Dear Advantage Member:
We hope you are having a safe and wonderful summer. As you may already know, the Advantage Board of Directors has entered into a strategic partnership with Pinnacle Physicians Network (PPN) of Nebraska (the I.P.A. affiliated with the Nebraska Chiropractic Physicians Association). The alliance came about after carefully studying the Advantage business model and making the determination that we needed to make some deliberate decisions regarding our future growth and relevance as an IPA in a new and emerging health care market.
The purpose of this letter is to provide you with comprehensive information regarding an important and strategic Board-approved initiative currently underway as it will impact all Advantage Member offices.
Effective March 1, 2010, Advantage Chiropractic Network will require all member offices to migrate to a standardized EDI solution, for the submission of claims. Our migration to the new process will begin in mid-to-late August 2009 and should be completed by March 1, 2010.
This decision was made with strong consideration and based on the success that PPN had migrating their member offices to one EDI solution and the positive feedback they received from their insurance company partners and PPN Members. Currently, Advantage Member offices use dozens of different EDI vendors for claim submission. The data we gather under one EDI solution will become an important part of a new utilization management program and will strongly position Advantage to remain competitive and meet the expectations of current and prospective insurance company partners/contracts. As you all know, health care reform will undoubtedly require greater accountability from providers, and the Advantage Board is confident that this move will further build our presence in the chiropractic managed care marketplace in Iowa. In addition, our claims data may be aggregated with Nebraska’s and lead to possibly creating a joint best practices program.
The selected vendor for Advantage and PPN is Infinedi, LLC (
www.infinedi.net
). Infinedi has been working with IPA’s for many years and has a successful track record in providing them with important statistical data. Infinedi has built relationships with payers and physician’s advocate groups across the nation in order to provide the absolute best service available from an EDI vendor. We have attached a Frequently Asked Questions (FAQ) sheet with hopes that you will gain better understanding of our new initiative and the benefits for both you and Advantage.
It is possible that some current EDI vendors servicing Advantage Member offices may try to convince you that change is not needed, but please keep in mind that these organizations are most concerned with saving client relationships and lost revenue. The Advantage Board had your best interests in mind when we made this important decision.
The migration to Infinedi will be carefully managed and your office will receive a great deal of information and training in the coming weeks and months – including a luncheon presentation/Q&A session with the president of Infinedi, Advantage Board Members and a few PPN representatives at the ICS Fall Symposium in October.
Given our new strategy, we highly recommend that your office avoid entering into any new or long-term agreements with EDI vendors. We are very excited to usher in a new era of change and growth for Advantage and are counting on you to help us make this possible.
Best regards,
Russell Van Hemert, D.C. Daniel D. Garrett
Chair, Advantage Chiropractic Network Executive Director
Frequently Ask Questions
Advantage Chiropractic Network & Standardized EDI Process
1. Why are we moving to a standardized EDI process?
Currently member offices use a wide variety of EDI vendors for the submission of claims. The current process of claim submission by members does not allow Advantage access to much needed claim data needed to perform important analysis for the network, which may be used to help secure future contracts.
2. How will Advantage use claim data?
Our new process will allow Advantage to receive standardized reporting and “dashboards” of all claims submissions from member offices. The data and “dashboards” will allow us to assist offices with refining billing practices and assist with contract negotiations. The new system will also help us identify practice outliers (both under and over utilizers), which will be the foundation of an Advantage utilization management program.
3. Why is this project so important?
Some of the most important relationships we have (and don’t have) are with our insurance partners. Imagine our strong market position when going to negotiate new contracts with a utilization review program and aggregate claim data. In today’s managed care environment there are increasing expectations that Advantage will actively manage the chiropractic network. To achieve this important business objective we must have access to claim data for efficient and accurate analysis.
4. I like my current EDI vendor. Am I required to move to the new standardized solution?
Yes. Your office will be required to use the new solution for the submission of claims. We recognize there are many good EDI solutions offered in the market. However, there are relatively few EDI solutions offered which also contain a toolset that can be used to analyze the activity of many different offices. It is this second component which became critical in the selection process. Infinedi was carefully vetted by both Advantage and PPN leadership and included meetings at their Tulsa headquarters. They currently serve nearly 8,000 chiropractic offices across the country and are close partners with many insurance companies including numerous Blue Cross Blue Shield organizations in other states. In addition to their focus on chiropractic, Infinedi also serves 8,000 other provider organizations and has been selected by prestigious organizations such as the California Medical Association as their preferred EDI partner.
5. How much will the Infinedi service cost my office?
Infinedi will charge a $50 flat fee per month per provider for all your electronic claims, including both contracted and non-contracted payers. The one-time $125 implementation fee will be paid by Advantage if your office is enrolled by December 31, 2009.
6. What if I have a multi-year contract with my current vendor?
Advantage will not require any office to break or violate an existing contract obligation. However, our assessment is that the majority of multiyear type contracts are non-exclusive. This means that you may enter into an agreement with more than one EDI vendor if you chose. Any office with a multiyear contract will receive special assistance and support to ensure you are able to take advantage of the features of the new EDI system while meeting your existing contract obligations.
7. Who do I contact if I have more questions?
Janean Carey at (515) 867-2806 (
jcarey@iowadcs.org
) and/or Dan Garrett at (515) 867-2804 (dgarrett@iowadcs.org).
8. Has the Advantage Board of Directors approved this action?
Yes and they have begun implementing the Infinedi System in their offices to begin August 1, 2009.
9. Will Infinedi work with my current practice management software and/or EHR software?
Infinedi’s CEO, Brad Cost, indicates that 99.9% of most practice management software programs are compatible, and if not, he will work towards finding a solution.
10. What do we do next?
In the next few weeks, you will be receiving a comprehensive informational packet from Infinedi, which will outline all of the necessary steps your office needs to take in order to implement this change. Advantage will compensate your practice $125 to cover your one-time set-up fee, if you are set-up by December 31, 2009. However, if you would like to get started right away, feel free to call Infinedi toll-free at 800-688-8087 and ask for Client Implementation. Please identify your office as an Iowa Advantage office, and they will “get the ball rolling” for you. You must be enrolled no later than March 31, 2010.
Also, as previously mentioned, extensive training from Infinedi via a combination of conference calls, in-person meetings and Webinars will begin to be scheduled in the next few weeks, so stay tuned. Infinedi has recently released new leading interactive technology that coupled with their extraordinary customer service and their commitment to Advantage Members, ensures a smooth and successful transition. Nebraska members have reported that Infinedi has exceeded their expectations in customer service.
Infinedi’s CEO, Brad Cost is sponsoring the Saturday, October 17, 2009, luncheon at ICS’s Fall Symposium. At this time, he will provide a full product demonstration/presentation of Infinedi along with a few Advantage Board Members who will report on their progress with implementation. In addition PPN’s CEO, Lou Andersen and a few PPN Board members will be on-hand to speak further about the importance of this initiative and partnership.