HB 125 Advisory Committee On Eligibility And Real Time Claim Adjudication Issues Final Report

Columbus, OH (CompNewsNetwork) –  The Advisory Committee on Eligibility and Real Time Claim Adjudication, as created by the Ohio General Assembly in 2008, has issued a final report of its findings to the Ohio General Assembly, Ohio Department of Insurance Director Mary Jo Hudson announced. The Advisory Committee met monthly from July through December.

The task of the Advisory Committee was to study and recommend standards that enable medical providers and payors to electronically exchange patient eligibility and claims adjudication information. The electronic exchange of patient information has the potential for significantly reducing costs in Ohio's healthcare industry. The Advisory Committee was also asked to investigate the process of real-time claim adjudication.

The Advisory Committee membership categories were designated by the General Assembly. The Committee included a cross-section of members representing insurance entities, employers, medical providers, consumers, technology vendors and the Governor's Office of Information Technology, of whom are experts regarding, and potentially affected by, standardizing this exchange of information. The members were appointed by Director Hudson.

The Advisory Committee's report includes the following findings and recommendations:

• In Ohio, all electronic administrative transactions related to health care insurance eligibility verification should be compliant with the national standards for electronically verifying patient eligibility proposed by the Committee on Operating Rules for Information Exchange (CORE).

• The Advisory Committee did express concerns regarding the cost of CORE compliance, as required technological system upgrades could cause financial burdens for some doctors and insurance companies.

• The Advisory Committee agreed on best practices that payors could follow to provide more accurate patient eligibility information to providers, and best practices to encourage providers to use electronic technology to check patient eligibility.

The Committee found that it was premature to focus on real time claims adjudication at this time, given the current state of the electronic communications in the healthcare sector. Citing that more work needs to be done, the Advisory Committee recommended that the members continue to work together to address the development of CORE technology, and also claims adjudication technology. The final report also outlines the current practices of patient eligibility verification in Ohio, and contains an in-depth explanation of CORE. 

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