Best Practice Recommendation

The AdminSimp solutions OneHealthPort develops are known as Best Practice Recommendations (BPRs).  A BPR is a better way to get things done that's pragmatic and works for everyone.  A BPR is not about just simplifying or standardizing current work flow or technology practices, the whole emphasis of a BPR is to move the industry toward best workflow and technology practices. Read more

Title Category Legislation
Browser Capabilities for Prospective Review & Admission Notification BPR Prospective Review - Medical ESSB 5346
Claim Coding Policy and Edits: Standardization & Transparency Claims Edits ESSB 5346
Creating and Receiving the Health Care Claim Acknowledgement (HIPAA 277CA) HIPAA Transactions
Electronic Processing of Corrections to Institutional Claims (HIPAA 837I) HIPAA Transactions ESSB 5346
Electronic Processing of Corrections to Professional Claims (HIPAA 837P) HIPAA Transactions ESSB 5346
Emergency Fills and Notification Timeframes Prospective Review - Pharmacy ESSB 6511
Exchanging & Processing Info about Pharmacy Benefit Management Prospective Review - Pharmacy ESSB 6511
Exchanging Explanation of Payment Information between Providers and Health Plans (HIPAA 837 & 835) HIPAA Transactions
Extenuating Circumstances around Pre-Authorization & Admission Notification Prospective Review - Medical ESSB 5346
General Applicability to HIPAA Transactions HIPAA Transactions
Health Plan Web Capabilities for Pharmacy Benefits and Pre-Auth Prospective Review - Pharmacy ESSB 6511
Processing and Reporting Remittance Information (HIPAA 835) HIPAA Transactions ESSB 5346
Reconsideration of a Health Plan's Policy Regarding Code Edits Claims Edits ESSB 5346
Requesting and Receiving Claims Status Information (HIPAA 276-277) HIPAA Transactions
Requesting and Receiving Coverage Information for Eligibility and Benefits (HIPAA 270-271) HIPAA Transactions ESSB 5346
Standard Notification Timeframes for Pre-Authorization Requests Prospective Review - Medical ESSB 5346
Submitting & Processing Claims (HIPAA 837) HIPAA Transactions

ESSB 5557

Although the Senate Bill 5557 is not directly related to a specific BPR, this bill contains information regarding the health plan reimbursement of pharmacist provided medical services.

Claims Policies and Guidelines

Prior to the development of the BPR model, payors and providers worked together to develop claims processing policies and guidelines that would simplify administration and facilitate plans and providers working together more efficiently.