Understanding the Administrative Simplification Provisions of the PPACA
|
|
- Clare Knight
- 6 years ago
- Views:
Transcription
1 Understanding the Administrative Simplification Provisions of the PPACA Annie Boynton BS, RHIT, CPCO, CCS, CPC, CCS-P, CPC-H, CPC-P, CPC-I Director Communications, Adoption&Training Regulatory Implementation Office UnitedHealth Group 1
2 700 Billion annually in wasteful spending What is Administrative Simplification? 2
3 Defining Administrative Simplification Patient Protection and Affordability Act (PPACA) H.R now referred to as Affordable Care Act (ACA) Administrative Provisions identified in two sections of health care reform bill Section 1104 Administrative Simplification Section Development of Standards for financial and Administrative Transactions Significant changes to the HIPAA requirements Allows for adoption of standards and operating rules via Interim Final Rules, eliminating the need for NPRMS Administrative Simplification What is it? Affordable Care Act * The Administrative Simplification provisions of the Affordable Care Act of 2010 (ACA), build on the Health Insurance Portability and Accountability Act of 1996 (HIPAA) with several new, expanded, or revised provisions, including requirements for: Operating rules for each of the HIPAA transactions Enumeration of a unique, standard Health Plan Identifier (HPID) New standards for electronic funds transfer and electronic health care claims attachments Health plans to certify compliance with the standards and operating rules Penalties for health plans that fail to comply or to certify their compliance with applicable standards and operating rules. * Source: CMS.gov web site 3
4 Who is impacted? All HIPAA-covered entities would be affected including: All health benefit plans Health care clearinghouses and vendors Physicians, facilities and health care professionals Software vendors Any other business associates providing transaction-related services, such as billing support and third party administrators. No Really What does it mean? Simplify! Make it more efficient! Make it more convenient! Spend less time on paperwork more time with patients! Applies to all areas of healthcare: Billing Coding Providers Health Plans Vendors 4
5 In order to get there, US Healthcare needs a few changes. 5
6 CAQH* Initiatives *Council of Affordable Quality Health Care CAQH CORE The Rule Makers 6
7 What are Operating Rules? Goals of Administrative Simplification 7
8 Timing Jan. 1, 2013 May 6, 2013 Jan. 1, 2014 Eligibility and claim status operating rules compliance date. National Provider Identifier compliance date. Electronic funds transfer and electronic remittance advice compliance date. Nov. 5, 2014 Health Plan Identifier compliance date. For small health plans, the date is Nov. 5, At least Oct. 1, 2015 ICD-10 new compliance date. Scope of Administrative Simplification HPID EFT/ERA CORE Operating Rules Next set of Operating Rules Administrative Simplification 8
9 To date, the CORE Rules tend to fall into one of two categories: 1. Infrastructure rules which promote interoperability and exchange of information to support business processes. 2. Enhanced data content to the information exchange, usually building beyond the requirements of the HIPAA X12 standards by requiring the use of specific data elements that are specified as situational in the standard. 9
10 EFT & ERA CORE Operating Rules CORE 360 Operating Rules CORE 380 Operating Rules CORE 382 Operating Rules CORE 370 Operating Rules CORE 350 Operating Rules What if providers do not submit transactions electronically? Some health care providers may choose not to conduct transactions electronically. But they are required to use these operating rules for HIPAA transactions that they do conduct electronically. In practice, health plans will only have to use the health care EFT standards if the provider wants to receive claim payments via EFT through the Automated Clearinghouse Network (ACH)Network. 10
11 What do providers need to do to prepare for conducting transactions electronically? The EFT standards are the implementation specifications for the electronic format that a health plan is required to use. The standards do not impact how a provider's financial institution transmits the TRN segment to the provider. There will be no direct systems costs to physician practices and hospitals to implement the new EFT standards. What if a provider chooses not to accept electronic funds transfers? Physician practices and hospitals drive overall adoption and usage of EFT. Most health plans give physician practices and hospitals a choice of payment between paper checks (sometimes accompanied by paper remittance advice) or EFT. 11
12 What if a health plan does not transmit payment electronically? HHS estimates that it will cost health plans, on average, $4,000 to $6,000 to implement the EFT standards. This is a one-time cost to health plans. HHS assumes that many commercial health plans will have minimal to no costs; for example: Health plans that must simply update their vendor contracts to accommodate this change without any additional operational costs. What are the financial benefits of EFT for the health care industry? The Interim Final Rule cited a 2009 UnitedHealth Group working paper that reported: $108 billion could be saved industry wide over the course of 10 years if electronic health care claim payments were required. 12
