BPM007093_IMPAXX_Attachment - Scope of Work Responses.pdf

Industrial Commission of AZ – BPM007093 -- Attachment: Scope of Work Responses -- IMPAXX

Scope of Work Responses

2.0 - IMPAXX Background

We have a 20+ year history of helping customers identify, create, and implement Medicare compliance programs. Since our inception in 2001, customer service has remained our top priority, and we wholeheartedly believe this customer centric approach has driven our success in the industry.

IMPAXX provides Section 111 Reporting services to their clients via their 111 Reporter software. This web-based platform provides a robust, full-service solution to stay compliant with MIR requirements. This system provides clients with both manual and EDI options to securely provide claim data to IMPAXX.

2.1 & 2.2 - Contract Pricing and Billing

IMPAXX will provide pricing for the service quarterly and will invoice for services quarterly.

3.1 - Reporting Process

IMPAXX utilizes industry best practices to query and report data to Medicare.

IMPAXX queries claimants monthly to determine the beneficiary status of the claims. Our pre-validation process identifies claims that have data elements which will prevent Medicare from querying the record, providing an opportunity to correct or complete the data before query submission.

Once a record is confirmed as a Medicare beneficiary, the system will validate the full claim to understand the ORM, TPOC, ICD and other related data fields. If a claim fails the validation process, it will not be included in the quarterly claim submission, which reduces the risk of rejected claims (or entire files) and therefore helps prevent Civil Money Penalties (CMPs) for late reporting.

For non-beneficiary records, the validation process only looks for issues related to SSN, first and last name, date of birth, and gender coding. This saves our customers time and focuses attention on the data elements needed to query the record.

For both the query and reporting cycles, the best practice in our process is to pre-validate the data for the cycle in which the claim resides and to provide our customers with clear and concise data and reports that will allow any corrective action to be completed. With weekly EDI file exchanges our customer at least four opportunities per month to correct query-related errors and at least twelve opportunities per quarter to correct reporting related errors.

Figure 1- 111 Reporter Data Flow

3.2 – IT System Requirements

IMPAXX has vast experience in building EDI connections for Section 111 Reporting and can exchange data via text/flat file, XML or API. IMPAXX has standardized exchanges with popular claim systems including Ventiv/Riskonnect, Origami, Insurity, Klear AI, JW File Handler, and others.

IMPAXX is attaching a PDF file of one of our text file specifications for the Commission to review. We hope that will provide an easier viewing experience than screenshots. Please note that there are many optional fields included, which can be pared down if desired. Additionally, IMPAXX can exchange data via an API should the Commission decide that is their desired methodology.

IMPAXX will host an SFTP environment to receive production claim data from the Commission and to provide response data including validation codes, query data and CMS reporting responses.

Figure 2 - File Transmission Process

3.3 – Experience

IMPAXX performs Section 111 Reporting services for customers of all sizes, with some having only a handful of claims and others with hundreds of thousands of claims. We report for individual Responsible Reporting Entities (RREs), third party claim administrators (TPAs) that manage many RREs, and insurance carriers.

The Medicare Reporting Services team is led by our Vice President of Technology Solutions, Frank Fairchok. Frank has sixteen years of experience in building and managing Section 111 Reporting programs and helped to build many of the industry’s best practices for reporting. He is considered a national subject matter expert in Mandatory Insurer Reporting.

3.4 – Reporting Results

IMPAXX will act as an intermediary for all transactions with CMS on behalf of the Industrial Commission of Arizona. In this role, IMPAXX will receive claim data from the Commission’s File Handler claim system on a weekly basis. As this data is processed, IMPAXX will analyze the data with a validation set that precisely matches CMS.

After processing the file, IMPAXX will return a response file to the Commission that will identify any data issues to facilitate the early correction of the data prior to the monthly query and quarterly claim report.

To facilitate this data exchange, IMPAXX will host the SFTP to allow for the secure exchange of data with the Commission.

IMPAXX will prepare and submit both the monthly query and quarterly reporting files to CMS on behalf of the Commission:

Query: IMPAXX will submit a monthly query file to the BCRC to identify beneficiaries in the claim data.

IMPAXX and the Commission will agree to a day within each calendar month for that file to be created and transmitted. IMPAXX will retrieve the query response file and update the claims in our 111 Reporter platform. Response data is transmitted back to the Commission via a weekly response file from IMPAXX. If the Commission would prefer to process the file from the BCRC, IMPAXX will also pass the file back to the Commission.

Reporting: IMPAXX will submit a quarterly claim file to BCRC in the week designated on the Commission’s Profile Report. IMPAXX will retrieve the reporting response from the BCRC and update the claims in our 111 Reporter platform. The responses from this process will also be included in the weekly response file from IMPAXX. If the Commission would prefer to process the file from the BCRC, IMPAXX will also pass the file back to the Commission.

An important differentiator for our reporting program is that IMPAXX returns an RRE Reporting Scorecard for every quarterly submission to CMS. This provides our customer/RRE with a high-level view of the results of their submission, removes the guesswork and increases understanding of their reporting compliance. A sample scorecard is provided below.

Figure 3- Sample Scorecard

3.5 – Performance Requirements

IMPAXX has several protocols in place that are designed not only to provide accurate, complete, and timely reporting, but also to reduce customers’ time and effort spent. This means that customers can focus their attention on the areas where it is needed most and not waste cycle time for activities not needed. Our protocols are as follows:

Cycle Separation: IMPAXX’s 111 Reporter separates our customers’ claim data into two distinct processes. The first is the query process for claims not yet identified as Medicare beneficiaries and claims in this cycle are only validated for data elements needed to send the record in the monthly query file. The second cycle is quarterly claim reporting, once a beneficiary match has occurred. There the record is evaluated for ORM and TPOC conditions that make the beneficiary claim reportable to CMS.

The platform validates data in this cycle against all the required reporting elements to ensure that it is error-free based on CMS standards.

Transmission of Complete and Error Free Claims: CMS has been exceedingly clear that only complete, error-free claims should be sent in the quarterly claim submission. In fact, with the Final Rule for Civil Money Penalties in place, submitting incomplete or error-filled claims could place the RRE in jeopardy of late reporting.

IMPAXX follows best practices and only sends claims clearing all validations in the quarterly reporting file to provide the RRE with the highest rate of acceptance without claim, or worse, file rejections.

IMPAXX is operating with a historical acceptance accuracy of 100% and strives to continue this accuracy in the future. This accuracy is calculated after removing errors CMS states cannot be avoided by the RRE or Reporting Agent such as the SP31 error code.

Results Review: IMPAXX reviews the CMS response file and provides our customer with a report showing high-level results. (See example in Section 3.4 above) This allows both IMPAXX and our customers with a view to the success level of the reporting and allows for any necessary changes to be made that could improve success.

The Industrial Commission of Arizona will be able to select how they would like to receive validation data. These methods include:

• Response files that allow File Handler to receive validation data and create diaries.

• The Commission will have access to our 111 Reporter portal for error reports to be created for download.

• A custom process where error reports are provided either through the SFTP or emailed to a specific contact or distribution list.

In addition, 111 Reporter will provide the County with automated notifications before and after query and reporting events that can be customized by user account. Notifications prior to a query or reporting submission help our customers stay focused on the pending submission. Post submission notifications allow our customers awareness that the BCRC has responded and provides high level metrics in the response.

Figure 4 - Notification Settings

Scope of Work Responses