)

HTTPS (web upload)

API

Formats Accepted275 X12 Format (5010 & 6020)

PDF

TIFF / JPEG / GIF

Other Image Formats

✓ Submitting attachments before bills or after, as single images or in

bulk, independent of a bill (directly from an EMR/document

management system) or indexed by a practice billing system.

✓ Able to match bills to images submitted using numerous indexing

protocols, which provides an easy way to search and share

supporting documents.

✓ If providers are required to submit specific attachments for a bill,

our tools give submitters the ability to classify the type of

attachments they are submitting, further helping ensure a “clean

submission”.

✓ COMING SOON: Orphan attachment submission processes

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Attachment Handling Process


Process Review

Technical Review

Customizations

Development

Connectivity & Testing

Kickoff Call

Rollout

• Operations team initial “Kickoff Conference Call” (30 min)

• WCEDI team outlines review of planned process flows

• Joint discussion on technical aspects of clearinghouse process (including formats, transmission, security)

• Identification of any customizations required• Tasks assigned to each team and coordination of schedules

• Code development & initial testing

• User acceptance testing (UAT)• Acceptance / Signoffs and release preparation

• Go-Live • Post implementation monitoring / validation (QA)

30 Min Call

3-20 Days

3-20 Days

Implementation Process Overview



EDI Clearinghouse services

VPP

Medical Bills

Accident Report

Medical Notes

Miscellaneous Docs

Mailroom

Fax

sFTP

System Integrations

Portal Systems

Direct

Submitters

Billing

Companies

Vendor

Submitters


iCompEDI™

CompFax®

WCEDI Management Solutions (BPO) IL

www.iCompEDI.com PLUS

Advanced Research Capabilities

• Trading Partners• Clearinghouses• Software Vendors• Billing Companies• Bill Review Firms• BPO Firms

SFTP

Regular user login(office specific access)

Admin Login (global access)

Transactions Submitted for Processing


WorkCompPay® provides a single vendor platform that dramatically increases payment acceptance andreduces administrative expenses. WorkCompPay® is an integrated one-stop-shop solution in thepayment marketplace, providing multiple delivery (virtual cards, ACH/EFT, eCheck and physical delivery& printing) and value added services.

Virtual Cards MCC code restricted, delivered securely through PCI-DSS /HIPAA certified compliant fax, mailor real-time directly to the merchant account.

Paper Checks – Print & MailFlexible printing process integrated with clearinghouseservices to reduce costs and pivot providers toelectronic payment services.

eChecks – DigitalCutting edge eCheck delivery and acceptance processensures 100% guaranteed delivery of payments andacceptance by banking institutions. Provider Relationsmanage Level 1 support and Opt Out process for ourclients.

ACH PaymentsFor providers who elect to receive ACH Payments,WorkCompPay™ provides you with significant savings throughour partnership with the nation’s largest ACH network. Weprovide access to more than 75% of the healthcare providerpopulation, representing over $400B in delivered HealthBenefit and Workers’ Compensation payments.

Enhanced ACH Payments **COMING SOON!


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Payer Provider POS or Virtual Terminal

Acquirer/Processor

Payment Filesent to WCEDI

Card & RemittanceData

Authorization

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Physical Payment Entry

Notification & Detailed

Remittance Reports

Intelligently Matches and

Route Transaction

Providers Bank Account

Settlement

WorkCompPay focuses on the end-to-end experience, while creating value for the Payer and Provider…


“Straight-Through-Processing” Automated

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An electronic billing portal that lets submitters upload bills & attachments, marry them together, and

release them to be delivered to over 3,000+ electronic receivers IMSLink™

iCompEDI™ Billing Management Portal



Unstructured Documents Technology Solution



QICS Image Sharing Technology Solution


A Glimpse Into iCompEDI™ Version 3.0

Coming Soon!


Numerous vendor partner solutions whereby our software engineering team helped construct a custom UI

system, or provide an integrated access to numerous systems

Integration Between Systems


Payor ID Support Systems & Architecture


Robust issues tracking system that helps manage challenges, timelines of responses and resolutions, as well as intelligence

reporting for types of issues faces to help meet service level guarantees (SLA) terms – FULLY INTEGRATABLE WITH SSO

TroubleTicket™ Support System


Private Label Solutions



Marc MenendezPresident & CEO

[email protected]

(800) 297-6909 x1305

Scott HefnerVice President, Business Development

[email protected]

(800) 297-6909 x1325