13 Health Plan Identification (HPID) The Health Plan Identifier (HPID) and Other Entity Identifier (OEID) were the result of the Simplification and Affordability Care Acts, which require the adoption of a standard for a unique health plan identifier to be used in HIPAA standard transactions, according to the Federal Registry/ Final Rule announced by the Department of Health and Human Services (HHS) Currently, health plans and other entities are identified in standard transactions using multiple identifiers that differ in length and format. Health care providers are frustrated by the lack of a standard identifier for health plans and other entities in use of standard transactions The adoption of the HPID and the OEID will increase standardization within HIPAA standard transactions and allow for a higher level of automation for health care provider offices and billing processes Health Plan ID (HPID) Why Health Plan ID? Adoption will allow for a higher level of automation for health care provider offices, particularly for provider processing of billing and insurance related tasks, eligibility responses from health plans, and remittance advice that describes health care claim payments. 1 The Health Insurance Portability and Accountability Act of 1996 (HIPAA) requires the Secretary to adopt unique identifiers for each of the following: Individuals(status: Congress delayed indefinitely) Employers (status: EIN adopted) Health plans (status: HPID adopted) Health care providers (status: NPI adopted) Structure 10-digit, all-numeric identifier with a Luhn check-digit as the 10th digit. Intelligence- free identifier except for 1 st digit 1 Federal Register / Vol. 77, No. 172 / Wednesday, September 5, 2012 / Rules and Regulations,
14 Health Plan Identification (HPID) Timeline Entity Type Compliance Date Full Implementation Date for Use in Standard Transactions Health Plans (excluding Small Health Plans) November 5, 2014 November 7, 2016 Small Health Plans November 5, 2015 November 7, 2016 SHPs Other Entities Not required to obtain HPID Not required to obtain OEID Not required but can use in standard transactions as of November 7, 2016 TBD (upon enumeration?) Health Plan ID (HPID) Definitions Definitions Controlling Health Plan (CHP) means a health plan that (1) Controls its own business activities, actions, or policies; or (2)(i) Is controlled by an entity that is not a health plan; and (ii) If it has a subhealth plan(s), exercises sufficient control over the subhealth plan(s) to direct its/their business activities, actions, or policies. Subhealth Plan (SHP) means a health plan whose business activities, actions, or policies are directed by a controlling health plan. Other Entity ID (OEID) An entity may obtain an OEID to identify itself if the entity meets all of the following: Needs to be identified in a transaction for which the Secretary has adopted a standard Is not eligible to obtain an HPID Is not eligible to obtain an NPI Is not an individual (defined as the person who is the subject of protected health information ) 14
15 Administrative Simplification Key Dates Next Set of Operating Rules Includes the following transactions as scope: Health Claims or equivalent health encounter information Claim attachments Enrollment and disenrollment in a health plan Health plan premium payments Referral certification and authorization CAQH has not published draft rules to date Expecting CAQH to publish by end of year 2014 Comment period after draft publication Finalized rules not expected until
16 Does Healthcare Need Simplifying? What s Happening to Your Payer? Over the past decade, premiums for Americans who get their insurance at work have more than doubled, says Jessica Santillo, a Spokeswoman at the Department of Health and Human Services. Employers already are passing on a bigger share of their healthcare costs to employees than they have over the previous decade, according to data from the Kaiser Family Foundation. The Menlo Park, California-based nonprofit found this year that family premiums went up 3 percent in 2010, but worker s share of those costs rose by 14 percent. But some companies, citing the new mandates, say costs are rising too fast: In a survey of more than 1,000 employers, Mercer, a humanresources consulting firm, found that corporate healthcare costs would rise by 10 percent next year if firms made no changes to their plans. Many are finding that they have little choice but to switch a greater share of costs to employees. Source: Wall Street Journal, October 9,
17 Act Now Get Involved If you build it they will come. May work in baseball, but not the case here Refuse to transact with paper Go Green Adopt the new standards! Appoint someone form your practice/organization to spearhead adoption efforts Providers work with your payers Payers work with your providers Vendors bridge the gap between payer and providers Look for vendors and payers who can guarantee their compliance CORE Certified 17
18 We will ALL need to work together to get there Most industry stakeholders agree that electronic payment/transactions will become the industry standard. Getting there will require industry wide cooperation: Providers need better IT capability Payers need to assist with more options Banks need to develop better tools Clearinghouses need to focus on process improvement between payers and providers All will depend on how fast and how well we can work together. Speaker Contact Annie Boynton BS, RHIT, CPCO, CCS, CPC, CCS-P, CPC-H, CPC-P, CPC-I Director Communications, Adoption & Training Regulatory Implementation Office UnitedHealth Group 18
Eligibility and Claim Status Operating Rules and HPID (Health Plan ID)
The 21 st Annual HIPAA Summit West Eligibility and Claim Status Operating Rules and HPID (Health Plan ID) February 21, 2013 9:30 am EST Timothy Kaja, MBA, CPC Senior Vice President, UnitedHealth Group
More informationINTERMEDIATE ADMINISTRATIVE SIMPLIFICATION CENTERS FOR MEDICARE & MEDICAID SERVICES. Online Guide to: ADMINISTRATIVE SIMPLIFICATION
02 INTERMEDIATE» Online Guide to: CENTERS FOR MEDICARE & MEDICAID SERVICES Last Updated: February 2014 TABLE OF CONTENTS INTRODUCTION: ABOUT THIS GUIDE... i About Administrative Simplification... 2 Why
