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Administrative Simplification

Administrative Simplification

Reducing and simplifying administrative work in health care is an important part of building a system that delivers better health, better care and lower costs for Oregon. 
 
As much as 10 percent of hospital revenue and up to 15 percent of physician revenue goes toward administrative costs. Health care providers are finding themselves doing more administrative work for the same number of patients.
 
These concerns led to the passage of Senate Bill 94, giving the Department of Consumer and Business Services the authority to adopt uniform standards on financial and administrative transactions for all Oregon health insurance plans, including public and private, Medicaid and non-Medicaid. This includes standards for numerous electronic transactions, prior authorization, and credentialing processes. 
 
The Oregon Health Leadership Council is a public-private collaborative organization that works on health care initiatives and is charged with developing the Oregon Companion Guides for administrative simplification. The Oregon Health Authority's Office of Health Information Technology is tasked with coordinating and communicating the new standards to the public. 
 
Starting Jan. 1, 2012, the newly streamlined electronic transaction standards for all Oregon health care insurance plans will go into effect. Details on how and when providers and plans must become compliant are below.

Rules in Process

The following Oregon Companion Guides (OCG) are in the process of being adopted into rule. Both guides require all Oregon Covered Entities to be fully compliant with federal standards by the required date of January 1, 2014. The OCGs do not add additional transaction requirements to federal standards.



Timeline for compliance

Jan. 1, 2012

Eligibility transactions (270/271 transactions)
If you submit transactions electronically, and have done so prior to July 15, 2011, you need to be compliant with the new eligibility transaction standards as outlined in the 270/271 Oregon Companion Guide PDF by Jan. 1, 2012.

Oct. 1, 2012

Eligibility transactions (270/271 transactions)
If you do not currently submit transactions electronically, or started to after July 15, 2011, you must be compliant with the new eligibility transaction standards as outlined in the 270/271 Oregon Companion Guide PDF by Oct. 1, 2012.
 
Claims and encounter transactions (837 transaction)
If you submit transactions electronically, and have done so prior to Oct. 31, 2011, you need to be compliant with the new claims and encounter transaction standards (code 837) by Oct. 1, 2012, as outlined in the Oregon Companion Guide for the following health care claims:

Jan. 1, 2013

Claims and encounter transactions (837 transaction)
If you do not currently submit transactions electronically, or started to after Oct. 31, 2011, you need to be compliant with the new claims and encounter transaction standards (837) by Jan. 1, 2013, as outlined in the Oregon Companion Guide for the following health care claims:

2012-2013

• Health care claim status inquiry and response (276/277 transactions).
 
• Health care claims payment and remittance advice (835 transaction).
 


Resources

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503-383-6260
ohit@state.or.us

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