Q1 2016 Update Published: February 12, 2016

Q2 2016 Update Available: No later than May 13, 2016

HIPAA and ACA Timeline

Change Healthcare Quarterly Updates

2.12.2016

PROPRIETARY & CONFIDENTIALCHANGE HEALTHCARE 2

HIPAA and ACA Timeline: 2013 to 2018

ICD-10

ASC X12N Version 7030

Operating Rules

Attachments

Health Plan Identifier (HPID)

Health Plan Certification

Meaningful Use Stage 3 (MU3)

Table of Contents

PROPRIETARY & CONFIDENTIALCHANGE HEALTHCARE 3

HIPAA and ACA Timeline

1/1/2014

EFT Standard and

EFT/ERA Operating Rules

Compliance

Enforcement Delay

Health Plan ID use in

Transactions

Compliance

TBD

Attachments Standard

and Operating Rules

Compliance

TBD

Attachments Standard

and Operating Rules

Effective

TBD

Claims, Enrollment,

Authorizations Premium

Payment, Operating Rules

Compliance

TBD

Claims, Enrollment,

Authorizations Premium

Payment, Operating Rules

Effective

2013 2014 2015

Jan

April

July

Oct

Meaningful Use Stage 1 and 2

TBD

Health Plan Eligibility,

Claim Status, EFT, ERA

Certification

TBD

Health Plan Claims,

Enrollment, Attachments,

Premium Payment, Referral

Certification

1/1/2013

Eligibility & Claim

Status Operating Rules

Compliance

Enforcement Delay

Health Plans must

register for HPID

Compliance

Enforcement Delay

Small Health Plans must

register for HPID

Compliance

TBD

Health Plan Eligibility,

Claim Status, EFT, ERA

Penalty Fees

2016 2017-2018

Regulations below have not been published at this time or have been delayed and the dates are to be determined.

These regulations may be effective sometime in 2016 with compliance dates in 2017- 2018.

Meaningful Use Stage 3

10/1/2015

ICD-10

Compliance

ASC X12N v7030 Staggered Public Comment

PROPRIETARY & CONFIDENTIALCHANGE HEALTHCARE

ICD-10

4

PROPRIETARY & CONFIDENTIALCHANGE HEALTHCARE

After much planning and anticipation, the October 1, 2015 ICD-10 transition deadline has

come and gone. In the few months since implementation, the ICD-10 code set has

become the accepted industry standard and all involved should be proud of the

role they played in this monumental accomplishment.

Change Healthcare is closely monitoring the transition to ICD-10 and, thus far, has seen

positive trends. Our observations and metrics reveal the following:

More than 95% percent of claims submitted to Change Healthcare at the beginning of

February 2016 were coded ICD-10.

Change Healthcare will continue to process ICD-9 for claims with dates of service or

discharge prior to October 1, 2015 to support run-out and amended claims.

Both providers and payers have demonstrated readiness to utilize ICD-10 codes.

A review of ICD-9 and ICD-10 claims to date reveals little variance in trends related to

average payer payment and denial rates.

While isolated issues continue to occur, these issues continue to diminish as

healthcare organizations tweak their systems and identify opportunities for process

improvement.

Please reference the article ICD-10 So Far, So Good" in Advance Healthcare Networks

ExecutiveInsight publication for more information.

5

ICD-10 in Retrospect

http://healthcare-executive-insight.advanceweb.com/Features/Articles/ICD-10-So-Far-So-Good.aspx

PROPRIETARY & CONFIDENTIALCHANGE HEALTHCARE

ASC X12N Version 7030

6

PROPRIETARY & CONFIDENTIALCHANGE HEALTHCARE

ASC X12N Version 7030 Public Comment

7

ASC X12N Insurance Subcommittee is currently finalizing version 7030 of the health care

Technical Reports Type 3 (TR3s). It is anticipated that ASC X12N will recommend to HHS

that version 7030 of the HIPAA-mandated transactions be adopted. Over the course of

2016, ASC X12N will be releasing the 7030 TR3s for public comment. The public comment

schedule will be announced in Q1; watch www.x12.org for more information.

PUBLIC COMMENT PERIOD KEY FACTS

Public comment periods for the TR3s will be staggered, beginning in April 2016 and

ending in December 2016.

NOTE: Public comment periods will be held for all 7030 TR3s, including those

transactions not mandated under HIPAA.