More informationCAQH CORE Open Call Initial Observations and Areas for Potential Comment on Proposed HHS Rule for Administrative Simplification:
CAQH CORE Open Call Initial Observations and Areas for Potential Comment on Proposed HHS Rule for Administrative Simplification: Certification of Compliance for Health Plans January 22, 2014 2:00 3:00
More informationNCVHS. May 15, Dear Madam Secretary,
NCVHS May 15, 2014 Honorable Kathleen Sebelius Secretary, Department of Health and Human Services 200 Independence Avenue, S.W. Washington, D.C. 20201 Re: Findings from the February 2014 NCVHS Hearing
More informationHealth Plan Identifier ( HPID ) Requirements. By Larry Grudzien Attorney at Law
Health Plan Identifier ( HPID ) Requirements By Larry Grudzien Attorney at Law 1 Agenda Introduction HIPAA Standard Transactions Rules Health Plan Identifier (HPID) Certification of Compliance with Standard
More informationDEPARTMENT OF HEALTH AND HUMAN SERVICES. Administrative Simplification: Adoption of a Standard for a Unique Health Plan
DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services 45 CFR Part 162 [CMS-0040-F] RIN 0938-AQ13 Administrative Simplification: Adoption of a Standard for a Unique Health Plan
More informationDebbi Meisner, VP Regulatory Strategy
Jan April July Oct Jan April July Oct Jan April July Oct Jan April July Oct Debbi Meisner, VP Regulatory Strategy HIPAA and ACA Timeline 2013 2014 2015 2016 1/1/2013 Eligibility & Claim Status Operating
More informationNational Health Plan Identifier (HPID) The Who, What When, Where, and Why of HPID & OEID. The Basic Principles of the 5Ws. What:
National Health Plan Identifier (HPID) The Who, What When, Where, and Why of HPID & OEID HIPAA COW Spring 2013 Conference April 12, 2013 Presented by: Laurie Darst Mayo Clinic Revenue Cycle Regulatory
More informationA copy of a voided check or bank letter must be provided for account verification.
The form may be attached to a provider portal ticket or may be sent as a hard copy to the address indicated on each of these Health Plans EFT Authorization Agreements. If a billing provider group exists
More informationSelf Insured Plans: Instructions for Reinsurance Contributions and Obtaining a HPID
Self Insured Plans: Instructions for Reinsurance Contributions and Obtaining a HPID 9/30/2014 Agenda Reinsurance Contribution o Reinsurance Overview o Registering on Pay.gov o Completing the Form o Preparing
More informationHIPAA Readiness Disclosure Statement
HIPAA Readiness Disclosure Statement Blue Cross of California and its affiliates have been diligently following the evolution of the Administrative Simplification provisions of the Health Insurance Portability
More informationAdministrative Simplification
Administrative Simplification Summary: Accelerates HHS adoption of uniform standards and operating rules for the electronic transactions that occur between providers and health plans that are governed
More informationHIPAA Electronic Transactions & Code Sets
P R O V II D E R H II P A A C H E C K L II S T Moving Toward Compliance The Administrative Simplification Requirements of the Health Insurance Portability and Accountability Act of 1996 (HIPAA) will have
More informationThe Alignment of Financial Services and Healthcare:
The Alignment of Financial Services and Healthcare: The Electronic Funds Transfer (EFT) Standard And Healthcare Operating Rules for EFT and Electronic Remittance Advice (ERA) Thursday, November 29, 2012
More information2016 Compliance Checklist
Brought to you by Risk Management Advisors, Inc. 2016 Compliance Checklist The Affordable Care Act (ACA) has made a number of significant changes to group health plans since the law was enacted over four
More informationOffice of ehealth Standards and Services Update: An Overview of Priorities and Key initiatives
Office of ehealth Standards and Services Update: An Overview of 2010-2011 Priorities and Key initiatives Lorraine Tunis Doo Senior Policy Advisor, OESS March 11, 2011 AREAS OF FOCUS Our Ever Changing World
More informationCoordinating Healthcare Operating Rules: Financial Services & Healthcare
Coordinating Healthcare Operating Rules: Financial Services & Healthcare 1 Stuart Hanson VP, Healthcare LOB Manager Steve Stone Sr. Vice President 2 Agenda Background Challenges with Acceptance Operating
More informationHIPAA Transactions: Requirements, Opportunities and Operational Challenges HIPAA SUMMIT WEST
HIPAA Transactions: Requirements, Opportunities and Operational Challenges -------------------------------------- HIPAA SUMMIT WEST June 21, 2001 Tom Hanks Co-Chair Privacy Policy Advisory Group Co-Chair
More informationTRANSACTION STANDARD TRADING PARTNER AGREEMENT/ADDENDUM
TRANSACTION STANDARD TRADING PARTNER AGREEMENT/ADDENDUM This Trading Partner Agreement ( TPA ) is entered into between DXC Technology Services LLC ( DXC Services ), as an agent for the Connecticut Department
More informationPhase III CORE 380 EFT Enrollment Data Rule version September 2014
Table of Contents 1 Background Summary... 4 1.1 Affordable Care Act Mandates... 5 2 Issue to be Addressed and Business Requirement Justification... 6 2.1 Problem Space... 6 2.2 CORE Process in Addressing
More informationGo Paperless and Get Paid: Industry Support of Provider EFT/ERA Adoption, with NACHA and WEDI
Go Paperless and Get Paid: Industry Support of Provider EFT/ERA Adoption, with NACHA and WEDI March 27, 2018 2:00 3:00 PM ET 2018 CAQH, All Rights Reserved. Logistics Presentation Slides and How to Participate
More informationPrior Authorization; Organizational Updates. WEDI Summer Forum July 31- August 1, 2019
Prior Authorization; Organizational Updates WEDI Summer Forum July 31- August 1, 2019 Disclaimer Conference presentations are intended for educational purposes only and do not replace independent professional
More informationWhat Regulatory Requirements are Responsible for the Transactions Standards?
