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Plan To Streamline Claims Processing Gets Tepid Review

MANAGED CARE June 1998. © MediMedia USA
Washington Initiatives

Plan To Streamline Claims Processing Gets Tepid Review

MANAGED CARE June 1998. ©1998 Stezzi Communications
Washington Initiatives

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.

Meetings

Pharmaceutical Pricing and Contracting Conference Philadelphia, PA September 22–23, 2014
Private Health Insurance Exchanges Conference Washington, D.C. October 7–8, 2014
National Healthcare Facility Management Summit Palm Beach, FL October 16–17, 2014
National Healthcare CFO Summit Las Vegas, NV October 19–21, 2014
National Healthcare CXO Summit Las Vegas, NV October 19–21, 2014
Innovative Member Engagement Operations For Health Plans Las Vegas, NV October 20–21, 2014
4th Partnering With ACOs Summit Los Angeles, CA October 27–28, 2014
2014 Annual HEDIS® and Star Ratings Symposium Nashville, TN November 3–4, 2014
PCMH & Shared Savings ACO Leadership Summit Nashville, TN November 3–4, 2014
World Orphan Drug Congress Europe 2014 Brussels, Belgium November 12–14, 2014
Medicare Risk Adjustment, Revenue Management, & Star Ratings Fort Lauderdale, FL November 12–14, 2014
Healthcare Chief Medical Officer Forum Alexandria, VA November 13–14, 2014
Home Care Leadership Summit Atlanta, GA November 17–18, 2014