HIPAA Transactions HealthCare
As you know that HIPAA transactions play an important role in Healthcare industry. DreamSoft4u HIPAA Service offers innovative electronic information services for the healthcare industry. We serve clients across the country with the most progressive technology solutions in the healthcare industry, which includes our full service healthcare Electronic Data Interchange (EDI) Clearinghouse and Payer. DreamSoft4u is dedicated to creating and implementing the latest technologies to ensure we exceed expectations when met with the many challenges associated with healthcare information systems. Our HIPAA and EDI Consulting Services are designed to make sure the flawless integration and the transactions are compliance with Payer Implementing Guidelines to reduce the rejection and increase acceptance. Our HIPAA experts and healthcare domain experts will make sure that you are 100% compliant with all the rules and regulations enforced by HIPAA. Most of our HIPAA-HITECH consulting services are focused around HIPAA Security (Physical, Administrative and Technical Safeguards), HIPAA Privacy, HIPAA Transactions and the Omnibus Rule.
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Overview of HIPAA Transactions and their Implementation:
Professional billing (EDI 837p)
Electronic Mode (837P) à Professional billing is responsible for the billing of claims generated for work performed by physicians, suppliers, and other non-institutional providers for both outpatient and inpatient services.
Paper Mode (CMS- 1500)à The CMS-1500 is the red-ink-on-white-paper standard claim form used by physicians and suppliers for claim billing.
Institutional billing (EDI 837i)
Electronic Mode (837I) à Institutional billing is responsible for the billing of claims generated for work performed by hospitals, skilled nursing facilities, and other institutions for outpatient and inpatient services, including the use of equipment and supplies, laboratory services, radiology services, and other charges.
Paper Mode (UB-04)à The UB-04 is the red ink on white paper standard claim form used by institutional providers for claim billing.
Electronic Remittance Advice (EDI 835)
It is a form of electronic communication which is HIPAA-compliant and contains claims payment information. With the help of ERAs, you can replace the paper-based Explanation of Benefits (EOB) statement. Some other benefits of ERA in payment posting include:
Insurance Eligibility Verification (EDI 270/271)
We also include Insurance Eligibility Verification it is the most important is the most important and the first step in the medical billing process. Research confirms that most of the claims are denied or delayed due to inadequate or incorrect coverage information provided by the patients during visits and current coverage information not updated by the office / hospital staff. And this type of ignorance or improper insurance eligibility verification directly impacts the reimbursements.
Acknowledgement and Response (EDI TA1/999/277 CA)
All types of responses and acknowledgements are handled and implemented here including TA1 file followed by 999 and 277 respectively for proper response management. For handling all these responses there are different – different mechanisms and modules are implemented.
Employee Benefit Enrollment (EDI 834)
The EDI 834 transaction set represents a Benefit Enrollment and Maintenance document. It is used by employers, as well as unions, government agencies or insurance agencies, to enroll members in a healthcare benefit plan. The 834 has been specified by HIPAA 5010 standards for the electronic exchange of member enrollment information, including benefits, plan subscription and employee demographic information. The 834 transaction may be used for any of the following functions relative to health plans:
Claim Status Enquiry and Response (EDI 276/277)
Health Care Claim Status Request and Response Transaction Set for use within the context of the Electronic Data Interchange (EDI) environment. The 276 Health Care Claim Status Request was created as an EDI request from the Trading Partner to a Payer for a status on their Claims. The 277 Health Care Claim Status Responses is the response to a 276 request for claim status. These are paired transactions and the 276 must precede the 277.
Authorization/Referral (EDI 278)
The EDI 278 transaction set is called Health Care Services Review Information. A healthcare provider, such as a hospital, will send a 278 transaction to request an authorization from a payer, such as an insurance company. The hospital is asking the insurance company to review proposed healthcare services to be provided to a given patient, in order to obtain an authorization for these services. The 278 transaction can be used to submit information in the following categories:
Premium Payment (820)
The X12 820 transaction set provides the EDI format for transmitting information relating to payments. It is typically used in conjunction with an electronic transfer of funds for payment of goods, insurance premiums or other transactions. The actual funds transfer is often coordinated through the Automated Clearinghouse (ACH) system, and an 820 may be effectively wrapped in an ACH banking transaction. The 820 transaction is used in a number of situations:
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