Ohio Department Of Insurance Establishes Committee To Standardize Communication Between Doctors And Insurers


Columbus, OH  (CompNewsNetwork) - The first meeting of the Advisory Committee on Eligibility and Real Time Claim Adjudication was held Tuesday, July 22.

The task of the Advisory Committee members, which were appointed by Insurance Director Mary Jo Hudson, is to recommend communication standards between doctors and insurance entities to the Ohio General Assembly. These standards will enable a medical provider to send and receive from insurance entities and other payers sufficient information to enable that provider to determine at the time of the enrollee’s visit the enrollee’s eligibility for services. Standardized real time adjudication of provider claims for services would also be handled at this time. The report of the findings and recommendations of the Advisory Committee, which was formed pursuant to Substitute House Bill 125, is due by January 1, 2009.

The Advisory Committee includes a wide cross-section of members representing insurance entities, employers, medical providers, consumers, technology vendors and the Governor’s Office of Information Technology that are potentially affected by standardizing this exchange of information.

The current Advisory Committee members are (in alphabetical order by last name):

Jeff Biehl, AccessHealthColumbus; John Burant, SEIU; Michelle Cadrin-Msumba, Athenahealth, Inc; Jeffrey Corzine, Unison Health Plan of Ohio; Kathie Fuson, Delta Dental of Ohio; Chris Goff, Employer’s Health; Karen Greenrose, American Association of Preferred Provider Organizations; Bill Hayes, Health Policy Institute of Ohio; Dr. Lawrence Kent, Academy of Medicine of Cleveland; Sue Kucinski, Paramount Health Plan; Joseph Liszak, Community Health Services; Trudi Matthews, HealthBridge; Dr. Holly Miller, University Hospitals; Dan Paoletti, OHA Solutions; Rex Plouck, Governor’s Office of Information Technology; Michael Ranney, Ohio Psychological Association; Joe San Filippo, Nationwide Better Health; Melissa Seffens, Aetna; Ray Shealy, Relay Health; Dr. Martha Simpson, Ohio University; Dan Sylvester, Quality Care Parners; Jeff Vossler, Joint Township District Memorial Hospital, Jim Weisent, Medical Benefits Mutual; and James Woodward, Ohio State Chiropractic Association.

Please contact Anne Jewel at 614-728-1014 or Anne.Jewel@ins.state.oh.us with questions about the Advisory Committee.

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