TechWeb

Proposed California eBilling Rules Released

Mar 05, 2010 (04:03 PM EST)
URL: http://www.techweb.com/show-press-release/X794702/proposed-california-ebilling-rules-released.html

Largest State Workers' Compensation System to Mandate Medical Billing EDI, Electronic / Paper Workflows, PHI Protections and Uniform Bill Data

CONCORD, Calif., March 5 /PRNewswire/ -- Jopari Solutions, a leading property and casualty industry bill cycle automation company, is expanding its offering of eBill processing services in California to assist Payers' compliance under the state's new proposed Business Rules for Paper and Electronic Billing, published March 4, 2010.  The proposed California rules encourage health care providers to use the ASC X12N 837 bill format, and require Payers to accept electronic and standard format paper bills containing equivalent information and data elements.

Jopari's eBill services already support the company's current Payers in California and will provide required expertise to Payers that have no prior exposure to jurisdictional eBill requirements. Jopari currently delivers electronic workers' compensation medical billing arrangements for Payers under other jurisdictional mandates, providing eBill connectivity with a myriad of health care provider organizations in almost every state.  

Under the new proposed California rules, Payers must implement several new bill processing competencies, and enhance existing medical bill workflow. This will include:

  • supporting HIPAA ASC X12N Transactions, non-ANSI electronic transactions, and Acknowledgment notifications
  • receiving, routing, processing, and storing (per NIST and FIPS guidelines) HIPAA compliant electronic bills and attachments
  • performing required eBill pre-adjudication, indexing, edits and data validation
  • executing secure EDI transmissions complying with Federal National Institute Standards and Technology (NIST), and Federal Information Processing Standards (FIPS) guidelines
  • compliance with contracting requirements and relationship management relating to Trading Partners, Business Associates and/or other third party vendors
  • establishing business process automation and health care provider trading partner connectivity strategies
  • supporting two-tiered timely payment disbursement time frames (15 day electronic bills / 45 day paper bills)

Stated Don St. Jacques, COO and SVP of Jopari Solutions, "Electronic billing requirements in workers' compensation generally, and in California particularly due to tightened PHI protections, payment deadlines and uniform bill data elements, obligate a new set of bill cycle competencies.  Jopari's expertise in establishing enterprise-level HIPAA conforming eBill compliance, paperless bill and attachment workflow, and – very important under the California prompt pay rule -- payment and remittance processing offers a complete package.  We are getting the message out early about the requirements for our existing Payers so they can take advantage of expanding their processing cost efficiency and cost advantage in this market; but also to assist those currently non-automated Payers in establishing a viable solution."

"California's proposed workers' compensation medical bill and attachment workflow requirements signal a more complex transactions environment for the industry going forward," commented Mr. St. Jacques.  "This modern environment entails the capacity to simultaneously and securely process a mix of bill formats and medical document media.  By referencing Federal standards and guidelines, in combination with jurisdictional rule sets, data requirements and performance time frames are aligning workers' comp medical services with the greater health care universe.  But this alignment has to respect the distinctive legal obligations attendant to administering work-related medical claims.  We believe availability of industry-centric medical EDI technology that fully understands this distinction is essential."

Summary of proposed California eBill rules and a description of Jopari's leading eBill Compliance services for workers' compensation payers are available at www.jopari.com.

About Jopari Solutions, Inc.

Jopari Solutions, Inc. supplies integrated eBill compliance and payment solutions to workers' compensation, auto, and health insurance industry Payers. Jopari significantly improves the technology Payers use to manage bills and disbursements, substantially reducing associated expenses. Jopari's SAS 70 Level II certified services enable insurance Payers to comply fully with regulatory requirements, including eBill and ePay jurisdictional initiatives, and HIPAA.  Insurance and other industry Payers take advantage of JopariPay™ to permanently downsize processing and labor costs, increase operational competitiveness and realize immediate returns on investment.  

Jopari plays an active role in supporting jurisdiction taskforces to develop eBill rules and regulations, and participates in National Standard Setting Organizations such as The Workgroup for Electronic Data Interchange (WEDI),  American National Standards Institute Accredited Standards Committee (ASC X12), and International Association of Industrial Accident Boards & Commissions( IAIABC ), helping to facilitate a national standardized approach to Property and Casualty Electronic Data Exchange (EDI).

SOURCE Jopari Solutions