News about HIPAA-compliant Electronic Claims
| Bulletin (Mar 3, 2004)
EDIFECS certification was passed on February 20, 2004.
|
||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
|
Testing Status (June 14, 2006) HIPAA requires all covered entities who transmit claims (and other information) electronically to conform to a particular standard, called ANSI 837 4010A. Unfortunately the standard is not standard--every payer can make up his own "business rules". The rules are supposed to be negotiated with the submitters, but you just try negotiating with Medicare. Claims may be submitted directly to the payer or through a clearinghouse. Most commercial insurance companies require submission through a clearinghouse, but Medicare, Medicaid, and the Blues can be submitted directly, saving clearinghouse fees. To submit claims directly, they must be tested separately with each and every payer. Medicare and Medicaid in particular have different processes in every state or region. This seems to be largely true of Blue Cross and Blue Shield, too. This page will contain news about this process as we learn it, and about our progress.. |
|
|||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
|
|
