Health insurance identification (ID) cards vary widely in terms of the type and amount of information they convey about the policyholder and the plan. This type of inconsistency results in a significant percentage of rejected claims, which must be re-worked and re-submitted, costing providers and payers countless staff hours.
Machine-readable health ID cards have the potential of optimizing this process by accurately capturing and transmitting the policyholder information directly into the provider's electronic patient management system, which is used to generate and track claims.
Current Environment
HASC developed the Health Identification Card Implementation Guide, which was approved by the Workgroup for Electronic Data Interchange (WEDI) in November of 2007. The Guide includes specifications for machine-readable ID cards, as well as required data elements that need to be included on the cards. Several large health plans have adopted the WEDI standard card, which was first developed by the X12 and American National Standards Institute (ANSI) organizations. Project SwipeIT, a national campaign sponsored by the MGMA, encourages stakeholders to pledge support to health ID cards that are WEDI-compliant.
The CAQH CORE Phase III is writing rules to address the use of the WEDI format for the cards in collaboration with WEDI. These rules will require that any CORE-certified plan, vendor or practice management system using a health ID card for verification purposes follow the WEDI ID Card standard. The rules will ensure a common implementation of the standard, taking into consideration that certain aspects of the WEDI are optional or provide options. This will allow vendors and providers to have a consistent approach across all payers.
Opportunities
Government and private sector entities need to address the standardization of health ID cards as a part of a broader administrative simplification and health information technology effort. Currently, CORE certifies vendors and practice management systems, plans, and large providers for administrative transactions. Several practice management software systems are Phase I-certified and their vendors are committed to Phase II certification by the last quarter of 2009.
HASC Recommendations
- Adoption of machine-readable health ID cards that are compliant with the WEDI Health Identification Card Implementation Guide by public and private payers.*
- Development and dissemination of low-cost software interface solutions by practice management software system and/or electronic health record vendors to allow the incorporation of machine-readable health ID cards utilizing the WEDI Implementation Guide into providers’ organizational workflow.
- Development and dissemination of standard educational materials to inform providers, vendors, and health plans about the value of issuing, supporting, and utilizing machine-readable health ID cards that are compliant with the WEDI Implementation Guide.
- Development and funding of a pilot program by CMS and private payers to identify opportunities to simplify administrative processes and challenges related to the use of a standardized machine-readable health ID cards for Medicare beneficiaries.
- Support of CORE Phase III certification by practice management systems/front-end vendors and plans, which would be required to use the WEDI health ID card standard and related requirements associated with data accessed by cards.
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*CORE Phase III supports this recommendation. Participation in Phase III rules writing and adoption of the Phase III rules are recommended.
