"To achieve the ultimate goal, a central directory of enrollment information must be maintained to determine primacy….The directory would receive enrollment information from insurers, apply the standard rules of primacy of coverage and payment responsibility, and code and array the policies for each insured individual accordingly."
In 1995, the US Office of Management and Budget testified to the Senate Finance Committee that
"We envision an on-line, up-front query system in which the primary and secondary payers will be determined at or before the time that the care is provided, thus eliminating the need for after-the fact attempts to match data across various databases, or the continuation of the Medicare Data Bank."
This is the technology under our patent claims, and the service we are deploying for you.
To achieve the ultimate goal of hands-free, online COB testing, Plan Sponsors (the only authoritative source of "who's covered where" data, and their TPAs have to complete three steps:
2. An interface to synchronize eligibility data between the Plan Sponsor, his TPAs, and Digital Healthcare must be installed. Online eligibility verification is a mandated process under HIPAA, so establishing this interface is an investment everyone must make.
3. Your claim payers must install an interface to test each claim against our database and switching capacity to establish their primacy on each claim.
Notes for Payers and their Software Vendors:
The mandated data ANSI eligibility and claims data sets needed to complete an automated COB test are available here, as is the relevant section of HIPAA.
Digital Healthcare, PO Box 470732, Cleveland, OH 44147. Tel: 714-384-0179; Fax: 216-520-1261.