The Health Care Financial Management Association (HCFMA) recently recognized the significant efforts and success of the RoundTable by awarding the unique group the Yerger Award for Collaboration. Health care stakeholders in Massachusetts initiated the RoundTable to encourage transparency, consistency, and efficiency in claims submission and processing, with the ultimate goal of reducing errors and cost. The group has established a culture of commitment, openness to change, and data sharing.

The RoundTable includes representatives from the MMS, the Massachusetts Hospital Association, the Massachusetts Association of Health Plans, Blue Cross Blue Shield of Massachusetts, Harvard Pilgrim Health Care, Tufts Health Plan, Fallon Community Health Plan, Health New England, and academic and private physician groups. In addition, Neighborhood Health Plan, Network Health, the Massachusetts Health Data Consortium, the Associated Industries of Massachusetts, the Massachusetts Business Roundtable, and the Massachusetts Group Insurance Commission have joined the collaboration, which has become a distinctive forum in which the health care community discusses important issues of administrative simplification.

In its first year, a subgroup of the RoundTable addressed the process of credentialing, which is critical for physicians and hospitals. The RoundTable designed uniform physician credentialing and recredentialing forms that were adopted by many insurance sponsors and providers. Additionally, the RoundTable developed a Statement of Principles focusing on application processing times, notification time periods, and review of hospital-based physician credentialing.

Ongoing RoundTable efforts include evaluating reductions in administrative referrals, addressing employee health-insurance eligibility issues, reassessing filing limits, and streamlining prior-authorization forms. At the RoundTable's September 2004 meeting, new areas of collaboration, including the rising cost of care, will be discussed.

- Dana Cooper
- Elaine Kirshenbaum

Initial and recredentialing applications are available online in pdf and downloadable versions at www.massmed.org/pages/uniform_apps.asp.

roundtable,Health Care Financial Management Association (HCFMA),health care administration