Commercial Payor News

The CPR Committee was established in 2009 with the main goal of establishing HBMA as the authority on claims management and resolution within the commercial payor industry since we had already accomplished this with CMS and the government payors. The work of the committee includes, but is not be limited to:

• Providing education, resources and information to our members
  
• Providing a feedback mechanism for members and payors for resolution to global issues
  
• Becoming known as the recognized authority on billing to commercial payors and their associations
  
• Working to achieve industry standards of a clean claim
• Reducing denials and rejected claims
  
• Promoting the use of standard denial reason codes One of the major accomplishments is the development of relationships with key industry stakeholders including: AHIP (American’s Health Insurance Plans); AMA; HASC; CAQH/CORE; the Cooperative Exchange; and the Medical Banking Project.

In 2009 a survey was launched to HBMA members to gather important information surrounding the dynamics of denial management as dealt with by the membership. This valuable survey was the basis for several meetings and presentations to AHIP. Favorable response by AHIP has initiated additional invitations to work with AHIP committees to address issues surrounding this convoluted process we call billing!

Committee Goals:

• Continue to solidify meaningful relationships with payors


• Participate in the development of articles for healthcare publications


• Work on a white paper surrounding claim denial issues and further engage the commercial community in a "think tank" summit