“NHXS’s solution suite augments our current solutions for medical offices,” said Trace Devanny, chairman and CEO of TriZetto. “Its offerings help group practices obtain accurate claim payments, recover underpayments and free up more time to provide medical care for patients. NHXS’s offerings benefit healthcare payers, as well, by reducing the number of appeals and administrative expenses associated with claim corrections and reprocessing. The addition of NHXS is one more step by TriZetto toward an integrated, real-time provider-payer technology platform that helps physicians and health plans achieve higher levels of efficiency and productivity and lays the foundation for improved clinical communications.”

TriZetto provides world-class information technology and service solutions that help providers and payers work more efficiently and collaborate to deliver better health. The acquisition further expands TriZetto’s combined provider-payer footprint, the industry’s largest. NHXS’s CEO is excited about the short- and long-term benefits of the union with TriZetto.

“In the short term, TriZetto’s and Gateway EDI’s solutions will enhance our offerings and our ability to serve the needs of today’s medical offices,” said Mark Reiger, CEO of NHXS. “Long-term, as part of TriZetto, we have an opportunity to play a larger role – to help the healthcare industry move beyond the acrimony that too often has characterized provider-payer relations and improve both the cost and quality of care delivery in our country.”

NHXS has worked with Gateway EDI since 2009, when the organizations jointly developed the Reimbursement Manager tool, which makes it easier for providers to identify payment inaccuracies. The tool finds such errors and automates the appeal/reconsideration process.

“On average, 4 to 10 percent of claims are incorrectly paid. Working in partnership with NHXS, we’ve helped providers identify inaccurate payments and reduce the time and effort required to get the payments corrected,” said Charlotte Martin, president and COO of Gateway EDI. “We look forward to the new offerings our joint teams will be able to bring our clients.”

NHXS’s current leadership team will continue to run the organization’s day-to-day operations.

About NHXS
NHXS is a leading provider of contract compliance and point-of-service adjudication workflow automation. Built around a robust claims pricing and payer business rules engine, NHXS has made it practical to check every line on every claim for payment accuracy and to calculate patient responsibility at the point of service. NHXS provides the business intelligence for the AMA’s National Health Insurer Report Card. For more information, visit http://www.nhxs.com/.

About Gateway EDI

More than 100,000 providers trust Gateway EDI’s advanced claims management tools and proactive team members to simplify the complex revenue management process. The company helps medical practices maximize revenue by securing accurate reimbursements, decreasing claims rejections and improving payment turnaround times. Gateway EDI’s services include electronic claims processing, real-time verification of a patient’s insurance eligibility, point and click access to identify and recover missing revenue, automated secondary claims and electronic remittance advice and tools that ease patient payment collection. For more information on Gateway EDI, a wholly owned subsidiary of TriZetto, visit http://www.gatewayedi.com/.

About TriZetto

TriZetto provides world-class information technology and service solutions that help payers and providers work more efficiently and collaborate to deliver better health. TriZetto solutions touch over half the U.S. insured population and reach more than 100,000 care providers. TriZetto helps healthcare organizations achieve compliance; enhance administrative efficiency; improve the cost, quality and delivery of care; and compete to win in an emerging retail market. Payer solutions include benefits administration, care management, network management and portal platforms, as well as consulting, application management and business management services.  Provider solutions include real-time eligibility assurance and claims editing and revenue cycle management technology and services that help providers get paid quickly and accurately. For more information, visit www.trizetto.com.

Last week, HHS Secretary Kathleen Sebelius announced a proposed rule that would delay the compliance date for ICD-10 from October 1, 2013 to October 1, 2014. This proposed rule has now been posted to the Federal Register, which marks the beginning of the 30-day comment period, with all comments due to HHS no later than 5:00 pm ET on May 17, 2012.

HHS believes the change in the compliance date for ICD-10, as proposed in this rule, will give providers and other covered entities more time to prepare and fully test their systems to ensure a smooth and coordinated transition among all industry segments.