Versions 5010 Why the Change? 99% of Medicare Part A and 96% of Part B Claims are submitted electronically New Accreditations standards adopted with Electronic Medical Records must align with the submitted
More informationNACHA Operating Rules Update: Healthcare Payments
NACHA Operating Rules Update: Healthcare Payments J. Steven Stone, AAP Senior Vice President PNC Bank Chuck Floyd, AAP Manager of Education Viewpointe, LLC 2 Disclaimer This course is intended to provide
More informationHIPAA Glossary of Terms
ANSI - American National Standards Institute (ANSI): An organization that accredits various standards-setting committees, and monitors their compliance with the open rule-making process that they must
More informationHIPAA Administrative Simplification Provisions
HIPAA Administrative Simplification Provisions AN OVERVIEW Brent Saunders Partner PricewaterhouseCoopers Florham Park, NJ (973) 236-4682 p w c Presentation Agenda HIPAA Background and Overview Proposed
More informationNational Provider Identifier Frequently Asked Questions. SECTION I What do I need to know about NPI?
National Provider Identifier Frequently Asked Questions SECTION I What do I need to know about NPI? 1. What is the National Provider Identifier (NPI)? The NPI is a unique identification number for health
More informationREPORT 8 OF THE COUNCIL ON MEDICAL SERVICE (I-11) Administrative Simplification in the Physician Practice (Reference Committee J) EXECUTIVE SUMMARY
REPORT OF THE COUNCIL ON MEDICAL SERVICE (I-) Administrative Simplification in the Physician Practice (Reference Committee J) EXECUTIVE SUMMARY In its ongoing effort to address health care costs that do
More informationExt (Fax)
Sentry Insurance a Mutual Company PO Box 8032 Stevens Point, WI 54481 800 739 3344 Ext 1340034 800 999 4642 (Fax) Attached is the Electronic Funds Transfer (EFT) enrollment form that you requested. The
More informationREPORT OF THE COUNCIL ON MEDICAL SERVICE
REPORT OF THE COUNCIL ON MEDICAL SERVICE CMS Report -I-0 Subject: Presented by: Referred to: Standardized Preauthorization Forms (Resolution -A-0) William E. Kobler, MD, Chair Reference Committee J (Kathleen
More informationImplementing and Enforcing the HIPAA Transactions and Code Sets. 6 th Annual National Congress on Health Care Compliance February 6, 2003
Implementing and Enforcing the HIPAA Transactions and Code Sets 6 th Annual National Congress on Health Care Compliance February 6, 2003 Jack A. Joseph Healthcare Consulting Practice PricewaterhouseCoopers,
More informationCLAIMS Section 6. Provider Service Center. Timely Claim Submission. Clean Claim. Prompt Payment
Provider Service Center Harmony has a dedicated Provider Service Center (PSC) in place with established toll-free numbers. The PSC is composed of regionally aligned teams and dedicated staff designed to
More information2017 CAQH INDEX. A Report of Healthcare Industry Adoption of Electronic Business Transactions and Cost Savings
2017 CAQH INDEX A Report of Healthcare Industry Adoption of Electronic Business Transactions and Cost Savings 2017 CAQH Index: A Report of Healthcare Industry Adoption of Electronic Business Transactions
More informationGlossary of Terms. Account Number/Client Code. Adjudication ANSI. Assignment of Benefits
Account Number/Client Code Adjudication ANSI Assignment of Benefits This is the number you will see in the welcome letter you receive upon enrolling with Infinedi. You will also see this number on your
More informationThe Privacy Rule. Health insurance Portability & Accountability Act
The Privacy Rule Health insurance Portability & Accountability Act Enacted on August 21, 1996 to amend the Internal Revenue Code of 1986 To improve portability and continuity of health insurance coverage
More informationChapter 19 Section 2. Health Insurance Portability And Accountability Act (HIPAA) Standards For Electronic Transactions
Health Insurance Portability and Accountability Act (HIPAA) of 1996 Chapter 19 Section 2 Health Insurance Portability And Accountability Act (HIPAA) Standards For Electronic Transactions Revision: 1.0
More informationOregon Companion Guide
OREGON HEALTH AUTHORITY OREGON HEALTH LEADERSHIP COUNCIL ADMINISTRATIVE SIMPLIFICATION GROUP Oregon Companion Guide For the Implementation of the ASC X12N/005010X279 HEALTH CARE ELIGIBILITY BENEFIT INQUIRY
