According to the CAQH Index Report, over 227 million electronic remittance advices (ERAs) were sent from health plans to providers in 2017. Providers rely on the ERA to understand why a claim was denied or adjusted and how, if possible, to recoup those dollars. However, if the codes used to convey a claim denial or adjustment on the ERA are unclear, both health plans and providers are subject to unnecessary administrative burdens through extraneous phone calls and redundant or ineffective claim resubmissions and appeals.

In the second webinar of a two-part summer collaboration between the Centers for Medicare and Medicaid Services (CMS), WEDI and CAQH CORE, the CMS Division of National Standards will provide an overview of the Compliance Review Program to ensure conformity among covered entities with HIPAA Administrative Simplification rules for electronic health care transactions.