ELLKAY

Connecting physicians, patients, and labs

Turnkey Insurance Mapping Service Description & White paper

Prepared by Kamal Patel, Co-founder & CIO

ELLKAY LLC. All rights reserved.

ELLKAY Live Mapping - Whitepaper

CONFIDENTIAL DOCUMENT

Contents
Introduction ............................................................................................................................................ 3 Industry Standard Approach ................................................................................................................... 3 ELLKAY Live Mapping ............................................................................................................................ 4 In Conclusion .......................................................................................................................................... 6

Copyright (c) 2011 ELLKAY, LLC. All rights reserved.

Page 2

ELLKAY Live Mapping - Whitepaper

CONFIDENTIAL DOCUMENT

Introduction
As the diagnostics laboratory industry continues to grow, it has become almost a necessity for laboratories to provide some form of connectivity to physician offices. Laboratories receive electronic orders by implementing either results-only or bi-directional interfaces to EMRs in physician offices. This exposes laboratories to rely on the insurance data provided by these electronic interfaces for their services. EMR/PM systems store insurance records comprised of a unique insurance code, insurance name, address and a phone number. Laboratories also have their master insurance list and for each interface, they cross-reference insurance data from each physician office to their master list. This mapped file is imported one-time by the EMR vendor during each interface implementation. Insurance information changes frequently and while the physician offices update their insurances, this mapped file or mapping remains static. EMRs do not have the ability to allow for continual management of cleanly mapped records prior to sending clean electronic orders to laboratories. It is imperative that laboratories retain the control of overriding mapped insurance information which they are able to identify as outdated or incorrectly coded to maintain a consistent rate of first-timesubmission approvals by insurance providers.

Industry Standard Approach

Laboratories typically manage an internal master listing of insurances in excel files. Every electronic orders interface implementation requires a cross-reference mapping of insurances. The most common form of mapping is either a one-time cross-reference during installation or some software based automation of mapping. Both methods are imperfect and lead to insurance provider declines over time as mapping information in physician office systems changes. In addition, there are several hundreds of these PMS/EMR vendors in the country and each system stores insurance plan & coding information in their unique and individual format. Finally, most PMS systems prefer a method of generating unique insurance codes on-the-fly i.e. at the time the physician office creates a master insurance record. This creates an environment where the code for a particular provider (e.g. "Aetna"), even in the same PMS/EMR vendor platform, could be different in each physician office installation. Some EMR/PMS platforms do not support uploading of cross-reference-mapping at all.

Copyright (c) 2011 ELLKAY, LLC. All rights reserved.

Page 3

ELLKAY Live Mapping - Whitepaper

CONFIDENTIAL DOCUMENT

One-time Mapping
During implementation of an interface at a physician office, laboratories normally receive a listing of insurances from either the EMR vendor or the PMS vendor. Laboratories then cross-reference each insurance with their master insurance list and generate a mapped file. This file is sent back to the EMR for loading within their application. Once loaded, laboratories have no control of their mapping as the one time mapping file is loaded into the EMR. While one-time mapping delivers high claim approval rates at the time of implementation and soon after, this method does not handle ongoing updates to the mapping as physician's data constantly changes. Patients switch insurances frequently and physician offices update their data to optimize their internal billing & collections processes. Eventually manual insurance mappings become useless in assisting the laboratory achieve their goal of high firsttime-claim-submission approvals.

Software Automation
Automating the ongoing mapping process seems intuitively ripe for automation with workflow and algorithmic software development, this approach comes with a significant limitation. As an example, physician offices often misspell insurance names and/or use the fields in PMS/EMR to store additional information about the providers and plans. An office might just add an asterisk next to the plan name to mark that plan as an HMO. It would require very advanced software to identify and correctly catalog the many non-standard scenarios such as this. Given the crucial nature of first-time-claim-submission approvals, laboratories attempting automation eventually re-invest in personnel to performing manual mapping.

ELLKAY Live Mapping

As the electronic healthcare management industry continues to evolve, a shared standard will hopefully emerge for insurance master listings. ELLKAY has developed a software tool and companion fulfillment service to offload this concern in the interim, until such time that a standard is established and adopted. ELLKAY has built an application for laboratories to manage and maintain their cross-reference mapping for all their physician accounts. The system also allows laboratories to maintain their master insurance listing. ELLKAY has a fulfillment center performing manual reviews and real-time adjustments of all ELLKAY Live Mapping enabled claims to maximize first-submission approvals. Live Mapping is available in SAAS or enterprise deployment model.

Copyright (c) 2011 ELLKAY, LLC. All rights reserved.

