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Best Practice Recommendations

TitleCategoryLegislative
Browser Capabilities for Prospective Review & Admission Notification BPRProspective Review - MedicalESSB 5346
Claim Coding Policy and Edits: Standardization & TransparencyClaims EditsESSB 5346
Creating and Receiving the Health Care Claim Acknowledgement (HIPAA 277CA)HIPAA Transactions
Electronic Processing of Corrections to Institutional Claims (HIPAA 837I)HIPAA TransactionsESSB 5346
Electronic Processing of Corrections to Professional Claims (HIPAA 837P)HIPAA TransactionsESSB 5346
Emergency Fills and Notification TimeframesProspective Review - Pharmacy ESSB 6511
Exchanging & Processing Info about Pharmacy Benefit ManagementProspective Review - Pharmacy ESSB 6511
Exchanging Explanation of Payment Information between Providers and Health Plans (HIPAA 837 & 835)HIPAA Transactions
Extenuating Circumstances around Pre-Authorization & Admission NotificationProspective Review - MedicalESSB 5346
General Applicability for HIPAA Transactions BPRHIPAA Transactions
Health Plan Web Capabilities for Pharmacy Benefits and Pre-AuthProspective Review - Pharmacy ESSB 6511
Processing and Reporting Remittance Information (HIPAA 835)HIPAA TransactionsESSB 5346
Reconsideration of a Health Plan’s Policy Regarding Code EditsClaims EditsESSB 5346
Web BPR: Requesting and Receiving Claim Status InformationHIPAA Transactions
Requesting and Receiving Coverage Information for Eligibility and Benefits (HIPAA 270-271)HIPAA TransactionsESSB 5346
Standard Notification Timeframes for Pre-Authorization RequestsProspective Review - MedicalESSB 5346
Submitting & Processing Claims (HIPAA 837)HIPAA Transactions
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