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Administrative Simplification: Past, Present and Future

September 21, 2012

Administrative Simplification was introduced as a component of the Health Insurance Portability and Accountability Act (HIPAA) to streamline administrative processes while increasing security of protected health information by standardizing electronic health care transactions between HIPAA-covered entities. Covered entities include all health benefit plans, health information technology vendors, physicians, facilities and other health care professionals.

Administrative Simplification is continuing as a provision of the Affordable Care Act (ACA). While HIPAA set the standard for electronic data interchange (EDI) transactions, new operating rules are being established under ACA to help promote greater uniformity in how electronic health care data is exchanged.

The Committee for Operating Rules on Information Exchange (CORE)1 has designated a phased approach for health plans to implement operating rules for each EDI transaction. Implementation dates are tentative, pending publication of the final rules. The proposed deadlines are as follows:

  • Eligibility and Benefits (ANSI 270/271) and Claim Status (ANSI 276/277) – Jan. 1, 2013
  • Claims payment and remittance, which includes Electronic Remittance Advice (ERA) and Electronic Funds Transfer (EFT) – Jan. 1, 2014
  • Referrals, preauthorizations, claim attachments – Jan. 1, 2016

Blue Cross and Blue Shield of Oklahoma (BCBSOK) will be making several enhancements prior to the first scheduled implementation deadline. Specifically, these enhancements will provide:

  • Extended hours of online availability
  • Ability to access past and future dates of service for eligibility and benefits
  • More flexible parameters when searching by name to allow users a more comprehensive return of data meeting the search criteria
  • A new notification process which will ensure that users are aware of any scheduled downtime or unscheduled outages

While you may see differences in the way information is returned – such as minimal screen changes – there is nothing you need to do at this time. Administrative Simplification under ACA can contribute to cost savings and help improve operational efficiencies for your office in the following ways:

  • Reduced paperwork
  • Streamlined daily operations resulting in less manual entry
  • Less time spent on phone calls with health plans

For additional announcements related to this important initiative, please continue to watch the Blue Review, as well as the News and Updates section on our website at bcbsok.com/provider. We also encourage you to visit the Centers for Medicare & Medicaid Services (CMS) website at cms.gov, where you will find additional information in the Regulations and Guidance section, under HIPAA Administrative Simplification.

1CORE is part of the Council for Affordable Quality Healthcare (CAQH) initiative. Providers may refer to the CORE section on the CAQH website at http://www.caqh.org/benefits.php  for detailed information and related resources.