health plan certification

Group health plans with 50 or more participants, including self-insured plans, must be able to conduct electronic transactions in accordance with HHS standards and operating rules.  One of the more challenging aspects of the electronic transaction rules has been the transition to the new International Classification of Diseases, 10th Revision (ICD-10) codes for health claims.
Continue Reading Health Plans Have an Extra Year to Prepare for ICD-10—And They Might Need It

By December 31, 2015, group health plans must complete a testing process and certify that they are able to conduct electronic transactions in accordance with uniform standards and operating rules.  Plans must also ensure that third-party administrators and other outside vendors are in compliance with the electronic transaction rules if the vendors conduct transactions on the plans’ behalf.

December 2015 might seem a long way off to group health plan sponsors and administrators focused on ACA’s shared responsibility rules.  Plan sponsors should bear in mind, though, that compliance with the certification requirements for electronic transactions can involve significant lead time.  Failure to comply carries substantial penalties.  Accordingly, group health plan sponsors that have not already addressed the electronic transaction rules might wish to develop a timetable for compliance.
Continue Reading Health Plans Must Certify Ability to Conduct Electronic Transactions