Tuesday, November 17, 2009

California Fast-Tracks Healthcare EDI

Posted by Mark Brousseau

California regulations for electronic workers' compensation billing slated for publication before end of this year are likely to see fast-tracked implementation, according to Jopari Solutions, a supplier of medical EDI connectivity and transmission for the property and casualty industry.

EBilling is a key initiative the California Insurance Commissioner and Division of Workers' Compensation officials say is essential, along with other benchmark recommendations, to streamline the state's workers' compensation system, rein in medical costs and keep employer costs down. This past week, the Commissioner rejected any recommended increase in California's workers' compensation pure premium rate.

California's eBill regulations will specify an 18-month phase-in period for workers' compensation payers to acquire the ability to process eBill transactions, after regulations get signed into law. n addition, California is adopting uniform electronic claim and remittance standards similar to those mandated in Texas and Minnesota, which are supported by national standards organizations.

Facilitating rapid transition by carriers is the fact that national and regional health care provider networks are eager to expand electronic bill submissions with payers into their California markets. A large percentage of local health care practices today also exchange electronic health insurance claims, payments and remittance, or have medical transaction ready EDI billing software. Compressed timely payment deadline for clean electronic bills under California eBill rules - fifteen days as opposed to forty-five days for uncontested paper bills - is another factor expected to put early pressure on carriers by their medical services trading partners.

As Jopari CEO JR "Steve" Stevens and veteran industry observer Peter Rousmaniere point out in a new whitepaper, The E-billing Transformation, the community of beneficiaries from the switch to electronic transmission of bills and supporting documentation, or attachments, goes beyond state agencies pushing for administrative simplification, better data and more stakeholder accountability. Stevens and Rousmaniere indicate, "Conventional transmission methods, heavily dependent on mail, faxing and scanning, impose delays and error rates which leading medical bill review firms estimate as upwards of 20 percent or more. Electronic submission largely sweeps away these defects." They explain that, "Claims payers should therefore approach e-billing not simply as a way of shaving the burdens of managing paper flow -- they should use e-billing to sweep away obstacles to improving the management of medical care."

Stevens and Rousmaniere conclude that payers undertaking early compliance initiatives will strengthen themselves competitively, both in California and nationally. Carriers slow to adopt electronic transmission methods, however, will remain burdened by antiquated workflow; unable to reduce delays and errors in the handling of medical information; and be handicapped in their attempts to control spiraling medical costs, they say.

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