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