{"id":1438,"date":"2022-11-17T09:13:15","date_gmt":"2022-11-17T17:13:15","guid":{"rendered":"https:\/\/\/?page_id=1438"},"modified":"2024-12-06T14:36:00","modified_gmt":"2024-12-06T22:36:00","slug":"best-practice-recommendations","status":"publish","type":"page","link":"https:\/\/www.qualityhealth.org\/adminsimp\/best-practice-recommendations\/","title":{"rendered":"Best Practice Recommendations"},"content":{"rendered":"

[vc_row][vc_column][vc_column_text]\n\n\n\n\t\n\n\t\n\t\n\t\n\t\n\t\n\t\n\t\n\t\n\t\n\t\n\t\n\t\n\t\n\t\n\t\n\t\n\t
Title<\/th>Category<\/th>Legislative<\/th>\n<\/tr>\n<\/thead>\n
Browser Capabilities for Prospective Review & Admission Notification BPR<\/a><\/strong><\/td>Prospective Review - Medical<\/td>ESSB 5346<\/a><\/td>\n<\/tr>\n
Claim Coding Policy and Edits: Standardization & Transparency<\/a><\/td>Claims Edits<\/td>ESSB 5346<\/a><\/td>\n<\/tr>\n
Creating and Receiving the Health Care Claim Acknowledgement (HIPAA 277CA)<\/a><\/strong><\/td>HIPAA Transactions<\/td><\/td>\n<\/tr>\n
Electronic Processing of Corrections to Institutional Claims (HIPAA 837I)<\/a><\/td>HIPAA Transactions<\/td>ESSB 5346<\/a><\/td>\n<\/tr>\n
Electronic Processing of Corrections to Professional Claims (HIPAA 837P)<\/a><\/td>HIPAA Transactions<\/td>ESSB 5346<\/a><\/td>\n<\/tr>\n
Emergency Fills and Notification Timeframes<\/a><\/td>Prospective Review - Pharmacy<\/td> ESSB 6511<\/a><\/td>\n<\/tr>\n
Exchanging & Processing Info about Pharmacy Benefit Management<\/a><\/td>Prospective Review - Pharmacy<\/td> ESSB 6511<\/a><\/td>\n<\/tr>\n
Exchanging Explanation of Payment Information between Providers and Health Plans (HIPAA 837 & 835)<\/a><\/td>HIPAA Transactions<\/td><\/td>\n<\/tr>\n
Extenuating Circumstances around Pre-Authorization & Admission Notification<\/a><\/td>Prospective Review - Medical<\/td>ESSB 5346<\/a><\/td>\n<\/tr>\n
General Applicability for HIPAA Transactions BPR<\/a><\/td>HIPAA Transactions<\/td><\/td>\n<\/tr>\n
Health Plan Web Capabilities for Pharmacy Benefits and Pre-Auth<\/a><\/td>Prospective Review - Pharmacy<\/td> ESSB 6511<\/a><\/td>\n<\/tr>\n
Processing and Reporting Remittance Information (HIPAA 835)<\/a><\/td>HIPAA Transactions<\/td>ESSB 5346<\/a><\/td>\n<\/tr>\n
Reconsideration of a Health Plan\u2019s Policy Regarding Code Edits<\/a><\/td>Claims Edits<\/td>ESSB 5346<\/a><\/td>\n<\/tr>\n
Web BPR: Requesting and Receiving Claim Status Information<\/a><\/td>HIPAA Transactions<\/td><\/td>\n<\/tr>\n
Requesting and Receiving Coverage Information for Eligibility and Benefits (HIPAA 270-271)<\/a><\/td>HIPAA Transactions<\/td>ESSB 5346<\/a><\/td>\n<\/tr>\n
Standard Notification Timeframes for Pre-Authorization Requests<\/a><\/td>Prospective Review - Medical<\/td>ESSB 5346<\/a><\/td>\n<\/tr>\n
Submitting & Processing Claims (HIPAA 837)<\/a><\/td>HIPAA Transactions<\/td><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n[\/vc_column_text][\/vc_column][\/vc_row]<\/p>\n<\/div>","protected":false},"excerpt":{"rendered":"[vc_row][vc_column][vc_column_text][\/vc_column_text][\/vc_column][\/vc_row]","protected":false},"author":132,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_bbp_topic_count":0,"_bbp_reply_count":0,"_bbp_total_topic_count":0,"_bbp_total_reply_count":0,"_bbp_voice_count":0,"_bbp_anonymous_reply_count":0,"_bbp_topic_count_hidden":0,"_bbp_reply_count_hidden":0,"_bbp_forum_subforum_count":0,"footnotes":""},"class_list":["post-1438","page","type-page","status-publish","hentry"],"aioseo_notices":[],"_links":{"self":[{"href":"https:\/\/www.qualityhealth.org\/adminsimp\/wp-json\/wp\/v2\/pages\/1438","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.qualityhealth.org\/adminsimp\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/www.qualityhealth.org\/adminsimp\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/www.qualityhealth.org\/adminsimp\/wp-json\/wp\/v2\/users\/132"}],"replies":[{"embeddable":true,"href":"https:\/\/www.qualityhealth.org\/adminsimp\/wp-json\/wp\/v2\/comments?post=1438"}],"version-history":[{"count":26,"href":"https:\/\/www.qualityhealth.org\/adminsimp\/wp-json\/wp\/v2\/pages\/1438\/revisions"}],"predecessor-version":[{"id":1724,"href":"https:\/\/www.qualityhealth.org\/adminsimp\/wp-json\/wp\/v2\/pages\/1438\/revisions\/1724"}],"wp:attachment":[{"href":"https:\/\/www.qualityhealth.org\/adminsimp\/wp-json\/wp\/v2\/media?parent=1438"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}