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Overview / Mission

Leadership

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Overview

The Operations Forum focuses on improvements to the provider payment system. The Operations Forum is made up of the managers responsible for claims operations in the major payers and providers in the state.

Mission

• Healthcare administration is complex and expensive
• There are opportunities for administrative simplification that can squeeze unnecessary costs out of the system
• The HIPAA mandates (standard transaction formats, standard identifiers) address some of the complexities/costs of healthcare administration
• Specifically, HIPAA should:
  1. Reduce costs related to data entry (as a result of electronic transactions)
  2. Reduce costs related to software maintenance (as a result of all organizations using the same data formats)
  3. Reduce database errors/costs (as a result of standard identifiers)
• However, there are additional opportunities for ADMINISTRATIVE SIMPLIFICATION and cost reduction beyond implementation of HIPAA mandates
• The BUSINESS PROCESSES related to claims generation, submission, editing, adjudication, payment, and posting can be improved
• To address these business processes requires the cooperation and collaboration of the major providers and health plans in a community
• The Operations Forum created by the Massachusetts Health Data Consortium can provide a vehicle for addressing these business process issues in the region by:
  1. Representing local healthcare organizations in discussions with state government regarding issues of administrative simplification
  2. Staying abreast of HIPAA requirements and compliance activities in the state
  3. Taking actions that drive improvements in the provider payment process via the adoption of standards, the creation of metrics/ benchmarks, etc.
  4. Establishing an agenda and priorities for the CIO Forum