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Topics. 2. Oregon Health Leadership Council (OHLC) BackgroundOHLC Administrative Simplification Exec CommitteeAdmin Simplification in 2011OHLC Admin Simplification Project StatusOneHealthPort UpdateElectronic Transactions UpdateCredentialing. Oregon Health Leadership Council. A collaborative o
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1. Oregon Health Leadership Council - Administrative Simplification January, 2011
2. Topics 2 Oregon Health Leadership Council (OHLC) Background
OHLC Administrative Simplification Exec Committee
Admin Simplification in 2011
OHLC Admin Simplification Project Status
OneHealthPort Update
Electronic Transactions Update
Credentialing
3. Oregon Health Leadership Council A collaborative organization working to develop practical solutions that reduce the rate of increase in health care costs and premiums so health care and insurance is more affordable to people and employers in the state
Formed in 2008 at the request of the Oregon business community
Participating organizations include health plans, hospitals, and physicians
Over 200 individuals have participated in four areas of foucs:
Payment and reimbursement reform
Evidence-based best practices
Value-based benefits
Administrative simplification 3
4. OHLC Admin Sim Exec Committee A group of senior leaders in OHLC participating organizations working to:
Develop and recommend to OHLC administrative simplification strategies
Partnering with the State of Oregon to define administrative simplification efforts. (currently defining electronic transaction implementation guides)
Overseeing administrative simplification projects to ensure successful implementation
Working within our own organizations to ensure resource commitment and overall support of the admin simplification projects 4
5. Administrative Simplification in 2011 5
6. Provider Portal Single Sign OnOneHealthPortUpdate June 28, 2010 6
7. Single Sign-On / OneHealthPort Update Goal: Implement single sign-on through OneHealthPort that enables providers to access multiple health plan portals with one set of credentials (username / password)
Current Status
As of January 2011, the following plans are participating in Oregon: Aetna, CIGNA, First Choice Health, LifeWise, PacificSource, and Regence
Health plans joining in 2011 include: CareOregon, HealthNet, Providence Health Plan, Samaritan Health Plan, and United Healthcare
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8. Electronic Transaction StandardsUpdate June 28, 2010 8
9. Electronic Transaction Standards Background Oregon Health Policy and Research (OHPR) commissioned an Oregon Administrative Simplification Work Group to develop a recommendation to reduce total system cost and the amount of provider resources that must be devoted to administrative transactions.
Recommendation was completed in June 2010
Oregon Health Policy Board approved the recommendation in August 2010
OHLC agreed to lead the development of the standards that were to be developed as part of the recommendation.
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10. Electronic Transactions Savings Opportunity 10 June 28, 2010
11. Recommendations Utilize Minnesota standard companion guides to serve as basis for developing an Oregon Standard (for 3 transactions)
Eligibility transactions (270/271)
Claims (837)
Remittance Advice (834)
Require all plans, providers, and clearinghouses to do the three transactions electronically
Phase in the development and adoption of the standards over time 11
12. Timeline of Recommendation 12 June 28, 2010
13. Credentialing Update June 28, 2010 13
14. Credentialing Status OHLC endorsed recommendation:
Pursue implementation of a single credentialing repository utilizing Medversant
Implementation should not begin until Washington has successfully implemented and been operational for a reasonable amount of time
Health Plan, Hospitals and Providers would bear the cost of implementing interfaces from their own systems to Medversant to upload or download the data
Overview
Primary benefit is workload reductions for provider offices
Value is only achieved if all health plans participate and most providers
Medversant was best option given Washington implementation and pricing for Tier 1 (single repository only)
Status
Based on current Washington status, Oregon likely to start implementation in late 2011 or 2012 14
15. References Oregon Health Leadership Council
http://www.orhealthleadershipcouncil.org/
OHLC Admin Simplification
http://www.orhealthleadershipcouncil.org/administrative-simplification
Oregon Administrative Simplification Workgroup
http://www.oregon.gov/OHPPR/HEALTHREFORM/AdminSimplification/AdministativeSimplificationWorkgroup.shtml
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