Page 4

ELLKAY Live Mapping - Whitepaper

CONFIDENTIAL DOCUMENT

Modules of Live Mapping

Below is the list of most common modules available in Live Mapping: Dashboard Web Services Integration for Interface Engines Identifying new and changed insurance records from physician offices Manage Internal Master Listings Insurance Mapping Insurance Record - Status Flags Audit-Trail (Each insurance record in each office) Batch updates across multiple physician offices Identifying Add/Del/Update New insurance records are constantly added in physician office systems as new patients visit the physician offices. Insurance coverage status for existing patients is also changing often. ELLKAY Live Mapping monitors all insurances across 450 different PMS/EMR vendor systems and formats. Live Mapping captures physician office updates, making them available to laboratories for cross-reference mapping. The synchronization interval is determined per-lab and can also be different for each physician office depending on volume of patient turnover. Managing Internal Master Listings Laboratories typically keep their master listing in Excel files, and manage these listings by writing notes in additional columns. While this solution may be simple with one person managing insurance mapping across an entire laboratory; laboratories grow, and inevitably asking multiple people to handle managing and coordinating multiple master listings. Using Live Mapping, laboratories can have several personnel working from various locations to centrally manage all of their master listings.

Dashboard When users sign-into Live Mapping, the dashboard view allows them to see a complete picture of insurance cross-reference mapping across all their physician office in one snapshot. If there are any records which are mapped to discontinued records, users can make the decisions to change them in a single view across multiple offices. It also provides an overall picture of new records that came in, how many insurances were mapped and which users mapped them etc. Web Services integration for Interface Engines Live Mapping exposes secure Web Services that allow outside applications to send request for mapping codes per physician office. This allows the mapping to be managed from one centralized location for a laboratory and have all their internal applications as well as their interface engine query for mapping codes. Interface engines can make direct calls to Live Mapping cloud server and request mapped insurances codes. This allows laboratories to continue fulfilling the implementation of orders and results interfaces without worrying about sending clean orders to their back office staff.

Copyright (c) 2011 ELLKAY, LLC. All rights reserved.

Page 5

ELLKAY Live Mapping - Whitepaper

CONFIDENTIAL DOCUMENT

Insurance Mapping Process Insurance Mapping is the actual process of cross-referencing and matching an insurance record from the physician office systems to a laboratory master insurance record. Live Mapping's cloud-based application allows laboratories to see an entire record in the physician's PMS/EMR system and then search and match an appropriate laboratory insurance master record.

Audit-Trail ELLKAY Live Mapping maintains a complete audit-trail of all changes in insurance records. The system captures the date/time the record was created, tracks the individual who mapped it, any changes in mapping, when the record was published to the physician office etc. AuditTrail is available at two levels: 1) For each insurance record in each physician office and 2) For each master laboratory master insurance record

Insurance Record - Statuses ELLKAY has broken down each aspect of the insurance record from identification, to uploading, mapping and then publishing to the physician office. Every insurance record in participating physician office systems should have an insurance record tracked and can be in one of these modes: Insurance record received (unmapped) Insurance record mapped but not published Insurance record mapped and published Audit-Trail (Each insurance record in each office) Mapped and Published Insurance record but the mapping is to a currently inactive code

Batch updates across multiple physician offices Laboratories are constantly changing and updating their master insurance records. For a growing laboratory, signing a new contract with an insurance company will trigger several additional new insurance records in their master listing. If a laboratory wishes to update all their existing clients and notify these offices that the laboratory now accepts a particular new insurance company, a laboratory can update the mapping code across all selected insurances via one click. All new orders will automatically be routed to use the new insurance code putting complete control in the hands of laboratory.

In Conclusion
Live Mapping puts control back in the hands of laboratories. ELLKAY has grown the Live Mapping offering to be a unique combination of software tools, unparalleled industry systems integration knowledge, and a team of mapping analysts working to ensure maximum accuracy and effectiveness of insurance mapping for ELLKAYs Live Mapping laboratory clients. This empowering combination of software and services improves laboratory operating efficiency, delivers a high first-submission approval of claims, and improves collection.

Copyright (c) 2011 ELLKAY, LLC. All rights reserved.

Page 6

ELLKAY Live Mapping - Whitepaper

CONFIDENTIAL DOCUMENT

Partner with the leader today!

Benefit from the industrys most experienced team providing connectivity solutions and services that deliver productivity and value to the Healthcare industry.

Contact us today
201- 791-0606 LKApps@ELLKAY.com
View all our services for physicians, hospitals, and laboratories: www.ELLKAY.com

Copyright (c) 2011 ELLKAY, LLC. All rights reserved.

Page 7