The 30-day comment period for this rule is an important way to provide feedback to HHS about the proposed ICD-10 compliance date change. You can submit comments in the following ways:

• Electronically by following the ‘‘Submit a comment’’ instructions on the Regulations.gov website
• By regular mail sent to:

Centers for Medicare & Medicaid Services
Department of Health and Human Services
Attention: CMS–0040–P
P.O. Box 8013
Baltimore, MD 21244–8013

More information about the proposed rule can be found in the One-Year Delay of ICD-10 Compliance Date fact sheet, which outlines the background of the ICD-10 compliance date, and highlights provisions of the proposed rule and standards compliance date.

Keep Up to Date on Version 5010 and ICD-10.
Please visit the ICD-10 website for the latest news and resources to help you prepare, and to download and share the implementation widget today! 

St. Louis, MO – March 22, 2012 – Gateway EDI, a revenue cycle management company, announced today it has achieved full accreditation with the Healthcare Network Accreditation Program (HNAP) from the Electronic Healthcare Network Accreditation Commission (EHNAC). EHNAC’s HNAP accreditation recognizes excellence in health data processing and transactions, and ensures compliance with industry-established standards and HIPAA regulations.

Through the consultative review process, EHNAC evaluated Gateway EDI in areas of privacy measures, systems availability and security infrastructure. In addition, EHNAC reviewed the organization’s process of managing and transferring protected health information and determined that the organization meets or exceeds all EHNAC criteria and industry standards. Through completion of the rigorous accreditation process, the organization demonstrates to its constituents, adherence to strict standards and participation in the comprehensive, objective evaluation of its business.

“With recent changes in legislation and compliance requirements, this is a crucial time for healthcare networks to ensure that they’re adhering to the latest standards in privacy, security and confidentiality,” noted Lee Barrett, executive director of EHNAC. “In order to earn EHNAC HNAP accreditation, healthcare networks are required to demonstrate excellence and a commitment to ensuring the security and privacy of health data processing and transactions for their customers. Gateway EDI joins this select group of HNAP-accredited organizations.”

Mark Waters, Gateway EDI Compliance Officer, said, “We feel the EHNAC Accreditation is an important piece to our business as it allows us to provide our clients an insight of knowledge that Gateway EDI does take the HIPAA/HITECH rules seriously. It gives our clients a level of comfort knowing we are performing all the necessary steps in a consistent manner to keep their data safe and secure.”

About Gateway EDI

Physician practices trust Gateway EDI, one of the nation’s largest health care electronic data interchange providers, to maximize revenue, increase cash flow and catch and fix claims issues before they can impact a practice.

Gateway EDI was founded almost 30 years ago by a physician who wanted to better manage the revenue cycle. Today, more than 95,000 physicians count on Gateway EDI’s suite of advanced tools and proactive service team to take the worry out of billing and claims management, so they can focus on what matters most: patient care.

We create customers for life through our special customer service touches, which range from handling all payer enrollment paperwork for you, to resolving 92 percent of our customer service questions within one call and proactively identifying and correcting common errors you may not notice. For more information, visit www.gatewayedi.com. 

About EHNAC

The Electronic Healthcare Network Accreditation Commission (EHNAC) is a voluntary, self-governing standards development organization (SDO) established to develop standard criteria and accredit organizations that electronically exchange healthcare data. These entities include electronic health networks, payers, financial services firms, health information exchanges and e-prescribing solution providers.

EHNAC was founded in 1993 and is a tax-exempt 501(c)(6) nonprofit organization. Guided by peer evaluation, the EHNAC accreditation process promotes quality service, innovation, cooperation and open competition in healthcare. To learn more, visit www.ehnac.org or contact info@ehnac.org.

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Press contact information:

Beth Minnigerode

Standing Partnership

314-469-3500

bminnigerode@standingpr.com

Webinar co-presenter and Gateway EDI ICD-10 team lead Shelly Guffey was surprised by the results. “I was concerned to see that 33 percent of the webinar’s attendees haven’t started ICD-10 planning.  This is a major overhaul for all providers, and they should at least have a plan in place,” said Guffey.

