Healthcare Payers Looking for a Solution to Avoid Compliance Penalties

Healthcare Payers Looking for a Solution to Avoid Compliance Penalties

<0> HealthxJennifer Young, Content Strategist, 317-218-0541 </0>

Healthx reports an increase in inquiries from Health Plans and Third Party Administrators looking to meet compliance standards for CAQH CORE Operating Rules for Eligibility & Claim Status – CORE II. The Affordable Care Act requires Healthcare Payers to certify to the Department of Health and Human Services that they are CAQH CORE II compliant by December 31, 2013, which has several Healthcare Payers looking for a solution. The Department of Health and Human Services will begin imposing penalties for non-compliance in 2014.

The CAQH operating rules regulate the healthcare claims transaction process, improving the efficiency of the 270/271 electronic data exchange of patient/member eligibility coverage information to the healthcare provider. The rules are requiring Healthcare Payers to enhance system reliability, improve data connectivity and provide faster real-time transactions of key coverage information for all plan designs.

Healthx believes the complexities of the infrastructure requirements, penalties and less than nine months to compliance date, has led to the increased inquiries that began in February. The penalties could equal $1 per covered life. Healthx estimates that for some of its customers, this penalty could equate to $1.5 million per year.

“With healthcare reform impacting everyone’s bottom line, Healthx is committed to developing cost effective technology tools that meet regulatory standards,” said Greg Bell, president of Healthx. “For the past 15 years we have been serving the healthcare payer market and we know the complexities of plan coverages to help our clients comply with this requirement.”

Healthx anticipates receiving more inquiries as these administrative requirements continue to unfold.

Healthx was formed in 1998 to meet the unique communication needs of the healthcare industry by helping payers deliver benefits faster, more effectively and at a lower cost. Healthx has rapidly grown to be the healthcare industry’s leading developer of self-service communication and portal technology serving more than 140 payers and 39,000 groups, representing over 12 million individual lives. To learn more go to .