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Payer Adoption Matrix - Implementation and Validation Status
Revision: 2011-05-02
OneHealthPort is serving as a lead organization to help implement SB 5346. One of OneHealthPort's responsibilities is to report on the rate of voluntary
adoption by health plans and providers. Each payer is asked to indicate whether they are complying with the BPR. The charts below share the reported level of adoption by various health plans.
Adoption Charts by Subject Area
Click on the BPR title below to open a detailed adoption table. Click on the link again to close the table. Each table is alphabetically sortable by column by left clicking the head of the column. Right clicking the head of the column will let you remove any columns you do not wish to view/print. Legend of terms is listed below all table chart links.
Validating Health Plan Capabilities
Validation is a structured and objective process for assessing how closely a health plan's implementation of their web site and/or HIPAA transactions matches the associated Best Practice Recommendation (BPR).
Click on the following link to access the validation materials developed by the workgroups. These materials can be used by health plans for self-assessment of their capabilities and by groups for providers for their assessment - in accordance with the structured methodology.
Web BPR: Requesting and Receiving Coverage Information for Eligibility and Benefits
See Adoption Matrix |
| Health Plan
| Adoption Level
| Validation: Either a link to supporting policy or a rating (depending on BPR)
| Health Plan Comment (click link to see)
|
| Aetna |
Adopt at CORE level |
Acceptable (Self) |
Comments |
| Asuris |
Fully Adopt |
Complete (self) |
|
| CHPW |
To Be Determined |
|
Comments |
| Cigna |
Adopt at CORE level, late 2011 |
Revalidation Pending 1Q2012 - Improvements Underway |
|
| CUP |
Fully Adopt |
|
Comments |
| FCHA |
Fully Adopt |
Acceptable (Self) |
|
| GHC |
Fully Adopt |
Complete (Providers) |
|
| Kaiser |
To Be Determined |
|
|
| KPS |
Fully Adopt |
|
|
| Lifewise |
Fully Adopt |
Complete (Self) |
|
| LNI |
To Be Determined |
|
Comments |
| Medicaid |
Fully Adopt, date TBD |
|
|
| Molina |
Fully Adopt, as of 01/2013 |
|
|
| PacificCare |
To Be Determined |
|
|
| Premera |
Fully Adopt |
Complete (Providers) |
|
| Regence |
Fully Adopt |
Complete (Self) |
Comments |
| United |
Partially Adopt |
Complete (Self) |
|
HIPAA Transaction BPR: Requesting and Receiving Coverage Information for Eligibility and Benefits
See Adoption Matrix |
| Health Plan
| Adoption Level
| Validation: Either a link to supporting policy or a rating (depending on BPR)
| Health Plan Comment (click link to see)
|
| Aetna |
Adopt at CORE level |
Acceptable (Self) |
|
| Asuris |
Fully Adopt |
Acceptable (Providers) |
|
| CHPW |
Fully Adopt |
Acceptable (Self) |
|
| Cigna |
Adopt at CORE level, late 2011 |
|
|
| CUP |
To be determined |
|
|
| FCHA |
Fully Adopt |
Acceptable (Self) |
|
| GHC |
Fully Adopt |
Complete (Providers) |
|
| Kaiser |
Fully Adopt as of 01/2014 |
|
Comments |
| KPS |
Fully Adopt as of 06/2011 |
|
|
| Lifewise |
Fully Adopt |
Complete (Self) |
|
| LNI |
To Be Determined |
|
Comments |
| Medicaid |
Fully Adopt |
|
|
| Molina |
Fully Adopt, as of 01/2013 |
|
|
| PacificCare |
Fully Adopt, as of 12/2011 |
|
|
| Premera |
Fully Adopt |
Acceptable (Providers) |
|
| Regence |
Fully Adopt |
Acceptable (Providers) |
Comments |
| United |
Fully Adopt |
Complete (Self) |
|
Web BPR: Browser Capabilities for Pre-Authorization and Admission Notification
See Adoption Matrix |
| Health Plan
| Adoption Level
| Validation: Either a link to supporting policy or a rating (depending on BPR)
| Health Plan Comment (click link to see)
|
| Aetna |
Partially Adopt |
- One-Stop-Shop Content
- Acceptable-Phase I (Self)
|
Comments |
| Asuris |
Fully Adopt |
- One-Stop-Shop Content
- Acceptable-Phase I (self)
|
Comments |
| CHPW |
Partially Adopt |
- One-Stop-Shop Content
- Acceptable-Phase I (Self)
|
Comments |
| Cigna |
Fully Adopt |
- One-Stop-Shop Content
- Acceptable-Phase I& II (Self)
| |
| CUP |
To Be Determined |
|
Comments |
| FCHA |
Fully Adopt |
- Acceptable-Phase I (Self)
|
|
| GHC |
Fully Adopt, date TBD |
- One-Stop-Shop Content
- Acceptable-Phase I (self)
|
|
| Kaiser |
To Be Determined |
|
Comments |
| KPS |
Fully Adopt as of 12/2011 |
|
|
| Lifewise |
Fully Adopt |
- One-Stop-Shop Content
- Acceptable-Phase I (Self)
|
|
| LNI |
Fully Adopt |
- One-Stop-Shop Content
- Acceptable-Phase I (Self)
|
Comments |
| Medicaid |
Fully Adopt, date TBD |
|
Comments |
| Molina |
