Administrative simplification refers to efforts to streamline, standardize and reduce the burden of administrative functions in the health care system to eliminate duplicative transaction costs and decrease overall health care expenditures. The Mass Collaborative’s primary focus is on improving how providers and payers interact with each other. Current targets for administrative simplification include billing and claims adjudication, eligibility verification, provider credentialing, and prior authorization.

In recent years, both federal and state regulators have recognized the importance of simplifying health care administration, and Chapter 224 is the most recent at the state level. Chapter 224 of the Acts of 2012, “An Act Improving the Quality of Health Care and Reducing Costs Through increased Transparency, Efficiency and Innovation,” was signed into law on August 6, 2012. It is a broad health care reform law that, among other requirements, seeks to simplify administrative processes for providers by requiring that all health plans use standardized forms for prior authorizations, eligibility determination, and claims statements. The law has an impact on the work of the Mass Collaborative, through requirements aimed at improving the eligibility process, increasing the efficiency of the authorization process through standardization and automation, and providing cost transparency tools to patients and providers.

We welcome your involvement. The Mass Collaborative is an open group that encourages community input. Feel free to contact us via e-mail. We also welcome your ideas for administrative simplification projects. Please provide as much detail as possible in your idea submission so that we can better understand your proposal, including what the problem is and any ideas for a proposed solution that you may have.

The Mass Collaborative Strategy and Operations group reviews and prioritizes all project submissions based on their impact to the health care community – whether financial or service-related.

While estimates vary, most health care experts feel that administrative complexities add $10B-$30B in waste nationally every year. Reducing or eliminating this administrative burden results in lower administrative costs for payers and providers which can translate into lower health care costs and insurance premiums.

Interactions among employers, consumers, providers and health plans for the delivery of and payment for health care are closely linked. Through streamlining processes and reducing unnecessary administrative complexity, administrative simplification helps consumers and employers too.