HIPAA Services

Back

HIPAA Transactions HealthCare


Overview

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.

Features

Our HIPAA Services Covers

  • HIPAA Risk Analysis
  • Meaningful Use
  • System Gap Analysis for HIPAA Compliance Technical, Administrative and Physical Safeguard
  • Our Advisors work with client and HIPAA Compliance Hosting Provider to choose best cost effective and trusted Hosting Partner.
  • Legacy System Integration
  • Implementing HIPAA policy and procedures at Organization Level
  • Privacy and Data Breach Notification, Remediation and Management
  • HIPAA White Papers, Business Associates, Procedure and Policy implementation
  • HIPAA regulatory compliance consulting
  • Professional EDI Billing, Claim Review and Submission
  • Institutional Billing and PMS integration with Clearinghouses
  • Claim Scrubbing & NCI Edit Rules
  • Automated ERA Processing (EDI 835) Parsing and Payment Posting
  • Plugin development and Implementation at Practice level for Real-time Eligibility Verification
  • EDI Plugin for Employee Benefit Management (EDI 834), Review EDI 834 for Completeness and identify gaps.
  • EDI Plugin development for Authorization/Referral Management (EDI 278)

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:

  1. It can post payments without any manual intervention.
  2. ERA is available for all types of benefit plans.
  3. Separate ERA files can be received for the same TIN (tax identification number) and can be grouped by billing address.
  4. Printable versions of ERAs make it easier to submit COB (coordination of benefits) claims.

 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:

  1. New enrollments
  2. Changes in a member’s enrollment
  3. Reinstatement of a member’s enrollment
  4. Disenrollment of members (i.e., termination of plan membership)

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:

  1. Advance notification – for scheduled inpatient, specialty care or other services
  2. Completion notification – for patient arrival to or discharge from a facility
  3. Information copy – for any health services review information sent to service providers
  4. Change notification – for reporting changes to previously sent information

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:

  1. By businesses to provide instructions to banks for making a payment, such as a funds transfer, to a payee
  2. By businesses directly to individual suppliers to communicate the details of a pending payment, including adjustments reflected in the payment
  3. By companies providing premium payment information to health insurance plans

Hiring Process

Post Your Requirement

Discuss Project Feasibility

Align Resource

Select Engagement Modal

Sign-off & Started

Request a Quote
Feel free to send over a request by filling out our quote form.


All fields are required*

Enter the sum of two numbers in the input field 5 + 9 =
All Rights Reserved. © 2016 DreamSoft4u Pvt. Ltd. / Sitemap