More informationPPACA and Health Care Reform. A Chronological Guide to Changes and Provisions Affecting Employee Benefits Plans and HR Administration
PPACA and Health Care Reform A Chronological Guide to Changes and Provisions Affecting Employee Benefits Plans and HR Administration AS OF 8/27/2013 Provisions Organized by Effective Date The Affordable
More informationPhase III CORE EFT & ERA Operating Rules Approved June 2012
Phase III CORE EFT & ERA Operating Rules Approved June 2012 Phase III CORE 350 Health Care Claim Payment/Advice (835) Infrastructure Rule. 2 CORE v5010 Master Companion Guide Template.... 11 Phase III
More informationA Healthcare Call to Action HIPAA Administrative Simplification, the Affordable Care Act, and the Health Care EFT & ERA Transactions
A Healthcare Call to Action HIPAA Administrative Simplification, the Affordable Care Act, and the Health Care EFT & ERA Transactions Matthew Albright Administrative Simplification Group Office of E-Health
More informationHIPAA s Medical Privacy Standards:
HIPAA s Medical Privacy Standards: The Long and Really Winding Road Michael D. Bell, Esq. Mintz, Levin, Cohn, Ferris, Glovsky and Popeo, P.C. Washington, D.C. (202) 434-7481 mbell@mintz.com The Health
More informationHIPAA Implementation: The Case for a Rational Roll-Out Plan. Released: July 19, 2004
HIPAA Implementation: The Case for a Rational Roll-Out Plan Released: July 19, 2004 1 1. Summary HIPAA Administrative Simplification, as it is currently being implemented, is increasing complexity and
More informationBest practices for migrating healthcare payments to ACH
Best practices for migrating healthcare payments to ACH Member FDIC Member FDIC Matt Brodis, MBA, MHA Adventist Health System, Inc. June St. John, SVP, CTP Wells Fargo Treasury Management Member FDIC Healthcare
More informationUpdate: Electronic Transactions, HIPAA, and Medicare Reimbursement
McMahon HIPAA Update 521 Pain Physician. 2003;6:521-525, ISSN 1533-3159 Practice Management Update: Electronic Transactions, HIPAA, and Medicare Reimbursement Erin Brisbay McMahon, JD Physician practices
More informationKey Features of the Affordable Care Act, By Year
Key Features of the Affordable Care Act, By Year Provision Definition UAB s Status Timeframe 2010 Prohibiting Denying Coverage Based on Pre-Existing Conditions Prevents denying coverage due to a pre-existing
More informationHIPAA 5010 Frequently Asked Questions
HIPAA 5010 Frequently Asked Questions Table of Contents 1. Navicure s Online Claim Form........5 Q: Will the format change on Navicure s online HCFA 1500 claim form?... 5 2. General 5010 Questions.............5
More information5010: Frequently Asked Questions
5010: Frequently Asked Questions ICD 10 Hub: 5010 FAQ Page 1 Table of Contents If you are viewing this document on your computer, simply hold down your Control button and click on the question to be taken
More informationCAQH Committee on Operating Rules for Information Exchange (CORE) Phase III CORE 370 EFT & ERA Reassociation (CCD+/835) Rule version 3.0.
Table of Contents 1 Background Summary... 3 1.1 Affordable Care Act Mandates... 3 1.2 Existing Standards and Operating Rules... 4 1.2.1 ASC X12 v5010 X12 835 Health Care Claim Payment/Advice... 4 1.2.2
More informationAETNA DENTAL ELECTRONIC REMITTANCE ADVICE (ERA) ENROLLMENT REGISTRATION PAYER ID NUMBERS SPECIAL NOTES
1304 Vermillion Street Hastings, MN 55033 Ph 800-482-3518 Fax 651-389-9152 www.edsedi.com AETNA DENTAL ELECTRONIC REMITTANCE ADVICE (ERA) ENROLLMENT REGISTRATION PAYER ID NUMBERS 60054 SPECIAL NOTES Electronic
More informationCAQH CORE Town Hall Webinar
CAQH CORE Town Hall Webinar June 20, 2017 2:00 3:00 pm ET Logistics Presentation Slides & How to Participate in Today s Session Download the presentation slides at www.caqh.org/core/events. Click on the
More informationClaim Submission. Molina Healthcare of Florida Inc. Marketplace Provider Manual
Section 9. Claims As a contracted provider, it is important to understand how the claims process works to avoid delays in processing your claims. The following items are covered in this section for your
More informationPhase III CORE 360 Uniform Use of Claim Adjustment Reason Codes and Remittance Advice Remark Codes (835) Rule version 3.0.
