New Claim Requirements May Vex Healthcare System

(PRLEAP.COM) Health Insurance Portability and Accountability Act (HIPAA) can help contain healthcare administrative costs by simplifying electronic insurance claims submission. The National Provider Identifier (NPI) can provide additional simplification. But turning the dreams into reality is proving tough. A new seminar for health IT professionals (http://hittransition.com/flashpoint/taxo) is designed to provide guidance on using provider taxonomy to ease the transition to the new system.

One of the promises of the Health Insurance Portability and Accountability Act (HIPAA) was to help contain rising healthcare administrative costs by simplifying electronic insurance claims submission. The National Provider Identifier (NPI) – a single number to identify each medical practitioner and healthcare provider organization in the U.S. – is intended to provide additional simplification. But turning these dreams into reality is proving complicated.

Provider taxonomy – a code that describes a type of healthcare facility or practitioner’s specialty or subspecialty – has taken on new significance as healthcare providers and health plans begin using the new National Provider Identifier instead of the multitudes of different “legacy” identifiers. The problem is in converting from the old system of multiple identifiers to the new one. According to Healthcare IT Transition Group, a health information technology think tank, the provider taxonomy codes are playing an increasingly significant role in the effort.

Until now, few health plans have required providers to use the codes; however, many plans have recently begun requiring taxonomy on some or all claims to use as a “crosswalk” from the new format to existing records based on legacy identifiers. Medicare has indicated it will require provider taxonomy on certain hospital claims.

But healthcare providers’ billing systems and health plans’ routing and adjudication systems may not be up to the challenge. Reports from the field suggest a perilous reliance on single-value databases, rudimentary matching algorithms and arbitrary mandates for specific values. Unless both providers and payers – and their technology vendors and service providers – come up with a solution, provider taxonomy could actually make the confusion worse.

To help providers, health plans and their vendors meet the challenge, Healthcare IT Transition Group http://hittransition.com (HITTG) will present two web-based seminars (“webinars”) titled “Decoding Provider Taxonomy: Practical Uses for Payers, Providers and Partners,” on August 28 and 30, 2006.

With real-world experience in taxonomy implementation and over three years of research and analysis, HITTG’s chief analyst Martin Jensen will explain how the provider taxonomy code set can be used effectively in the context of multi-trading partner exchanges. Healthcare providers will learn how to evaluate whether their systems are at risk, and how to work with their payers and vendors to resolve issues. Health plans will learn what they can reasonably expect from a taxonomy-dependent NPI strategy, and how to more effectively deal with the realities of the provider universe. Vendors will learn how to sort out diverging trading partner requirements, and provide solutions that add value on both sides of the transaction.

Additional information and registration for the 90-minute webinars is available online at
http://hittransition.com/flashpoint/taxo or by calling (918) 406-3998.

Healthcare IT Transition Group (HITTGroup) http://hittransition.com is a technology and policy consultancy that works with organizations to reduce the cost and improve the quality of healthcare through the use of information technology. The company’s clients include healthcare providers large and small, healthcare industry software developers and technical services companies, and some of the nation’s largest health plans.

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