Close Close
Popular Financial Topics Discover relevant content from across the suite of ALM legal publications From the Industry More content from ThinkAdvisor and select sponsors Investment Advisor Issue Gallery Read digital editions of Investment Advisor Magazine Tax Facts Get clear, current, and reliable answers to pressing tax questions
Luminaries Awards

Life Health > Health Insurance > Health Insurance

Groups Start Uniform Medical Claims Payer Reporting Standard Project

Your article was successfully shared with the contacts you provided.

Standards group say they hope to free health insurers, public health plans and other payers from variations in state medical claims reporting requirements.

The Accredited Standards Committee X12 (ASC X12), Falls Church, Va., and the All-Payer Claims Database (APCD) Council, Durham, N.H., are starting a Uniform Medical Claims Payer Reporting Standard project to help states with single reporting standard.

The Patient Protection and Affordable Care Act of 2010 (2010) and other legal and market changes have increased states’ interest in gathering and pooling medical claims data.

Today, 14 states have agreed to try to streamline data collection and analysis by supporting creation of state all-payer claims databases (APCDs), ASC X12 says.

ASC X12 is an established insurance data standards group; the APCD Council represents states participating in the APCD effort.

Many states are collecting dental and pharmacy claims, and eligibility and provider files, along with medical claims, ASC X12 says.

Medicare and Medicaid programs have been gathering similar information from plans, and “there is a very real opportunity to align these processes,” ASC X12 says.

ASC X12 work groups met with the APCD Council July 12 to talk about developing a uniform state reporting implementation guide, and developing a single, standardized model that the various business needs for the reporting requirements.

ASC X12 will be coordinating another meeting that will take place in October, at an ASC X12 meeting.

The October meeting will be open to any interested parties, and organizers are especially interested in attracting people who understand the reporting needs, ASC X12 says.

- Allison Bell

Other health claims administration coverage from National Underwriter Life & Health:


© 2024 ALM Global, LLC, All Rights Reserved. Request academic re-use from All other uses, submit a request to [email protected]. For more information visit Asset & Logo Licensing.