Phase III CORE 360 Uniform Use of Claim Adjustment Reason Codes and Remittance Advice Remark Codes (835) Rule *NOTE: This document is not the most current version of the CORE Code Combinations. The current
More informationHousekeeping. Link Participant ID with Audio. Mute your line UNMUTED. Raise your hand with questions
Housekeeping Link Participant ID with Audio If your Participant ID has not been entered, dial #ParticipantID#. EXAMPLE: Participant ID is 16, then enter #16#. Mute your line UNMUTED MUTED OTHER MUTE OPTIONS
More informationE-BRIEF. Keys to Driving Adoption of Electronic Payments with Provider Networks
E-BRIEF Keys to Driving Adoption of Electronic Payments with Provider Networks JUNE 2017 By Russell Jackson, editor of Predictive Modeling News Payers have moved aggressively to embrace the future, relying
More informationMatching Payments to Services Delivered
Matching Payments to Services Delivered What Every Provider and Health Plan Should Expect, and What Every Trading Partner Should Deliver Tuesday, November 10 th, 2015 2:00-3:00pm ET 2015 CAQH, All Rights
More informationNPI Utilization in Healthcare EFT Transactions March 5, 2012
WEDI Strategic National Implementation Process (SNIP) WEDI SNIP Transactions Workgroup EFT Subworkgroup EFT NPI Utilization Issue Brief NPI Utilization in Healthcare EFT Transactions March 5, 2012 Workgroup
More informationHIPAA Summit ACA Operating Rules Update. NACHA The Electronic Payments Association
HIPAA Summit ACA Operating Rules Update March 28, 2012 Janet O. Estep NACHA The Electronic Payments Association 2 NACHA The Electronic Payments Association Non-profit rule-making entity Author of the NACHA
More informationhcrnews Risk Adjustment is a big part of the Affordable Care Act s provider RISK ADJUSTMENT and PREDICTIVE MODELING
hcrnews provider New Rules, New Challenges, New Opportunities Provider HCR (health care reform) News is a monthly special edition publication for network providers from the Network Administration Division
More informationTexas Children s Health Plan. HIPAA 5010 Compliancy Plan STAR & CHIP. January 4, Version 1.1
Texas Children s Health Plan HIPAA 5010 Compliancy Plan STAR & CHIP January 4, 2010 Version 1.1 Exhibit 4.3.14-U Page 1 Background: The Workgroup on Electronic Data Interchange (WEDI) released its specifications
More informationStandard Companion Guide
Standard Companion Guide Refers to the Implementation Guide Based on X12 Version 005010X279A1 Health Care Eligibility Benefit Inquiry and Response (270/271) Companion Guide Version Number 3.0 November
More informationHIPAA 5010 Webinar Questions and Answer Session
HIPAA 5010 Webinar Questions and Answer Session Q: After Jan 2012, do the providers who bill on paper have to worry about 5010? Q: What if a provider submits all claims via paper? Do the new 5010 guidelines
More informationStandards and Operating Rules for Electronic Funds Transfer and Claims Payment/Remittance Advice. 2010, Data Interchange Standards Association
Standards and Operating Rules for Electronic Funds Transfer and Claims Payment/Remittance Advice 2010, Data Interchange Standards Association Overview Our Role and expertise in the Remittance Advice Transaction
More informationReporting Requirements for Employers and Health Plans
Brought to you by The Noble Group Reporting Requirements for Employers and Health Plans The Affordable Care Act (ACA) created a number of federal reporting requirements for employers and health plans.
