Ask the doctor


How New Technology Can Help Claims Managers

Information technology (IT) has long beenreceive private health information pursuant
touted as the key to improved businessto HIPAA law by using standard,
processes. So, how is IT advancing to helpHIPAA-compliant code sets; HIPAA-compliant
make a claims manager's life easier, bettertransactions; eliminate all proprietary and
respond to patients' needs, meet mandatedor local codes for waived services, and
guidelines, ensure patient privacy, and bringaccommodate 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 datahelp  reduce  management  overhead and costs.
interchange (EDI) systems that help connect
insurers to patients and physicians, haveThe next wave of technology advancements may
already made their mark in the healthcarelie directly on the Internet. Internet-based
industry. Nearly every large provider orWeb portals hold the promise of helping
hospital delivery system has some sort of EDIclaims managers improve the overall claims
system in place. Electronic medical recordreview process by enabling them to
(EMR) systems hold the promise of makingcollaborate with their customers and vendors
patient information accessible to allelectronically. This includes requesting and
parties, any time anywhere, yet only sevenreceiving independent medical reviews, with
percent of today's providers have EMR systemsHIPAA-compliant transmission of medical
in place. And, how do claims managers tierecords  and  other  sensitive  PHI.
into  these systems securely and efficiently?
As new forms of electronic data exchange
According to the 1996 Health Insuranceemerge, 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 providersmanageable, lower costs; increased security,
and payers must ensure they can send andand improved HIPAA compliance.



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