Most providers file a patient's claims as a courtesy today. Even if this is
the first time you've dealt with a payer. You just print the HCFA-1500 or
HCFA-1450 form and put it in the mail. If a new payer moves into your region,
then you may find you have enough volume to justify paying for a clearinghouse
solution or asking your vendor to supply a direct interface.
------------------( Forwarded letter 1 follows )--------------------
Date: Wed, 26 Jun 2002 22:07:13 -0400
To: WEDi/SNIP.ID.&.Routing[routing]@wedi.org.comp
From: William.J.Kammerer[wkammerer]@acm.org.comp
Sender: [EMAIL PROTECTED]
Subject: Transactions Listserve: Unsolicited 277 in response to claim submissions
Here's a new one on me: Cynthia Korman told us on the WEDI/SNIP
Transactions Listserve of NJ's HINT law. How is the payer going to know
how to get the 277U back to the provider? And what's this nonsense
about providers having to file claims on behalf of the patient? What if
this is the first time the provider has ever dealt with the patient's
insurance company? Is this another example of lawmakers writing rules
which are almost impossible to implement? Will the Healthcare CPP
Registry be of any help here?
See the Health Information Electronic Data Interchange Technology Act
("HINT") at http://www.state.nj.us/dobi/pn01_63.htm. Note especially:
The Department also notes that the Act does not require
providers to implement electronic systems for the
processing of health care transactions. The Act merely
states that 12 months after HINT becomes operative all
health care providers shall file claims on behalf of
patients unless the patient elects to personally file
the claim. It should be noted, however, that the Act
does provide incentives where providers file
electronically. For instance, electronically filed
claims must be paid in 30 days while paper claims must
be paid in 40 days. Electronically filed claims must
be acknowledged by payers within two days of receipt,
and paper claims within 15 days of receipt.
Any discussion? Yoo-hoo!! Anyone? Or is this too far off-topic from the
usual run of anti-SPAM vigilantism?
William J. Kammerer
Novannet, LLC.
Columbus, US-OH 43221-3859
+1 (614) 487-0320
----- Original Message -----
From: "Cynthia Korman" <[EMAIL PROTECTED]>
To: <[EMAIL PROTECTED]>
Sent: Wednesday, 26 June, 2002 09:27 PM
Subject: Unsolicited 277 in response to claim submissions
Joe, your mention of the idea of sending an unsolicited 277 whenever a
claim is submitted reminds me that great minds can think alike! Here in
New Jersey, where we have the HINT law, health plans will be required to
reply to claim submissions with the 277, unless a provider indicates
that they cannot receive and process this transaction. For these
providers, the health plan is required to provide a mutually-agreeable
way of acknowledging receipt on a claim-by-claim basis.
The HINT rule calls for an earlier version of the 277: X12.317 Version
003070, Release 7, sub-release O...
----- Original Message -----
From: "Barton, Joe" <[EMAIL PROTECTED]>
To: <[EMAIL PROTECTED]>
Sent: Wednesday, 26 June, 2002 07:49 PM
Subject: RE: an inquiry for a non-existing member
It may good customer relations practice to send an unsolicited 277
whenever a claim is submitted. We do not have adjudication, once we
receive a claim, and valid, it is sent off for payment. An unsolicited
277 from us would let our partners know either it passed edits, and is
off to be processed for payment (1-2 days) or if there was something
wrong with the transaction.
discussions on this listserv therefore represent the views of the individual
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http://snip.wedi.org/tracking/.
Posting of advertisements or other commercial use of this listserv is
specifically prohibited.
discussions on this listserv therefore represent the views of the individual
participants, and do not necessarily represent the views of the WEDI Board of
Directors nor WEDI SNIP. If you wish to receive an official opinion, post
your question to the WEDI SNIP Issues Database at
http://snip.wedi.org/tracking/.
Posting of advertisements or other commercial use of this listserv is
specifically prohibited.
