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