Online Tools & Reports

In order to provide easily accessible information to provider and hospital staff in their offices, and with the goal of saving time and reducing phone calls to health plans, the Administrative Simplification Workgroups collaborated on the development of ten (10) dynamic reports.

1. Adjustments to Payments: This report defines how nine (9) different participating health plans will handle adjustments to payments.
   
   
2. Using Common Modifiers: This report defines how twelve (12) different participating health plans will handle the twenty-five most commonly questioned modifiers.
   
   
3. Splitting Claims: This report defines the conditions under which eleven (11) different participating health plans will split a claim.
   
   
4. Injury Codes: This report defines when ten (10) different participating health plans require accident information to be included with a claim form.
   
   
5. Referral Guidelines: This report defines which services require referrals for seven (7) different participating health plans.
   
   
6. Prospective Review Guidelines: This report defines which services can be prospectively reviewed by seven (7) different participating health plans.
   
   
7. Inpatient Stay Review: This report answers common processing questions about inpatient stays for seven (7) participating health plans.
   
   
8. Solutions Finder: This report allows an end user to drill down to solutions by selecting the area with which s/he needs help.
   
   
9. Health Plan Contacts: This report provides contact information for:
   • Accountable parties who participate in the Administrative Simplification Effort, including ten (10) Steering Committee members and thirteen (13) health plans
   • Contact and address information regarding operational questions for administrative processes, for thirteen (13) different health plans
   • Where to send required documentation for thirteen (13) different health plans
     
     
10. Adoption Matrix: This report provides a matrix of health plans who have adopted each of the Forum's twenty-three (23) policies on Administrative Simplification.