Colorado Medical Society

Clean claims update

Sunday, March 01, 2015 11:18 AM

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The Colorado Clean Claims Task Force (CCCTF) is approaching completion of the development of a standardized set of payment rules and claim edits that are to be used by providers and payers in billing and processing of medical claims in Colorado beginning Jan. 1, 2017. The task force comprises 28 industry experts representing a variety of stakeholders, including health care providers and employees from a diverse group of settings, persons or entities that pay for health care services, practice management system vendors, billing and revenue cycle management service companies, and government payers.

CCCTF’s standardized set of payment rules and claim edits will be governed by contract law and affect the business transactions of the providers and payers in the health insurance marketplace. They are projected to save between $80 million and $100 million each year in administrative expenses in Colorado, based on calculations using the report of the Colorado Blue Ribbon Commission for Healthcare Reform (208 Commission) and the American Medical Association’s white paper on administrative waste in the health care system. These savings can be redirected toward reducing the actual cost of care.

CCCTF is seeking a legislative change to the oversight of the project. Currently, the health committees in both chambers have jurisdiction over the project, including the final report due in 2016. CCCTF has asked the 2015 legislature to transfer oversight to the business committees in both chambers. CCCTF believes the oversight responsibilities of the business committees are more in line with the final CCCTF reporting and recommendations concerning a business entity that will sustain the standardized set of rules after the CCCTF is sunset.

Colorado Medical Society strongly supports the work of CCCTF and recognizes that maintaining the Jan. 1, 2017 implementation date is critical. The CMS Board of Directors voted in January to strongly oppose any attempt by any third party to delay or repeal the implementation period of Colorado law requiring the use of a common claims edit set.

The board acted out of concern that the two largest companies in the United States that build and sell claims edits for profit might disengage from CCCTF and thereby force health insurance plans to bring legislation to repeal the clean claims law or to delay its implementation, thereby preserving the claims edit line of business for the vendors and extending the administrative burden caused by private claims edits well into the future.

Colorado Medical Society continues to support the finalization of the Colorado common edit set by providing leadership and collaborative interaction with all CCCTF stakeholders, including the claim vendors, to achieve a successful implementation date of Jan. 1, 2017.