Insurers Object To New Compliance Fees

A new HHS proposal designed to ensure uniformity in how providers and payers handle patient data has created a division between insurance companies who oppose the plan, and hospitals and physicians who support it. The proposal “mandates insurance company compliance with a federal law that requires certain health plans to certify their compliance with the standards for claim status, electronic funds transfer and electronic remittance advice.” The proof of compliance the plans need would confirm it has completed certain testing of its electronic transaction capabilites, as mandated by the Health Insurance Portability and Accountability Act. HHS initially released to rule to create uniformity in data exchange and to reduce reliance on paper and manual processes to transmit data; the rule applies only to “controlling health plans (CHP),” which are organizations that control their own business activities.

Insurance companies argue that the rule as written is too hard on plans and that as an alternative, plans should have the option to correct the error and resubmit it. Insurance companies also cite the fact that the the policy designates CAQH, a non-for-profit alliance of health plans and trade associations, as the only entity that can determine if a company is in compliance, which could lead to instances of conflict of interest, since CAQH could give preferential treatment to its members.

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