Administrative Simplification in Washington State
In collaboration with Washington state health plans, public payers, hospitals, practices and public policy
makers OneHeathPort is working hard in the following areas to help simplify health care administration
in Washington state:
Technology services: One of the simplest ways to reduce administrative waste is to stop using paper
and get off the telephone. Whenever possible use online services and other electronic systems to transact business with
your trading partners and finds answers to the questions you have. OneHealthPort offers three technology services to help
you save time by avoiding the telephone.
- Single sign on to the health plan web sites that answer questions about eligibility, benefits, claims status and other
important issues. If you already have a OneHealthPort digital ID, save this link to the health plan sites. If you
don't yet have a OneHealthPort digital ID go to Registration
to get one now, it's FREE.
- A free browser based tool to help you edit and submit claims to payers online. If you don't have an existing
clearinghouse relationship, our partner Office Ally offers an easy way to submit claims online. No need to buy an expensive
system, all you need is a computer and an internet connection. Learn more about Office Ally.
Washington Senate Bill 5346 - In 2009 the Washington state legislature passed SB 5346, a bill to help
simplify health care administration. The bill calls on the Office of the Insurance Commissioner (OIC) to appoint a private
sector organization to lead implementation of the bill. The OIC has designated the Washington Healthcare Forum and OneHealthPort
to serve in this capacity.
Under SSB 5346 the Lead Organization is responsible for making two sets of recommendations to the OIC.
1) "to protect providers and hospitals from
the costs of, and payors from claims for, services to patients who are ineligible for insurance coverage in circumstances where a payor provides eligibility
verification based on best information available to the payor at the date of the request" and for
2) "a set of goals and work plan for the development of medical
management protocols, including whether to develop evidence-based medical management practices addressing specific clinical conditions." WorkSMART convened representative
stakeholder groups to study these issues and prepare recommendations for the OIC. The recommendations are contained in these two reports:
Medical Management Recommendation
Best Practice Recommendations - Local payers and providers are working with OneHealthPort to identify
"Best Practice Recommendations" (BPR) in a number of areas. BPRs define a better way to get things done that's pragmatic and
works for everyone. Rather than standardize the current work flow, BPRs aim to move the industry toward the Best Practices
for working together. Some BPRs are addressed in SB 5346 some are not. However, all BPRs reflect a standard that participating
payers and providers are committed to adopt.
Policies and Guidelines - There are some areas where a clearly defined Best Practice is not available or
relevant but there is an interest in improving or standardizing work between plans and providers. OneHealthPort hosts a
library of policies and guidelines that indicate how plans and providers can work together more efficiently.
Pre-Auth and Admit Notifications - OneHealthPort has worked in collaboration with provider organizations and
health plans to develop a set of Best Practice Recommendations for using your browser to simplify the Prospective Review and Admission Notification processes. This table provides a
"One-Stop-Shop" of links to a variety of health plans and their references for Prospective Review and Admission Notifications.
Credentialing Data Collection- OneHealthPort has contracted with Medversant for the use of their provider data collection application, ProviderSource. ProviderSource is free to
provider organizations entering data. ProviderSource is an easy-to-use online portal to the OneHealthPort Provider Data Service, a statewide system hosted by OneHealthPort
for centralized collection, verification and distribution of all provider data to be used for credentialing, privileging and a statewide provider directory for the Washington State Health Information Exchange.
Adoption Matrix- 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 on the Adoption Matrix page share the reported level of adoption by various health plans.
Stakeholder Groups - The WorkSMART Stakeholder Groups are a vital part of developing and implementing Best Practice Recommendations (BPR) and making SB 5346 work for everyone. If you
like solving problems rather than just hoping someone else will do something, then please join a Stakeholder Group. Any member of OneHealthPort's trusted community can join the Stakeholder Groups.
Breadcrumb Trail - across the top of each Administrative Simplification web page is a "breadcrumb trail" or series of links that let you easily find all the major start pages for Administartive Simplification projects.