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5010 in the Rearview Mirror

Public Policy

I have spent the past couple months reflecting, watching claim statistics across our client base and reading the latest of industry news. It never surprises me that planning and statistics can only take the pursuit of knowledge so far. There is no replacement for hands on, in the trenches, experience.

A discovery over the last month or so was that the claim statistics for exclusions (clearinghouse), rejections (carriers) and denials (carriers) across our client base were holding within pre-5010 ranges. While encouraging news, I couldn’t quite get thoughts on paper to post to this blog.

As it happened a quarterly meeting with our Product Advisory Group was scheduled in April, so we put the topic on the agenda to show the advisors the statistics and get their thoughts. It was apparent early on in the conversation that while the day to day claim submissions are statistically back to normal, in the trenches of the day to day, there is still ongoing cleanup. The providers submitting the claims for their services are left with above average clean-up and claim chasing as a result of all healthcare parties adjusting their systems/edits during the transition to 5010. I estimate that those in the trenches won’t feel relief/settling for another month. If you are still in the middle of the claim chase, stay with it, there is an end in sight. Just in time for summer vacations!

Topic: Public Policy

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