About ClaimHeader
Purpose
The ClaimHeader has multiple purposes. It has been published in one form
or other for
seven years. Over 125 health plans subscribe. The ClaimHeader is published
in order to:
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Provide a Forum to gather claims process best practices.
The claims process is not charactized by a significant and common
understanding in terms of the core steps and processes. Translation:
Few people know how claims works. The claimHeader seeks to gather best
practice and other claims related information to further the industry understanding
of the claims process.
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Provide a Forum to gather claims process best benchmarks.
In addition to the process knowledge gaps, there are signficant performance
gaps ("what is a common EDI rate?"). A second objective is to gather and share
process benchmarks. The ClaimHeader observes a number of rules with regard to gathering
and sharing benchmarks. First, we strictly adhere to HIPAA guidelines. Data governed
by HIPAA rules is neither gathered nor shared. Second, we provide various levels of sharing
for survey participants. We are not in the business of gathering information to provide a
competitive advantage to a payer or a provider. We allow our survey respondents
control over what they disclose ("You don't have to tell us your EDI rate if you don't
want to, or you can do it anonymously").
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Enable our parent company (Data Method) to continue to learn about the claims process.
The ClaimHeader parent company (Data Method) provides software to payers. The software
is used to monitor and audit the claims process. Our selfish interest in publishing the
ClaimHeader is to continue to build our knowledge base about claims, and claims process issues
and performance.