Administration Simplification

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.

Subgroups have worked to increase the use of websites for eligibility and claims information, increase the use of electronic transactions, improve prior authorization processes and work toward standardization and automation of key processes.

Updates on our work

Executive Committee
The Executive Committee oversees the work of the claims eligibility workgroup and the EDI workgroup. These are the two 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.

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. A team will present the resolution strategy to the OMA Practice Roundtable in the near future. Progress will be reviewed on implementation of these strategies via a survey in 2017.

The workgroup also 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.

OneHealthPort continues to show strong growth in subscribers during this quarter, adding 301 organizations and almost 2000 subscribers for a total of 10,246 and 44,329 respectively. Authentications dropped to 999,696 after spiking to 1.3 million last quarter. The decline may be attributed to settling into new policy arrangements (following open enrollment), and also the OHLC efforts to educate Providers on conducting multiple functions per authentication. Since tracking these metrics, it appears authentications tend to spike during the first quarter of every year.

The workgroup will meet in September to discuss codes sets and follow-up action on related issues. The full Claims and Eligibility team will continue to meet twice a year.