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Best Practice Recommendations : Washington Senate Bill 5346: Patient Payment Tools

Administrative Simplification Policies & Guidelines

Best Practice Recommendations (BPR) describe a better way to get things done that are pragmatic and work for everyone. Participating payers and providers commit to adopting BPRs, their progress is measured and their adoption status is reported. In some cases the adoption of the BPR is addressed in Washington Senate Bill 5346. However, there are other instances where a clearly defined Best Practice is not available or relevant but there is an interest in improving or standardizing work between plans and providers. Prior to the development of the BPR model, payors and providers worked together to develop policies and guidelines that would simplify administration and facilitate plans and providers working together more efficiently. These documents are guidelines only. Adoption will vary among plans and providers and OneHealthPort does not measure adoption or report on progress.

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

» Claims Processing

» Practitioner Credentialing

» Referral & Prospective Review

Dynamic Reports

Using Common Modifiers: This report defines how twelve (12) different participating health plans will handle the twenty-five most commonly questioned modifiers.

Splitting Claims: This report defines the conditions under which eleven (11) different participating health plans will split a claim.

Injury Codes: This report defines when ten (10) different participating health plans require accident information to be included with a claim form.

Referral Guidelines: This report defines which services require referrals for seven (7) different participating health plans.

Prospective Review Guidelines: This report defines which services can be prospectively reviewed by seven (7) different participating health plans.

Premera introduces new online tools to assist practices with estimation of patient responsibility of payment. Click here to find out more.

Credentialing and Privileging Data Collection - COMING in September. To read more about the new FREE service for practices to manage their practitioner data click here

KPS Health Plans is LIVE on OneHealthPort. To read more about the services KPS is offering click here

Providence and ProviderSource join Cigna on list of sites using the new OneHealthPort enhanced login security. The new Browser Second Factor is similar to what your online bank offers. Read more about Browser Second Factor click here

NEW! WA State Labor and Industries will soon be launching its advanced imaging UM program using Qualis iEXCHANGE click here to pre-register

HIE UPDATE: OneHealthPort prepares RFP for HUB vendor solution for mid-August release. Strategic and operational plan filed with ONC.

Read the latest update on the health information exchange (HIE) within Washington state. Click here to find out more.