Numerous claims are denied by a health plan, which negatively impacts a provider, practice or hospital revenue cycle, as well as adding to the health plan's claim processing cost.
Many of these denials occur because, for example, specific information is missing from the claim, yet the information is available. This is why using well coupled Claim Adjustment Reason Codes (CARCs) and Remittance Advice Remark Codes (RARCs) play a vital role in streamlining claims submission.
Join us on October 4th to learn how the CAQH CORE 360: Uniform Use of CARCs and RARCs Rule is providing Anthem Inc. with uniformity in the use of claim payment adjustment/denial codes resulting in a more efficient and accurate process to pay claims. Margaret (Meg) Kutz, Senior Business Consultant at Anthem Inc., will share the system improvements and data governance criteria Anthem executed to take full advantage of the efficiencies being brought about by the CAQH CORE 360 Rule and the CORE Code Combinations.
What will you learn?
- Receive an orientation to the CAQH CORE Code Combination Maintenance Process and specific examples of how changes in the Code Combinations have real-world effects.
- Learn how a national health plan with over 37 million ERAs a year optimized their denial management process by developing new and improved corporate data governance for the remittance transactions.
- Receive tips on how your health plan or practice/facility could be reducing hassles with its claim denials by adapting work flow and governance structures to get the most benefit from the CORE Code Combinations.
About CAQH CORE
CAQH CORE is a national multi-stakeholder initiative that streamlines electronic healthcare administrative data exchange and improves health plan-provider interoperability through an integrated model of operating rule development, adoption and maintenance. CAQH CORE has been designated by the Secretary of the Department of Health and Human Services (HHS) as the author for ACA-mandated operating rules. To learn more about CAQH CORE, visit www.caqh.org.
This call is open to all non-CORE and CORE Participants and is for informational purposes only; no voting or decisions will occur. If you have any questions, please contact CORE@caqh.org.
Please note - all registrants will receive a copy of the webinar slide deck and recording after the event.