Month: March 2015

Stagnation in HIPAA Adoption Rates

Kalon Mitchell PayerLink, Remittances ,

A few weeks ago I wrote a short blog about the recently released statistics on the adoption rate of HIPAA transactions compiled by CAQH for the calendar year of 2013. This report is called the 2014 CAQH index and is available through the CAQH web site (http://www.caqh.org/) or directly through this link:

http://www.caqh.org/pdf/2014Index.pdf

This study is actually the second year in a row where they collected this data so in addition to providing adoption rates for 2013, the data for 2012 is available as well along with a measurement of change in the adoption rate of these transactions over a year.

Here are the adoption rates for the two years for the three most common standardized healthcare electronic transactions:

Claim Submission 2012 90.2% 2013 91.8% Change +1.46%
Eligibility 2012 64.7% 2013 65.3% Change +0.6%
Remittance Advice 2013 42.7% 2013 46.4% Change +3.7%

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Medicare Eligibility through HETS and the Hospice Notice of Election (NOE)

Kalon Mitchell Electronic Billing, PayerLink ,

Medicare maintains a computer system dedicated to the processing of eligibility requests through the HIPAA ANSI 270/271 transactions designed for this purpose. The system is called HETS which stands for HIPAA Eligibility Transaction System. You can obtain more information about this system from their site:
http://cms.gov/Research-Statistics-Data-and-Systems/CMS-Information-Technology/HETSHelp/HowtoGetConnectedHETS270271.html

This system is updated daily with information from the Common Working File (CWF) and other CMS systems to include current eligibility data and billing history for all current Medicare patients. This system is supported by the MCARE help desk. As one of the National Service Vendors for this system, we work closely with this organization to monitor reported issues and suggest enhancements. So far, they have done a very good job in dealing with the issues reported and correcting them.

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