Fully Adopt, date 12/2011 |
|
|
| PacificCare |
Fully Adopt |
| Comments |
| Premera |
Fully Adopt |
- One-Stop-Shop Content
- Acceptable-Phase I (Providers)
|
|
| Regence |
Fully Adopt |
- One-Stop-Shop Content
- Acceptable-Phase I (Self)
| Comments |
| United |
Fully Adopt |
- One-Stop-Shop Content
- Acceptable-Phase I&II (Self)
| Comments |
- Notes: Only implementation of Phase I capabilities is required by 12-31-10
- Acceptable - Implementation of Phase I capabilities
- Complete - Implementation of Phase I & II capabilities
Policy BPR: Extenuating Circumstances around Pre-Authorization and Admission Notification
See Adoption Matrix |
Policy BPR: Standard Notification Timeframes for Pre-Authorization Requests
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HIPAA Transaction BPR: Standard Coding of Denials and Adjustments in the HIPAA 835
See Adoption Matrix |
| Health Plan
| Adoption Level
| Validation: Either a link to supporting policy or a rating (depending on BPR)
| Health Plan Comment (click link to see)
|
| Aetna |
Partially Adopt |
|
Comments |
| Asuris |
Fully Adopt |
|
|
| CHPW |
Fully Adopt as of 12/11 |
|
Comments |
| Cigna |
Adopt at CORE level as of 06/11 |
|
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| CUP |
Fully Adopt |
|
|
| FCHA |
Fully Adopt |
|
|
| GHC |
Fully Adopt |
|
|
| Kaiser |
Fully Adopt 01/2012 |
|
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| KPS |
Not Yet Reported |
|
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| Lifewise |
Fully Adopt |
|
|
| LNI |
Fully Adopt, Date TBD |
|
Comments |
| Medicaid |
Fully Adopt as of 06/11 |
|
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| Molina |
Fully Adopt |
|
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| PacificCare |
Partially Adopt, Date TBD |
|
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| Premera |
Fully Adopt |
|
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| Regence |
Fully Adopt |
|
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| United |
Partially Adopt |
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HIPAA Transaction BPR: Electronic Processing of Corrections to Institutional Claims
See Adoption Matrix |
| Health Plan
| Adoption Level
| Validation: Either a link to supporting policy or a rating (depending on BPR)
| Health Plan Comment (click link to see)
|
| Aetna |
Fully Adopt |
Complete (self) |
Comments |
| Asuris |
Fully Adopt |
Complete (Providers) |
|
| CHPW |
To Be Determined |
|
Comments |
| Cigna |
Fully Adopt |
Complete (self) |
|
| CUP |
Fully Adopt |
|
Comments |
| FCHA |
Fully Adopt |
Complete (self) |
|
| GHC |
Fully Adopt |
Complete (Providers) |
|
| Kaiser |
Fully Adopt |
Complete (self) |
|
| KPS |
Fully Adopt |
|
|
| Lifewise |
Fully Adopt |
Complete (self) |
|
| LNI |
Fully Adopt, as of 06/11 |
|
|
| Medicaid |
Fully Adopt |
Complete (Providers) |
|
| Molina |
Fully Adopt |
|
|
| PacificCare |
Fully Adopt |
|
|
| Premera |
Fully Adopt |
Complete (Providers) |
|
| Regence |
Fully Adopt |
Complete (Providers) |
|
| United |
Fully Adopt |
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HIPAA Transaction BPR: Electronic Processing of Corrections to Professional Claims
See Adoption Matrix |
| Health Plan
| Adoption Level
| Validation: Either a link to supporting policy or a rating (depending on BPR)
| Health Plan Comment (click link to see)
|
| Aetna |
Fully Adopt |
Complete (self) |
Comments |
| Asuris |
Fully Adopt |
Complete (self) |
|
| CHPW |
To Be Determined |
|
Comments |
| Cigna |
Fully Adopt |
Complete (self) |
|
| CUP |
Fully Adopt |
|
Comments |
| FCHA |
Fully Adopt |
Complete (self) |
|
| GHC |
Fully Adopt |
Complete (self) |
|
| Kaiser |
Fully Adopt |
Complete (self) |
|
| KPS |
Fully Adopt |
|
|
| Lifewise |
Fully Adopt |
Complete (self) |
|
| LNI |
Fully Adopt, as of 06/11 |
|
|
| Medicaid |
Fully Adopt |
|
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| Molina |
Fully Adopt |
|
|
| PacificCare |
to be determined |
|
|
| Premera |
Fully Adopt |
Complete (Providers) |
|
| Regence |
Fully Adopt |
Complete (Self) |
|
| United |
Fully Adopt |
|
|
Policy BPR: Claim Coding Policy and Edits Standardization & Transparency
See Adoption Matrix |
Policy BPR: Reconsideration of a Health Plan's Policy Regarding Code Edits
See Adoption Matrix |
Web BPR: Requesting and Receiving Claim Status Information
See Adoption Matrix |
| Health Plan
| Adoption Level
| Validation: Either a link to supporting policy or a rating (depending on BPR)
| Health Plan Comment (click link to see)
|
| Aetna |
|
|
|
| Asuris |
Fully Adopt |
Complete (Self) |
|
| CHPW |
