February 2023
Introduction and Opportunity
On December 19, 2022, the Department of Health and Human Services (HHS) issued a notice of proposed rulemaking (NPRM): Administrative Simplification: Adoption of Standards for Health Care Attachments Transactions and Electronic Signatures, and Modification to Referral Certification and Authorization Transaction Standard. The NPRM represents a watershed moment for the healthcare industry by naming the X12 275 and HL7 C-CDA as standards for the electronic exchange of attachments for health care claims and prior authorization. These provisions, among others included… Read more »
February 2023
Customization is often seen as a luxury--a product or solution that is tailor-made to fit one's exact needs. When it comes to customization in the business of healthcare, customization can be counterproductive.
This is because, on average, physician practices contract with 20 health plans. If each health plan implements its own credentialing process, providers are forced to juggle multiple requirements, formats and timelines. This can be costly and frustrating and may increase the likelihood of delays or incorrect information.
A standardized solution, on the other hand, reduces many of the… Read more »