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Validating Health Plan Capabilities

Validation is a structured and objective process for assessing how closely a health plan's implementation of their web site and/or HIPAA transactions matches the associated Best Practice Recommendation (BPR). These materials can be used by health plans for self-assessment of their capabilities and by groups for providers for their assessment - in accordance with the structured methodology.

Validation Materials

A validation methodology and related materials have been developed for each of the following Best Practice Recommendations (BPRs). Click on the list to view and print the document(s) of interest. All documents are in pdf format, some allow data entry for electronic completion and submission.

 

Validation
Web BPRs and Validation Materials
BPR
Validation Methodology Materials
Eligibility & Benefits
Requesting and Receiving Coverage Information for Eligibility and Benefits VIA Web Access
  • Validation Worksheet

  • Rating Worksheet
  • Pre-Authorization and Admission Notification
    Browser Capabilities for Pre-Authorization and Admission Notification
  • Validation Worksheet

  • Rating Worksheet
  • Claims Status
    Requesting and Receiving Claim Status Information VIA Web Access
  • Validation Worksheet

  • Rating Worksheet
  •  

    Transaction BPRs and Validation Materials

    BPR
    Validation Methodology Materials
    Claims
    Electronic Processing of Corrections to Institutional Claims
  • Validation Worksheet

  • Rating Worksheet
  • Electronic Processing of Corrections to Professional Claims
  • Validation Worksheet

  • Rating Worksheet
  • Processing and Reporting Remittance Information (HIPAA 835)
  • Validation Worksheet
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