More informationDOCUMENT CHANGE HISTORY. Description of Change Name of Author Date Published. Rules Work Group Straw Poll Rules Work Group December 23, 2009
Phase IV CAQH CORE 452 Health Care Services Review - Request for Review and Response (278) Infrastructure Rule version 4.0.0 Draft for Rules Work Group Ballot March 2015 DOCUMENT CHANGE HISTORY Description
More informationGo Paperless and Get Paid: Use of the EFT/ERA Transactions with X12 and OhioHealth
Go Paperless and Get Paid: Use of the EFT/ERA Transactions with X12 and OhioHealth November 14, 2018 2:00 3:00 PM ET 2018 CAQH, All Rights Reserved. Logistics Presentation Slides and How to Participate
More informationA Special Event: Electronic Funds Transfer (EFT) Standard and ACA-mandated EFT and Electronic Remittance Advice (ERA) Operating Rules
A Special Event: Electronic Funds Transfer (EFT) Standard and ACA-mandated EFT and Electronic Remittance Advice (ERA) Operating Rules June 24, 2013 2pm 3:30 pm ET Participating in Today s Interactive Event
More informationThe benefits of electronic claims submission improve practice efficiencies
The benefits of electronic claims submission improve practice efficiencies Electronic claims submission vs. manual claims submission An electronic claim is a paperless patient claim form generated by computer
More informationACH Primer for Healthcare. A Guide to Understanding EFT Payments Processing
ACH Primer for Healthcare A Guide to Understanding EFT Payments Processing ACH Primer for Healthcare A Guide to Understanding EFT Payments Processing 2011 NACHA The Electronic Payments Association All
More informationGetting started with and using electronic remittance advice (ERA) and electronic funds transfer (EFT)
Quality health plans & benefits Healthier living Financial well-being Intelligent solutions Getting started with and using electronic remittance advice (ERA) and electronic funds transfer (EFT) www.aetna.com
More information2015 Heath Care Reform Compliance Overview
2015 Heath Care Reform Compliance Overview The Affordable Care Act (ACA) has made a number of significant changes to group health plans since the law was enacted over four years ago. Many of these key
More informationPatient Protection and Affordable Care Act
September 27, 2010 Patient Protection and Affordable Care Act 1 9020 Stony Point Parkway Suite 200 Richmond, VA 23235 804-267-3100 Agenda Overview Employer Feedback Terms Components of Health Care Reform
More informationPhase IV CAQH CORE 452 Health Care Services Review Request for Review and Response (278) Infrastructure Rule v4.0.0
Phase IV CAQH CORE 452 Health Care Services Review Request for Review and Response (278) Infrastructure Rule v4.0.0 Table of Contents 1 Background Summary... 3 1.1 Affordable Care Act Mandates... 3 2 Issue
More informationAffordable Care Act Toolkit
Affordable Care Act Toolkit for Businesses with 50 or more employees Choose coverage that fits. Form No. 3-1019 (07-14) The Affordable Care Act Blue Cross of Idaho prepared this toolkit to help you define
More informationAetna Better Health of Kansas
Aetna Better Health of Kansas FAQ s from 8/16/18 Webinar General 1. We understand that the injunction and protest by Amerigroup as well as the protests by Wellcare and AmeriHealth will delay some of the
More informationAn Open Mic Session with ASC X12 and CAQH CORE
An Open Mic Session with ASC X12 and CAQH CORE Implementing CAQH CORE Eligibility Data Content Operating Rules and an In-Depth Look at the ASC X12 270/271 Eligibility Transaction January 31, 2013 12pm
More informationPolicies Targeting Administrative Simplification. Harry Reynolds Blue Cross Blue Shield of North Carolina
Policies Targeting Administrative Simplification September 10, 2009 Harry Reynolds Blue Cross Blue Shield of North Carolina Discussion Successful payer harmonization is occurring via industry-driven efforts
More information2013 ALABAMA SHRM STATE CONFERENCE
2013 ALABAMA SHRM STATE CONFERENCE BENEFIT TRENDS AND BEST PRACTICES 2013 & BEYOND PRESENTED BY MARK JOHNSON 1 COBRA stick Private Exchanges Better Health Decisions Penalties HIPAA carrot Safe Harbor Procedures
More informationKAH DEVELOPMENT 4, LLC National Provider Identifiers Registry
1871018432 KAH DEVELOPMENT 4, LLC National Provider Identifiers Registry The Administrative Simplification provisions of the Health Insurance Portability and Accountability Act of 1996 (HIPAA) mandated
More informationOverview of HIPAA and Administrative Simplification
Overview of HIPAA and Administrative Simplification Denise M. Buenning, MsM, Director Administrative Simplification Group Office of E-Health Standards and Services Centers for Medicare & Medicaid Services
More informationCutting the Cost of HIPAA Compliance and Realizing the Benefits
Cutting the Cost of HIPAA Compliance and Realizing the Benefits Presented By: Steven S. Lazarus, PhD, FHIMSS Boundary Information Group 4401 South Quebec Street, #100 Denver, CO 80237 (303) 488-9911 sslazarus@aol.com
More informationThe Basics of HIPAA Business Partner and Chain of Trust Agreements Coverage and Requirements
The Basics of HIPAA Business Partner and Chain of Trust Agreements Coverage and Requirements First National HIPAA Summit Lisa L. Dahm, JD and Paul T. Smith, Esquire October 16, 2000 Now That Everything
More informationTRICARE NON-NETWORK NUTRITIONIST PROVIDER APPLICATION
TRICARE NON-NETWORK NUTRITIONIST PROVIDER APPLICATION We expect providers to submit claims electronically. If it is necessary to submit a paper claim, the only acceptable forms are the approved red and
More information835 Health Care Claim Payment/ Advice Companion Guide
835 Health Care Claim Payment/ Advice Companion Guide Standard Companion Guide Transaction Information Instructions related to Transactions based on ASC X12 Implementation Guides, version 005010 Companion
More informationBelow are instructions to complete the Disaster Louisiana Medicaid Packet for Temporary Enrollment of Out of State (OOS) Individuals.
