| Information technology (IT) has long been touted as the | | | | HIPAA law by using standard, HIPAA-compliant code |
| key to improved business processes. So, how is IT | | | | sets; HIPAA-compliant transactions; eliminate all |
| advancing to help make a claims manager's life easier, | | | | proprietary and/or local codes for waived services, |
| better respond to patients' needs, meet mandated | | | | and accommodate unique identifiers for providers, |
| guidelines, ensure patient privacy, and bring efficiencies | | | | health plans (payers) and employers. Once the HIPAA |
| to the overall process? | | | | EDI standard is fully in place, it will help reduce |
| New advancements, such as electronic data | | | | management overhead and costs. |
| interchange (EDI) systems that help connect insurers | | | | The next wave of technology advancements may lie |
| to patients and physicians, have already made their | | | | directly on the Internet. Internet-based Web portals hold |
| mark in the healthcare industry. Nearly every large | | | | the promise of helping claims managers improve the |
| provider or hospital delivery system has some sort of | | | | overall claims review process by enabling them to |
| EDI system in place. Electronic medical record (EMR) | | | | collaborate with their customers and vendors |
| systems hold the promise of making patient | | | | electronically. This includes requesting and receiving |
| information accessible to all parties, any time | | | | independent medical reviews, with HIPAA-compliant |
| anywhere, yet only seven percent of today's providers | | | | transmission of medical records and other sensitive |
| have EMR systems in place. And, how do claims | | | | PHI. |
| managers tie into these systems securely and | | | | As new forms of electronic data exchange emerge, |
| efficiently? | | | | claims managers can look forward to a new era with |
| According to the 1996 Health Insurance Portability and | | | | improved turn around times; more manageable, lower |
| Accountability Act (HIPAA) legislation, all U.S. health | | | | costs; increased security, and improved HIPAA |
| care providers and payers must ensure they can send | | | | compliance. |
| and receive private health information pursuant to | | | | |