“Also, only 1 percent stated they are securing a line of credit. Our entire industry saw the impact 5010 had on cash flow, and it’s predicted that ICD-10 will have an even larger impact. It’s important for providers to have a line of credit ready just in-case they need it,” continued Guffey.

SURVEY RESULTS

How is your practice responding to the potentially delayed ICD-10 deadline? 

• We’re continuing to move forward with preparations (56%)
• We haven’t yet begun planning for ICD-10 (33%)
• We’re postponing our preparations until a new deadline is announced (11%)

What steps is your practice currently taking to prepare for ICD-10? (Check all that apply) 

• Identifying training needs (58%)
• Identifying processes/areas that will be impacted by ICD-10 (48%)
• Finding out where our vendors stand with the transition: EMR, PMS, etc. (28%)
• Reviewing policies, procedures and systems for necessary updates to meet compliance needs (25%)
• Conducting training (17%)
• Identifying internal and/or external related costs (16%)
• Reviewing payer contracts (8%)
• Other (5%)
• Securing a line of credit (1%)

Results are based on the responses from 170 of the webinar attendees.

About Gateway EDI

Physician practices trust Gateway EDI, one of the nation’s largest health care electronic data interchange providers, to maximize revenue, increase cash flow and catch and fix claims issues before they can impact a practice.

Gateway EDI was founded almost 30 years ago by a physician who wanted to better manage the revenue cycle. Today, more than 95,000 physicians count on Gateway EDI’s suite of advanced tools and proactive service team to take the worry out of billing and claims management, so they can focus on what matters most: patient care. For more information, visit http://www.gatewayedi.com/. You can also find a compilation of helpful online ICD-10 tools and resources at Gateway EDI’s ICD-10 Insights website.

What does this mean for you?  At this time, the ICD-10 implementation date remains October 1, 2013.

We at Gateway EDI encourage practices to continue on the path to ICD-10 implementation.  Beginning or continuing your preparation for ICD-10 implementation will allow you to reduce the impact that this massive change will have on your practice.  Here is a sample of an ICD-10 planning worksheet to help you get started or continue in your planning.

We encourage you to visit our ICD-10 Insight website at www.gatewayedi.com/icd10 for a compilation of helpful industry resources on ICD-10. 

How did you begin your Gateway EDI career?

Renee: I started working at Gateway EDI in our customer service department eight years ago, and have spent the past five years working exclusively with our vendors and channel partners. Since I’ve worked with vendors for so long, I help bring our field sales representatives up to speed so they can better serve our vendors.

What do you like most about working with Gateway EDI’s vendors?

Renee: I really enjoy getting to know our vendors’ businesses, developing personal relationships with them and helping them to be successful. I’ve been their go-to person for years, so I understand their business needs and know how to best assist them. Of all the jobs someone could have, I think mine is one of the best.

Over the past few months, you’ve been helping address 5010 concerns. How has Gateway EDI been handling the transition for your clients?

Renee: Normally, we have 25% of employees dedicated to customer service. With 5010, we now have more than 85% of our employees dedicated to customer service, including many of us who usually work with vendors. Because many of our clients are our vendors’ clients too, we have been trying to reduce the pressure of the transition for them by helping their customers with 5010-related issues. Hopefully, this has decreased the number of 5010 calls our vendors receive.

What types of resources does Gateway EDI provide for vendors?

Renee: We always point vendors to our preferred vendor partner portal. There, they can find tools and reports that will help them analyze their clients’ claims, identify where frequent errors may be occurring and provide extra value to their clients by showing them how they can correct their claims to avoid delays in reimbursement. We have also provided a 5010 tool on the vendor site, which may help them answer their clients’ questions about 5010 rejections.

What do you like to do in your free time?

Renee: I have twin daughters in college who keep me busy, and I also enjoy traveling and playing in a competitive bowling league.

Applications can be found on your Gateway EDI vendor website by clicking here. If you need assistance logging in please contact your vendor account manager.

Hurry! The application deadline is June 30th. Questions about the program should be directed to Jim Bettendorf at jbettendorf@gatewayedi.com or 800-969-3666 x1213.