The Administrative Simplification Workgroup identifies effective ways to simplify the administrative challenges faced by physicians and other healthcare professionals to streamline the business side of health care and provide cost-savings to the entire system.
The Executive Committee (EC) has overall responsibility for the administrative simplification efforts of OHLC. To that end the EC identifies issues and establishes work groups (permanent or ad hoc) as necessary. The EC oversees the work of the claims eligibility workgroup and the EDI workgroup. These are the two current permanent workgroups established by the committee. The committee also discusses other issues involving administrative simplification that arise from time to time, and maintains a working relationship with the Oregon Health Authority (OHA). Currently, the committee is staying up to date on the work of OHA toward implementing the Common Credentialing Solution, with several members of the committee serving on the Common Credentialing Advisory Group within OHA. The Executive Committee also stays abreast of the work of OHA in implementing the Provider Directory solution. Several members of the committee serve on the Provider Directory Advisory Group within OHA. The EC keeps abreast of other activities of the OHLC that have an operational and administrative impact, and provides feedback to OHLC.
Electronic Data Interchange Workgroup
The workgroup identified and agreed on several strategies to resolve issues raised by Providers in the recently completed EDI Survey conducted in collaboration with the Oregon Medical Association (OMA). Health Plans have agreed to implement these improvements in the next few months.
The workgroup continues to track progress and provide input to CAQH/CORE phase IV rules and HIPAA X12 transactions version 7030, and continues to be a center for information exchange and consensus relating to EDI across the Oregon-based health care industry.
The EDI Survey activities are near completion and the group plans to reduce meetings to twice a year.
Claims Eligibility Work Group
This workgroup is primarily in a monitoring phase, following metrics designed to track the success of administrative simplification initiatives. A sub-team from the group will be joining discussions with the OMA Practice Roundtable to help improve codes sets reporting specifically relating to Claims Adjustment and Procedure codes.
The full Claims and Eligibility team will continue to meet twice a year.
The Administration Simplification group is working with Washington’s OneHealthPort to see if implementing their Workflow Navigator application for Oregon will be workable.