InstaMed Blog

What’s ahead for payers?

On January 1, 2013, payers will be required to meet the first set of mandated operating rules for Eligibility and Claim Status, under the Patient Protection and Affordable Care Act (PPACA). Click here to view the complete set of CAQH CORE Eligibility and Claim Status Operating Rules.

What can payers do to prepare?

1. Focus on Education

Frequently, half the battle of preparing for mandates is gathering all of the information you need. CAQH CORE released an analysis and planning guide for adopting the upcoming operating rules (click here to download the guide).

2. Assess Your Organization’s Needs

Conduct an assessment of your organization to understand what areas of your business (internal and external) will be impacted by the mandates to determine the work required to achieve compliance in time for the January deadline.

Tip: Map out a timeline of actions that need to be taken, and factor in staff training time.

3. Collaborate

Communicate with the clearinghouses, trading partners and vendors you work with to understand what steps they need to take to be compliant, and how you can support each other to achieve compliance.

4. Check System Availability

Some of the key components of the mandate include requirements for payer system availability, including response time. Ensure that you have maximum uptime even in the event of a disaster by leveraging a secure, private cloud network with fully redundant, geographically dispersed data centers and the ability to process continuously through a disaster.

For more tips to ensure that you have True Availability, click here.

5. Spread the Word

Communicate to your provider network that you are preparing to meet the compliance deadline for upcoming mandates, and educate them on the benefits to them of transmitting CORE-compliant clearinghouse transactions. If your provider network transmits compliant transactions, you will both operate more efficiently.

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