Administrative Simplification Policies & Guidelines

An Administrative Simplification Steering Committee included representatives of: several key provider organizations, the Washington State Hospital Association, the Washington State Medical Association, First Choice Health Plan, Group Health Cooperative, Premera Blue Cross, and Regence Blue Shield. The steering committee identified specific projects that met the following criteria:

• Reduce staff costs to refer, authorize, bill, and process claims
• Decrease turnaround time between claims submissions and payment
• Improve the patient experience

The guiding principles for adopting projects included:

• Win-win: Impacts multiple providers and plans
• Quick win: Can be implemented within three to six months without information system changes
• Significant relief: Represents a high cost, high volume and/or high frequency headache
• Affordable: Can be implemented at a reasonable cost
• Enduring: Will have lasting impact
• Widely available: Accessible to a large segment of health care community
• Local impact: Local health plans can make a difference on the issue

Administrative Simplification Policies & Guideines are available for the following areas:

» Claims Processing

» Practitioner Credentialing

» Referral & Prospective Review