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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.
Claims Adjustments: How health plans handle underpayments and overpayments
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FREE CMS ICD-10 Implementation Handbooks Click here to find out more.
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Credentialing and Privileging Data Collection - videos.
To view the training videos on Provider Attestation and Browser Second Factor Provisioning
click here
WPA Field Mapping Guide NOW Available to assist in mapping your provider data to the new ProviderSource application.
click here
Health Information Exchange Project Updated.
Read the latest on the Washington State HIE:
click here
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