Each public comment period will extend for 60 days.

Staggered approach allows for more focused reviews and hopefully, increased

participation from the industry.

The intent of ASC X12N is to publish all TR3s together when the public comment cycles

have been completed and all comments considered.

Change Healthcare is actively participating in the standards development process.

ASC X12N v7030 Staggered Public Comment

http://www.x12.org/

PROPRIETARY & CONFIDENTIALCHANGE HEALTHCARE

Operating Rules

8

PROPRIETARY & CONFIDENTIALCHANGE HEALTHCARE

Change Healthcare Operating Rules Readiness

9

CAQH certifies and awards CORE Certification Seals to entities that create, transmit or use

the administrative transactions addressed by applicable Operating Rules.

CORE Certification means an entity has demonstrated that its IT system or product is

operating in conformance with a specific phase(s) of the Operating Rules.

Change Healthcare is CORE Phase I, Phase II, and Phase III certified, as evidenced by

our Phase III seal.

Link to Change Healthcares CORE Phase III Seal.

Link to our CORE Voluntary Certification (Clearinghouses tab).

Link to the Change Healthcare Press Release announcing our certification.

Additional information regarding the Change Healthcare Operating Rules program can be

found on www.HIPAASimplified.com.

Change Healthcare is CORE Phase III Certified which is one of the two

options proposed in the Health Plan Certification NPRM. To become

CORE Phase III certified entities must be CORE-certified on the earlier

phases. Our CORE Phase III certification serves as Change Healthcares

exhibit of readiness.

https://www.changehealthcare.com/news/certificationshttp://www.caqh.org/core/core-certified-organizations-pending-and-currenthttp://emdeon.mediaroom.com/index.php?s=43&item=172http://www.hipaasimplified.com/

PROPRIETARY & CONFIDENTIALCHANGE HEALTHCARE

Enforcement Delay

Health Plan ID use in

Transactions

Compliance

TBD

Attachments Standard

and Operating Rules Compliance

TBD

Attachments Standard

and Operating Rules Effective

TBD

Claims, Enrollment,

Authorizations Premium Payment, Operating Rules

Compliance

TBD

Claims, Enrollment,

Authorizations Premium Payment, Operating Rules

Effective

TBD

Health Plan Eligibility,

Claim Status, EFT, ERA Certification

TBD

Health Plan Claims,

Enrollment, Attachments, Premium Payment, Referral

Certification

Enforcement Delay

Health Plans must

register for HPID

Compliance

Enforcement Delay

Small Health Plans must

register for HPIDCompliance

TBD

Health Plan Eligibility,

Claim Status, EFT, ERA

Penalty Fees

2016 2017-2018

Regulations below have not been published at this time or have been delayed and the dates are to be determined.

These regulations may be effective sometime in 2016 with compliance dates in 2017- 2018.

10

Operating Rules build on applicable HIPAA and other related standards to make adopted

electronic transactions more predictable and consistent.

Change Healthcare participated with the industry in defining and preparing for the CORE

Phase IV operating rules.

Phase IV rules did not address Health Claim Attachments, as prescribed under the ACA,

because attachment transaction standards have not yet been established.

Operating Rules HIPAA and ACA Timeline

Phase IV Operating Rules anticipated in 2016

PROPRIETARY & CONFIDENTIALCHANGE HEALTHCARE

Regulatory Roadmap Phase IV Operating Rules

11

In September 2015, CAQH CORE via their voting process, approved the Phase IV

Operating Rules for voluntary certification.

The Phase IV rules define infrastructure, connectivity, and companion guide

requirements for Health Care Claims (837), Health Care Services Review Request for

Review and Response (278), Benefit Enrollment and Maintenance (834), and Premium

Payment (820) transactions.

The Department of Health and Human Services (HHS) will determine if the new

Phase IV CAQH CORE Operating Rules will be included in any regulatory

mandates.

NEXT STEPS

In February 2016 the National Committee on Vital and Health Statistics (NCVHS),

advisory body to HHS, will conduct a hearing relating to the adoption of the Phase IV

rules.

NCVHS will make a recommendation to the HHS Secretary as appropriate.

HHS is expected to publish a proposed rule with comment period in 2016.

The Change Healthcare Regulatory Program team will begin to flesh out impact areas

and key resources to build out our enterprise Phase IV Operating Rules program

whi