To Whom It May Concern: Below are instructions to complete the Disaster Louisiana Medicaid Packet for Temporary Enrollment of Out of State (OOS) Individuals. Please be sure to include NPIs both Type 1
More informationA Guide to Healthcare Buzzwords and What They Mean: Part One (A through L)
A Guide to Healthcare Buzzwords and What They Mean: Part One (A through L) Welcome to our guide to Healthcare Buzzwords! ACO An acronym for Accountable Care Organization, an ACO is a model of healthcare
More informationTHE ERISA INDUSTRY COMMITTEE Advocating the Employee Benefit and Compensation Interests of America s Major Employers
THE ERISA INDUSTRY COMMITTEE Advocating the Employee Benefit and Compensation Interests of America s Major Employers FINDINGS FROM SURVEY OF LARGE EMPLOYERS ON HEALTH PLAN IDENTIFIERS (HPID) AND CONTROLLING
More informationPhase III CAQH CORE 301 Pledge version May CORE Pledge
Phase III CAQH 301 Pledge Pledge NOTE: Organizations that are Phase I and Phase II -certified are required to sign only the Phase III Addendum found on page 5. The ( CAQH ) has created the Committee on
More informationTRICARE NON-NETWORK AMBULANCE APPLICATION
TRICARE NON-NETWORK AMBULANCE APPLICATION We expect providers to submit claims electronically. If it is necessary to submit a paper claim, the only acceptable forms are the approved red and white NUCC
More informationCORE Phase I Policies and Operating Rules Approved April 2006 v5010 Update March 2011
Phase I CORE Policies (100-105) 100 Guiding Principles v.1.1.0 101 Pledge v.1.1.0 CORE Phase I Policies and Operating Rules Approved April 2006 v5010 Update March 2011 Phase I CORE Seal Application v.1.1.2
More information2018 CAQH Index. Healthcare Industry Adoption of Electronic Business Transactions and Cost Savings
2018 CAQH Index Healthcare Industry Adoption of Electronic Business Transactions and Cost Savings April Todd SVP, CAQH CORE and CAQH Explorations Kristine Burnaska Director, Research and Measurement, CAQH
More informationInterim 837 Changes Issue Brief
WEDI Strategic National Implementation Process (SNIP) s and Code Sets Workgroup 837 Subworkgroup Interim 837 s Issue Brief s for ASC X12 837 s: Version 005010 to 006020 TM 4/9/2015 Disclaimer This document
More informationBCBSNC Welcome! Health Insurance Institute North Carolina Healthcare Financial Management Association
BCBSNC Welcome! Health Insurance Institute 2010 North Carolina Healthcare Financial Management Association Workshop Overview HealthCare Reform ICD-10 Inter-Plan Programs Blue Medicare HMO/PPO Federal Employee
More informationHIPAA Redux 2013 Kim Cavitt, AuD Audiology Resources, Inc. Expert e-seminar 4/29/2013. HIPAA Redux Presented by: Kim Cavitt, AuD
HIPAA Redux 2013 Presented by: Kim Cavitt, AuD Moderated by: Carolyn Smaka, Au.D., Editor-in-Chief, AudiologyOnline Expert e-seminar TECHNICAL SUPPORT Need technical support during event? Please contact
More informationHIPAA Implementation Strategies for Small and Rural Providers
HIPAA Implementation Strategies for Small and Rural Providers By Edward A. Meyer, Attorney at Law Greensboro, North Carolina HIPAA Summit West II San Francisco, California The Sheraton Palace Hotel March
More informationThe Sleeping Dragon Stirs: The Dawning of Section 1104 Regulatory Enforcement
The Sleeping Dragon Stirs: The Dawning of Section 1104 Regulatory Enforcement Matthew Albright Zelis Healthcare December 2016 Though silent in terms of new regulations, CMS has turned its attention toward
More informationCONROE DOCTORS URGENT CARE LLC National Provider Identifiers Registry
1710493655 CONROE DOCTORS URGENT CARE LLC National Provider Identifiers Registry The Administrative Simplification provisions of the Health Insurance Portability and Accountability Act of 1996 (HIPAA)
More informationGetting Started with Insurance Billing for CHIP
Getting Started with Insurance Billing for CHIP The following guide is for U.S. physicians and dietitians seeking to bill Medicare and insurance providers for their running of Complete Health Improvement
More informationNew Medicare Card Project Copyright, CGS Administrators, LLC
New Medicare Card Project Background The Health Insurance Claim Number (HICN) is a Medicare beneficiary s identification number, used for processing claims and for determining eligibility for services
More informationAETNA BETTER HEALTH OF OHIO 7400 W. Campus Rd., New Albany, OH Fax
, Email OHEFTFinanceEnrollment@aetna.com Instructions for Electronic Funds Transfer (EFT) Enrollment/Change/Cancellation Page 1 Please use this guide to prepare/complete your Electronic Funds Transfer
More informationMMA Mandate: Medicare Contract Reform
MMA Mandate: Medicare Contract Reform Julie E. Chicoine, JD, RN, CPC The Ohio State University Medical Center julie.chicoine@osumc.edu Medicare Program Created in 1965 Part A: Facilities, including hospitals
More information