Clean Claims Task Force

Friday, July 15, 2016 08:43 AM

General Assembly repeals Medical Clean Claims Transparency Uniformity Act; honors task force members

by Kate Alfano, CMS Communications Coordinator

After working for the past five years toward the development of a standardized set of claim edits, the Colorado Clean Claims Task Force (CCTF) has completed its work. The 2016 Colorado General Assembly passed a bill – SB16-127: Repeal of the Medical Clean Claims Transparency Uniformity Act by Sen. Jack Tate, R-Centennial, and Rep. Jeni Arndt, D-Fort Collins – repealing the CCTF. The bill was signed into law by Gov. John Hickenlooper on April 5. Both the Senate and the House passed Resolution SJR16-029 – by Sen. Tate and Sen. John Kefalas, D-Fort Collins, and Rep Arndt and Rep. Dan Nordberg, R-Colorado Springs – which recognizes the work of the CCTF.

In 2010, the general assembly passed the “Medical Clean Claims Transparency and Uniformity Act” as part of the state’s effort to streamline administration within the health care system. It required the executive director of the Department of Health Care Policy and Financing to establish a task force of industry and government representatives to develop a standardized set of payment rules and claim edits to be used by payers and health care providers in Colorado.

Task force members deliberated in a fully transparent process for five years, sought input from stakeholders, and worked by consensus to develop a set of recommendations. “The task force’s work resulted in recommendations that achieve major accomplishments for Colorado and that reach consensus on the descriptions of diverse types of edits and payment,” said Marilyn Rissmiller, CMS senior director in the Division of Health Care Financing, and task force co-chair.

“The task force has demonstrated that payers and providers can work together to develop a transparent and collaborative process to simplify professional edits for medical claims. The task force has moved the process as far as a single state can in light of the limitations imposed by the national governance of Medicare, Medicaid, and ERISA (the Employee Retirement Income Security Act of 1974).”

The task force finalized a document that describes the governance and dispute resolution process, providing a detailed description of the transparent and inclusive process for developing rules to arrive at a final edit set. This was one of its most significant and valuable accomplishments.

Per the joint resolution, the members of the Colorado general assembly recognize all of the accomplishments of the task force and commend its nonprofit and private-sector participants who donated thousands of hours of volunteer time over a five-year period. They recommend that the federal Department of Health and Human Services (DHHS) accept the work product of the task force, adopt its rules as the basis for the development of a common edit set for professional claims, make this edit set available for adoption in all states, and assume the oversight and funding of the process for development of a common set of edits for professional claims.

Colorado Medical Society has strongly supported the work of CCCTF since its inception by providing leadership and collaborative interaction with all CCCTF stakeholders. We join our elected officials in applauding their achievement.