HETS to Fix Hospice Prior Benefit Period Identification Issue

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Over the last several months, the announcement that CMS was phasing out eligibility information currently available through Direct Data Entry (DDE) next April has driven providers to eligibility reporting solutions using the CMS HIPAA Eligibility Transaction System (HETS).

“HETS to replace Common Working File (CWF) for eligibility inquiries”

http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/downloads/SE1249.pdf

“How to Get Connected – HETS 270/271”

http://cms.gov/Research-Statistics-Data-and-Systems/CMS-Information-Technology/HETSHelp/HowtoGetConnectedHETS270271.html

The providers and vendors who were early adopters of this technology noticed differences in the data reported through these two systems.  Recently, I co-wrote an article for Health Data Management that described these systems, how they work, and the differences between them.  It is available on our blog or through this link:

“A Primer on the HIPAA Eligibility Transaction System”

http://info.medtrandirect.com/blog/bid/182677/A-Primer-on-the-HIPAA-Eligibility-Transaction-System Continue reading

Obamacare and HIPAA Transactions

 

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 HIPAA legislation introduced the current standards for certain electronic transactions now familiar in the healthcare industry.  These included the healthcare claim (837i and 837p), ERA (835), claim status transaction (276/277) and health plan eligibility (270/271).  These standards were finalized in 2000 and finally enforced by CMS in 2003 (837 and 835).  The intent of this legislation was to improve the efficiency of transaction processing in the healthcare industry by mandating a specific standard whenever these transactions were used.  However, there was one gaping loophole in the legislation that prevented the industry from receiving the full benefit of these standards.  Although HIPAA covered entities, providers and payers, had to use these formats when conducting electronic transactions, they could avoid HIPAA implementation and the associated cost by simply conducting these transactions on paper.  Continue reading

277 vs 277CA

277CA -The Claims Acknowledgement (277-CA) in 5010 replaced proprietary error /pre-pass report in 4010A1. This report is generated after your 837 (I or P) claim file has been received and has also received the TA1 Interchange Acknowledgement and then the 999 Functional Acknowledgement. The 277CA acknowledges all accepted or rejected claims in the 837 file. After your claims in the 837 file are accepted at the 277CA level, they forwarded to the Payers adjudication system where policy edits are applied and then payment or denial is determined and returned to the payer via 835 or paper remittance advice. Continue reading