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Overview / Mission
Leadership
Initiatives
Reports
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Initiatives - Claims Performance Metrics
Project Status
Date of Status Report: May 19, 2003
The Metrics Workgroup convened monthly during 2001. One useful product that came out of the Workgroup's efforts was a diagram that depicted a high level overview of the claims payment process. In September 2001, the Workgroup published a Status Report that recommended a set of "standard" report templates (the Consortium Reports), community education, and a pilot of the Consortium Reports.
Between October 2001 and February 2002, a pilot of the Consortium Reports was conducted. The participants were two payers (Department of Medical Assistance, the state Medicaid agency and Neighborhood Health Plan, a Boston-based payer) and three provider organizations (Boston Medical Center, an academic medical center; Greater Lowell Pediatrics, a primary care physician group; and Lighthouse Medical Management, a billing service that focuses on specialty physicians).
The participants reported the results of the pilot to the Operations Forum. In summary, both payers and providers found the Consortium Reports to be a positive tool. The use of the reports promoted a healthy payer-provider dialog on problems related to specific claims and the overall claims payment process.
Over the last year, there has been continued interest in the Consortium Reports. The Consortium has made presentations to officials in state government, the Massachusetts Medical Society, the Massachusetts Hospital Association, and the Massachusetts Association of Health Plans. Fallon Community Health Plan has piloted the Consortium Reports with several large provider clients and other health plans have developed similar reporting templates.
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