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© 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
© 2006-2018 WorkCompEDI, Inc.
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
© 2006-2018 WorkCompEDI, Inc.
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
Connectivity Simplified™
3
Additional Corporate Information
© 2006-2018 WorkCompEDI, Inc.
Connectivity Simplified™
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
Fax
Website
File Exchanges
Vendor Integrations
Historic Files
© 2006-2018 WorkCompEDI, Inc.
Connectivity Simplified™
Gateway Connectivity Solutions
6
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
© 2006-2018 WorkCompEDI, Inc.
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
© 2006-2018 WorkCompEDI, Inc. 8
Healthcare Connectivity Simplified™
WorkCompEDI Clearinghouse
Pro-spective Bill Flow
© 2006-2018 WorkCompEDI, Inc. 9
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
© 2006-2018 WorkCompEDI, Inc.
Transmission MethodssFTP (File Transfer)
HTTPS (web upload)
API
Formats Accepted275 X12 Format (5010 & 6020)
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
10
Attachment Handling Process
© 2006-2018 WorkCompEDI, Inc.
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
© 2006-2018 WorkCompEDI, Inc. 12
Connectivity Simplified™
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
© 2006-2018 WorkCompEDI, Inc.
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
© 2006-2018 WorkCompEDI, Inc.
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!
Connectivity Simplified™
14
© 2006-2018 WorkCompEDI, Inc.
Payer Provider POS or Virtual Terminal
Acquirer/Processor
Payment Filesent to WCEDI
Card & RemittanceData
Authorization
15
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…
Connectivity Simplified™
“Straight-Through-Processing” Automated
15
© 2006-2018 WorkCompEDI, Inc. 16
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
© 2006-2018 WorkCompEDI, Inc.
Connectivity Simplified™
Unstructured Documents Technology Solution
© 2006-2018 WorkCompEDI, Inc.
Connectivity Simplified™
QICS Image Sharing Technology Solution
© 2006-2018 WorkCompEDI, Inc. 19
A Glimpse Into iCompEDI™ Version 3.0
Coming Soon!
© 2006-2018 WorkCompEDI, Inc. 20
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
© 2006-2018 WorkCompEDI, Inc.
Payor ID Support Systems & Architecture
© 2006-2018 WorkCompEDI, Inc. 22
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
© 2006-2018 WorkCompEDI, Inc. 23
Private Label Solutions
© 2006-2018 WorkCompEDI, Inc.
Connectivity Simplified™
Marc MenendezPresident & CEO
(800) 297-6909 x1305
Scott HefnerVice President, Business Development
(800) 297-6909 x1325