Plan Structure, Contract Language, HIPAA Compliance

Our goal is to help all parties in healthcare finance avoid large budget commitments on systems that do not execute automated COB testing - systems that are likely to be thrown away under HIPAA.

If you are a plan sponsor, the appearance of HIPAA and the automation of COB may require small modifications in your Plan Documents: we provide standard SPD language for that purpose.

You will also need to make certain that your agreements with your vendors, particularly your PBMs, which in the past had no means of conducting COB, start doing so. We supply model language that will help protect your interests in the new, automated environment.

If your TPA for some reason wants you to continue to incur the costs of its manual COB work and the undiscovered COB claims, we can supply you with an interface that will audit each check register for COB before you fund it. To make this tool useful, you will need contract language that enables you to reject claims that are not paid in sequence.

In order to make certain you get automated COB in the future, you should include this tool as a baseline requirement in all your RFPs. We supply model language for that purpose.

Last, many TPAs and PBMs are adopting our interfaces, and in due course will have fully automated COB. These vendors will have lower operating costs and will pay fewer claims than vendors who do not. They deserve your business. We attach a list of payers who are adopting our interfaces, and encourage you to invite them to bid on any business open for renewal - remember, their claims will be lower than their competition!!

Digital Healthcare, PO Box 470732, Cleveland, OH 44147. Tel: 714-384-0179; Fax: 216-520-1261.