DMX (Denial Management Exchange)

Universata will enable the exchange of medical records between the Business Office and Health Information Management (HIM) to improve the denials management process. The Business Office will be trained by Universata to electronically request and receive medical records from the HIM department using their own computers.

* The Business Office will e-request records through the use of PHI-nd IT™.

* HIM personnel will scan the records into PHI-nd IT™.

* HIM staff within HIM will be trained to support the business office in the use of PHI-nd IT by Universata.

* The Business Office will be able to forward the paperwork generated for billing plus the medical record directly to the payer if the payer accepts electronic deliver.

The Business Office will work with HIM and Universata to get third-party requestors that are not already requesting and receiving e-medical records from Universata to adopt PHI-nd IT as their electronic correspondence system for health information exchange (HIE). This electronic exchange can take 2 to 5 days off the accounts receivable timeline.

What is the DMX system and what does it do?

The DMX is an integrated control system for a caregiver’s business office process of:

Responding to and collecting on claim denials.

Managing the process of submitting original bills.

These are noted in the order of implementation as the denial process is the logical place to implement the DMX first, followed by a rollout to the entire enterprise.

* As an integrated control system, the DMX allows a single user or set of users to systematically manage the denial response and bill submission process. There is a finite set of variables affecting how long it takes to respond to a denial as well as contributing factors to an original claim ending up as a denial. The DMX integrates into key caregiver systems affecting these processes for the purpose of creating a complete beginning and end process that:

* Speeds up collection on denials. Often referred to as “days in AR”, the DMX has demonstrated a guaranteed reduction in days in AR of 2 to 5 days at all sites aggressively and correctly using the DMX proof of concept. Each day is worth several millions of dollars per month (depending on size of the organization) of additional cash-flow the enterprise would not have otherwise realized.

* Prevents subsequent denials to denial responses. There is a cause and effect loop that often triggers additional denials after the first one.

* Manages accountability with payor organizations to reduce delays. Caregivers often complain that payors lose key documents, either in process or within their own organizations. By using DMX functionality to track and route up to all billing and denial information/content, the caregiver has an assurance of absolute accountability via any of the DMX’s delivery mechanisms and reporting tools.

* Reduces the overall proportion of denials in any organization. Key reports about the entire process will provide business intelligence that allow the DMX’s users to understand, compensate for, and take control of why denials are occurring.

About the Technology

1. Tailor-able Rules – this component dictates how the application will process the customer’s requests for information (ROI). The customer can tailor the system’s rules to reflect standard protocols and procedures for the handling of protected health information requests. For instance, special approval procedures can be put into place for certified copies of medical records. Once the record is assembled, it is routed to an HIM manager to review, approve, and attach the Letter of Certification.

2. Workflow Management – The workflow dictates how the system will process requests once they make it into the system. For instance, in a situation where hundreds of requests are in the queue, the system permits our customers to prioritize the requests based upon a variety of factors. For example, requests from the Business Office associated with high dollar denials can be processed with a higher priority. This simple change in workflow process can dramatically reduce the days in A/R for denied claims, thereby significantly reducing the overall day’s In A/R.

3. Reporting and Auditing (HIPAA Disclosure Audit) – As mentioned above, every user action is time and date stamped along with the user’s ID. Every component of the process is available for reporting and auditing. For example, HIPAA permits patients to request an Accounting of Disclosure (AOD), whereby providers must produce a report showing each and every disclosure made of that patient’s information. In the Universata world, this is accessed with the press of a button and is a natural byproduct of the PHI-nd IT™ system.

4. Push Technology - The system can be used to proactively notify participants in your network. For instance, an email notification can be automatically routed to the primary care physician of a patient who was seen in the Emergency Department over the weekend. This email can contain a link to the patient’s record so that the physician can review the episode to determine if a follow-up visit is necessary. If the patient is admitted to the hospital, they physician will then be alerted to the fact that this patient health needs to be included in his/her daily rounds.