|
|
|
| Cigna |
|
|
|
| CUP |
|
|
|
| FCHA |
|
|
|
| GHC |
Fully Adopt |
Acceptable (Self) |
|
| Kaiser |
To Be Determined |
|
|
| KPS |
|
|
|
| Lifewise |
Fully Adopt Date TBD |
|
|
| LNI |
|
|
|
| Medicaid |
|
|
|
| Molina |
|
|
|
| PacificCare |
|
|
|
| Premera |
Fully Adopt Date TBD |
|
|
| Regence |
Fully Adopt |
Complete (Self) |
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| United |
|
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Credentialing Record Pick-up and Outreach
SB 5346: Health Plan Participation - who's waiting to use your records
Click to See Readiness Results | | |
| Health Plan
| Participating
| Retrieving Records Now
| Provider Communications Plan
|
| Aetna |
Yes |
No |
Published an article in provider newsletter in March communicating our plans to begin using ProviderSource.
Has a plan in place to begin building the transition to use ProviderSource. |
| Asuris |
Yes |
Yes |
TBD |
| CHPW |
Yes |
Yes |
Yes, has detailed communication plan in place. |
| Cigna |
Yes |
Yes |
No |
| CUP |
Yes |
No |
TBD, Just signed contract, putting together plan |
| DLI |
No |
No |
No |
| DSHS |
No |
No |
No |
| FCHA |
Yes |
Yes |
Yes, has detailed communication plan in place. |
| GHC |
Yes |
No |
Yes, has detailed communication plan in place. |
| KPS |
Yes |
No |
Yes, has detailed communication plan in place. |
| Lifewise |
Yes |
Yes |
Yes, has detailed communication plan in place. |
| Molina |
Yes |
Yes |
TBD |
| Premera |
Yes |
Yes |
Yes, has detailed communication plan in place. |
| Puget Sound Health Partners |
Yes |
TBD |
TBD |
| Regence |
Yes |
Yes |
TBD |
| United |
No |
No |
No |
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Legend:
1. Adopt BPR at CORE Level - CORE is a national collaborative that encourages standard operating practices. The Washington State BPR's address a broader set of operating practices than does CORE and at a more rigorous level. Adopt at Core indicates that the health plan reported that they will adopt a subset of the BPR practices that corresponds to CORE's recommended practices.
2. Partially Adopt BPR - indicates that the health plan reported that they will adopt a subset of the BPR practices. Some health plans provided more information in their comments about which practices they adopt/don't adopt.
3. Validation: Either a link to supporting policy or a rating (depending upon the BPR): For some BPRs, a method of validating the health plan's implementation of the BPR has been defined.
a. In some cases, that validation method calls for a health plan to post, on their website, their policy that corresponds to the BPR. In these cases, health plans were asked to provide the link to their web site policy.
b. In other cases, a structured validation methodology has been developed that results in a rating of the level of implementation -- Unacceptable, Acceptable, Complete. In these cases, health plans were asked to use that methodology to validate their implementation of the BPR and report their rating. These ratings are indicated by '(Self)'. Depending upon interest, a group of providers may be convened to use the methodology to validate a health plan's implementation. These ratings are indicated by '(Provider)'
c. In the case of the BPR- Browser Capabilities for Pre-Authorization and Admission Notification, health plans were asked to provide web links / instructions for how providers should request a prospective review and for how providers should notify them about an admission. This information is put in one place on the OHP web site, and is referred to as 'One-Stop-Shop Content'. If the health plan provided this information, 'One-Stop-Shop Content' is included in this column along with their Validation Rating.
4. Browser Capabilities for Pre-Authorization and Admission Notification: This BPR outlines a set of capabilities that can be implemented in phases. The first phase is to have been implemented by 12-31-2010. No date has been set for the second phase of capabilities.
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FREE CMS ICD-10 Implementation Handbooks Click here to find out more.
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Credentialing and Privileging Data Collection - videos.
To view the training videos on Provider Attestation and Browser Second Factor Provisioning
click here
WPA Field Mapping Guide NOW Available to assist in mapping your provider data to the new ProviderSource application.
click here
Health Information Exchange Project Updated.
Read the latest on the Washington State HIE:
click here
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