Oregon Health Leadership Council - Administrative Simplification

Oregon Health Leadership Council - Administrative Simplification
January, 2011

Topics Oregon Health Leadership Council (OHLC) Background OHLC Administrative Simplification Exec Committee Admin Simplification in 2011 OHLC Admin Simplification Project Status OneHealthPort Update Electronic Transactions Update Credentialing

Oregon Health Leadership Council A collaborative organization working to develop practical solutions that reduce the rate of increase in health care costs and premiums so health care and insurance is more affordable to people and employers in the state Formed in 2008 at the request of the Oregon business community Participating organizations include health plans, hospitals, and physicians Over 200 individuals have participated in four areas of foucs: Payment and reimbursement reform Evidence-based best practices Value-based benefits Administrative simplification

OHLC Admin Sim Exec Committee A group of senior leaders in OHLC participating organizations working to: Develop and recommend to OHLC administrative simplification strategies Partnering with the State of Oregon to define administrative simplification efforts. (currently defining electronic transaction implementation guides) Overseeing administrative simplification projects to ensure successful implementation Working within our own organizations to ensure resource commitment and overall support of the admin simplification projects

Administrative Simplification in 2011 Q1 Q2 Q3 Q4 OneHealthPort Complete Implementation Electronic Transactions Implement 270/271 Define 837 Begin 837 Implementation Define 835 Credentialing Assess WA Plan Implementation

Provider Portal Single Sign OnOneHealthPortUpdate

Single Sign-On / OneHealthPort Update Goal: Implement single sign-on through OneHealthPort that enables providers to access multiple health plan portals with one set of credentials (username / password) Current Status As of January 2011, the following plans are participating in Oregon: Aetna, CIGNA, First Choice Health, LifeWise, PacificSource, and Regence Health plans joining in 2011 include: CareOregon, HealthNet, Providence Health Plan, Samaritan Health Plan, and United Healthcare

Electronic Transaction StandardsUpdate

Electronic Transaction Standards Background Oregon Health Policy and Research (OHPR) commissioned an Oregon Administrative Simplification Work Group to develop a recommendation to reduce total system cost and the amount of provider resources that must be devoted to administrative transactions. Recommendation was completed in June 2010 Oregon Health Policy Board approved the recommendation in August 2010 OHLC agreed to lead the development of the standards that were to be developed as part of the recommendation.

Electronic Transactions Savings Opportunity Estimates from the Oregon Administrative Simplification Strategy and Recommendations (June 5, 2010) completed by the Administrative Simplification Workgroup

Recommendations Utilize Minnesota standard companion guides to serve as basis for developing an Oregon Standard (for 3 transactions) Eligibility transactions (270/271) Claims (837) Remittance Advice (834) Require all plans, providers, and clearinghouses to do the three transactions electronically Phase in the development and adoption of the standards over time

Timeline of Recommendation

Credentialing Update

Credentialing Status OHLC endorsed recommendation: Pursue implementation of a single credentialing repository utilizing Medversant Implementation should not begin until Washington has successfully implemented and been operational for a reasonable amount of time Health Plan, Hospitals and Providers would bear the cost of implementing interfaces from their own systems to Medversant to upload or download the data Overview Primary benefit is workload reductions for provider offices Value is only achieved if all health plans participate and most providers Medversant was best option given Washington implementation and pricing for Tier 1 (single repository only) Status Based on current Washington status, Oregon likely to start implementation in late 2011 or 2012

References Oregon Health Leadership Council http://www.orhealthleadershipcouncil.org/ OHLC Admin Simplification http://www.orhealthleadershipcouncil.org/administrative-simplification Oregon Administrative Simplification Workgroup http://www.oregon.gov/OHPPR/HEALTHREFORM/AdminSimplification/AdministativeSimplificationWorkgroup.shtml

Oregon Health Leadership Council - Administrative Simplification

Télécharger la présentation

Plus de contenu associé

Oregon Health Leadership Council - Administrative Simplification