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In this educational webinar, you will hear from industry experts on the current healthcare landscape from the payer and Third Party Administrator (TPA) perspective and on efforts to reduce costs, streamline provider payments and meet healthcare reform mandates. You will understand how one major TPA increased operational efficiency and realized savings by adopting innovative technology and processes. Finally, you will learn about the federally mandated healthcare operating rules, per Section 1104 of the Patient Protection and Affordable Care Act (ACA) and the benefits to the industry of their adoption. As part of this, CAQH CORE, a collaboration of healthcare industry stakeholders and operating rule author, will provide an overview of the Draft EFT and ERA CAQH CORE operating rules.

Learning Objectives:

  • Learn the healthcare payment market drivers for payers, including regulatory pressures like MLR, growth in self-pay members and provider engagement demands
  • Understand the industry challenges payers are facing to increase operational efficiency, meet reform mandates and improve provider relations, with strategies on how to effectively overcome specific challenges
  • Learn how a major TPA has adopted technology and improved business processes to meet current industry challenges
  • Be able to outline the timeline for adoption of federally mandated operating rules
  • Understand the draft set of CAQH CORE operating rules for Electronic Funds Transfer (EFT) and Electronic Remittance Advice (ERA) transactions

Who should attend?
If you work in the following fields, this webinar will be helpful to you:

  • Operations and Customer Service
  • Finance
  • Technology/EDI
  • Provider Network Relations/Management
  • Business Development/Strategy/Organizational Intelligence
  • Compliance

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