Liberty Mutual Auto & Home insurance
Liberty Mutual Auto & Home insurance
Discovery log number
00349
Discovery description
Due to a system issue involving the inpatient grouping software that is still being tracked, some inpatient claims received by HCA may either improperly fail to group to a DRG, causing a denial, or in a smaller number of cases, group to an incorrect DRG, which may cause some denials or pricing changes. The issue will be resolved as quickly as possible.
In most cases involving this issue, providers will see inpatient claims deny for failure to group to a DRG. In a minority of cases, there may be some claims which group to an incorrect DRG.
Date reported
ETA
Provider impact
Phase 1
Workaround
Follow established processes for checking into claims denials through customer service phone or email. Alternatively, the user may attempt to adjust claims themselves as most claims group correctly on the second attempt.
Value-based purchasing (VBP)
The Health Care Authority (HCA) is the largest health care purchaser in the state. We purchase health care for almost 3 million Washington residents through our Apple Health (Medicaid), Public Employees Benefits Board (PEBB), and School Employees Benefits Board (SEBB) programs.
HCA is leading the effort to transform health care, helping ensure Washington residents have access to better health and better care at a lower cost. Our goal is to achieve a healthier Washington by containing costs while improving outcomes, patient and provider experience, and equity through innovative VBP strategies.
We call this effort “paying for health and value.” One way we achieve this is through value-based purchasing (VBP).
What's VBP?
VBP is a range of strategies intended to contain costs while improving outcomes by tying health care payment to care quality. VBP rewards providers for health care quality, incentivizing them to focus on primary and preventive care. It also holds plans and providers accountable for providing high-quality, high-value care and a satisfying patient experience.
What's fee-for-service?
Traditional health care payment is called fee-for-service (FFS) payment. In FFS contracts, providers are paid for each patient they see and each service they provide. This means that providers receive the same pay whether or not the patient improves and regardless of the appropriateness of care. FFS payment also incentivizes seeing a high volume of patients and providing more expensive specialty services.
VBP strategies take the place of traditional FFS payment. VBP comes in many forms, and HCA uses a variety of tools and approaches to promote VBP.
Goals
We achieve a healthier Washington by:
- Aligning Apple Health, PEBB, SEBB, and other programs to a VBP philosophy.
- Holding health care plan partners and delivery system networks accountable for providing quality and value.
- Exercising significant oversight and quality assurance over contracting partners and implementing corrective action, if necessary.
News and updates
Visit our news page to view announcements.
- What should employees do if they have questions?
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The SEBB Program is directing employees to contact their payroll or benefits office.
- How can BAs get help with employee questions?
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Call SEBB Outreach and Training at 1-800-700-1555 or send a question via HCA Support. This phone number and email address are for benefits administrators only. Do not give it to employees.
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Flexible spending arrangements (FSA)
SmartHealth wellness program
Willamette Dental Group of Washington, Inc.
