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Administrative Simplification

Mass Collaborative

 

The Mass Collaborative (www.masscollaborative.org) developed by Blue Cross Blue Shield of Massachusetts (BCBSMA), Massachusetts Association of Health Plans (MAHP), MassHealth, Massachusetts Health Data Consortium (MHDC), Massachusetts Hospital Association (MHA), and Massachusetts Medical Society (MMS) serves as a leading voice of health care administrative simplification in Massachusetts. Its mission is to simplify and improve health care administration by increasing efficiency, eliminating waste, and promoting standardization.

 

The Mass Collaborative is working to further create efficiency and simplification by:

  • Identifying gaps in the electronic eligibility process and further increase efficiencies.

  • Reducing the administrative burden on payers and providers by standardizing prior authorization forms for medical, lab and prescription services.

  • Addressing new Massachusetts General Laws (Chapter 111 Section 228) requiring physicians and hospitals to provide cost information for procedures and services to patients.

  • Creating a standardized patient-information form that can be used by health plans and physician practices to determine cost estimates for patients.

 

Initiatives to Date

  • Implementation of a first-in-the-nation standardized 'alpha search’ feature that improves the accuracy of locating health care providers.

  • Creation of the universal Provider Request for Claim Review Form, which is used to submit a claim to a health plan or MassHealth for additional review. An accompanying reference guide provides valuable information on how to submit the form.

  • Development of a streamlined process for health plan credentialing (www.hcasma.org).

  •  Creation of an email distribution list to improve how health plans communicate with credentialed providers.

  • Establishment of standardized processes for application status inquiries and hospital roster update notifications.


Credentialing

  • The establishment of a standardized process for physician credentialing by Massachusetts health plans and hospitals.

  • The development of a uniform credentialing application used by physicians, MA health plans and MA hospitals.

  • Commitment by MA health plans to process 95% of complete initial applications within 30 days and communicate regularly with physicians on their application status.

  • In January 2005, Massachusetts health plans founded Health Care Administrative Solutions (HCAS) in order to collaborate on administrative simplification initiatives.

  • HCAS currently serves as the single point-of-entry for providers to submit credentialing information used by HCAS and participating health plans to verify a provider’s qualifications.  Please visit the HCAS website for more information.

 

Coding

A statewide advisory committee has been formed, comprised of various state agencies, legislators from the House and Senate, MAHP, MMS, MHA, BCBSMA, the Massachusetts Health Information Management Association (MaHIMA), the Massachusetts Health Data Consortium (MHDC), America's Health Insurance Plans (AHIP), and a MassHealth contracted managed care organization.

 

This advisory committee has worked on the adoption, implementation and compliance with the Health Insurance Portability and Accountability Act (HIPAA) compliant code sets; the International Classification of Diseases (ICD); the American Medical Association's Current Procedural Terminology codes, reporting guidelines and conventions; and the Centers for Medicare and Medicaid Services Healthcare Common Procedure Coding System.