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As the October 16, 2003,
HIPAA Transaction and Code Set Compliance deadline approaches,
we want to give you an up-to-the-minute update and answer
any questions that you might have regarding OfficeMate, HIPAA, and electronic
claims.
As recently as September
23, 2003, Medicare announced a plan to accept HIPAA non-compliant
transactions after the October 16, 2003, compliance deadline. The Centers for Medicare and Medicaid Services (CMS) said, "CMS made
the decision to implement its contingency plan after reviewing
statistics showing unacceptably low numbers
of compliant claims being submitted."
Here are a few additional
facts for you to consider: Gateway EDI, the clearinghouse of
choice for OfficeMate clients, has noted that there are still many
payers unable to test HIPAA-compliant transactions even as the
October 16, 2003, deadline nears. Gateway EDI also reported that they are
currently testing three versions of the HIPAA claims transaction
with health plans in their network and only one of the
versions, the 837 4010 1A, is "HIPAA compliant."
Confusion and uncertainty
remain as this deadline approaches! What do we recommend? OfficeMate
recommends submitting your electronic
claims exactly the same way that you do right now and "letting the dust
settle" unless you are notified otherwise by the entity to whom
you are submitting claims. In addition
- If you are
using Gateway EDI, continue to
submit claims with no changes at this time. Gateway EDI will
take either the HIPAA-compliant format or the current NSF (3.01)
file produced by OfficeMate and expeditiously process your claims
for prompt payment.
- If
you are sending your current vendor a print image file from
OfficeMate, continue sending it.
- If
you are sending another clearinghouse a print image or NSF file
from OfficeMate, continue sending it.
- If you are
re-keying your data into a third party program, continue doing so until you are notified by your vendor that a change is required.
- If you are
printing HCFA-1500 forms, continue printing and submitting forms on paper
until denials begin occurring.
OfficeMate has delayed
the release of Version 4.5 pending the final outcome of the HIPAA
regulations with respect to the Transactions and Code Set Compliance. OfficeMate
does have the HIPAA-compliant ANSI 004010X098 version available
for direct submission to your carriers, assuming this one, standard
version will be acceptable to all carriers.
As always, OfficeMate
strongly advocates the clearinghouse concept to simply and easily submitting all of your third party claims. If
you use OfficeMate to create fee slips with insurance information, your claims
are ready to submit electronically. When you consider the staff
time involved to re-key data or print, fold, and stuff HCFA forms,
the clearinghouse fees are well worth the added convenience, efficiency, and fast reimbursement turnaround time.
Gateway
EDI offers a complete service to submit all printed and
electronic claims for a total monthly fee of $75.00 per provider.
All claims available for electronic submission are sent electronically
and the remaining claims are dropped onto paper. Gateway
EDI also offers a $35 minimum service charge plus 35 cents per claim.
If you submit claims
using your current methodology and the claims are rejected or
you are given a compliance warning, please contact
OfficeMate at 800.942.5353. When you call, please provide specific
information about your health plan including name, address, phone
number, and a specific contact name at the health plan.
Future updates will
be forthcoming to keep you posted on HIPAA.
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