Politics & policy

Insight into federal and state health care legislation & CMS regulation

Plan To Streamline Claims Processing Gets Tepid Review

The health insurance community is reacting cautiously to plans by the Department of Health and Human Services to streamline claims processing and to establish a standardized format for submission of electronic claims.

HHS's May 7 announcement included proposals to:

  • Require every health care provider to maintain a unique eight-digit identification number for filing electronic claims. This identifier would be like a Social Security number in that a provider has it for life and it never changes, no matter where it does business
  • Require health plans to accept electronic claims that have been filed in a standardized format
  • Enable health plans to pay providers, authorize services, certify referrals and coordinate benefits using one standard electronic format for each transaction
  • Allow employers to use a standard electronic format to enroll — or disenroll — workers and make premium payments to health plans

Richard Coorsh, a spokesman for the Health Insurance Association of America, says HIAA "has always been supportive of efforts to simplify the administration of health care claims and efforts of electronic task forces to reduce paper work." That said, Coorsh adds, "We think, of course, that there should be consistency in the law."

The American Association of Health Plans and the Blue Cross/Blue Shield Association are also studying the proposal.

HHS says the regulations would save at least $1.5 billion in the first five years of implementation. The comment period ends July 6.

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