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Along with increasing financial, operational and regulatory pressures on health plans, payers, providers and executives are also being burdened by the growing electronic transactions. Considering this scenario, Health Insurance Portability and Accountability Act (HIPAA) legislation also gave a go ahead to the use of standard transactions and code sets between trading partners. This was seen as a step to ease the burden of telephonic and paper communication between payers, providers, employers and other stakeholders. But it was realized that there are many backend processes and systems that can only achieve the highest possible levels of automation by meeting specific data content and format requirements. As against what HIPAA expected, automation rates have gone down instead of up in many cases. This has resulted in creating unintended costs and negative impacts for payers, providers and consumers. Along with the standard transactions mentioned by HIPAA, healthcare organizations must support other standards also to be effective and efficient. Some of these are HL7, NCPDP, NSF, UB92 along with proprietary file formats whose use is made necessary by the wide variety of trading partner requirements. In order to effectively respond to the market, organization leadership must work to address the questions created by all these requirements.
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