HIPAA Electronic Health Transactions Standards
One of the most daunting tasks for HIPAA Compliance involves Electronic Health Transaction Standardization (sometimes referred to as EDI). While the Healthcare industry has struggled with the idea of standardization, there are still over 400 “standards” being used. HIPAA changes that drastically by making one standard. Standard Transactions and Code Sets will be very precise and NOT optional. It is expected to provide a substantial cost savings in processing claims. Some estimates cite a 25% saving of healthcare costs!
What will be changed?
The following Transactions under HIPAA Standards:
- Health Care Eligibility Inquiry and Response (Fast Response Transactions 270 & 271)
- Health Care Patient Information-Attachment (Standard Transaction 275)
- Health Care Claim Status Inquiry (Fast Response Transactions 276 & 277)
- Health Care Patient Information Request (Standard Transaction 277)
- Health Care Services Review (Fast Response Transaction 278)
- Premium Payment (Standard Transaction 820)
- Health Care Enrollment (Standard Transaction 834)
- Health Care Claim Payment & Remittance Advice (Standard Transaction 835)
- Coordination of Benefits (Standard Transaction 837)
- Health Care Claim (Standard Transaction 837 & NCPDP Standard)
- First Report of Injury
The following Standard Identifiers will eliminate the labor in processing claims and improve the ability to monitor for fraud and abuse. Currently, each entity can have many, many identifiers even though it is the same entity:
- Employer: The federal Employer Identification Number (EIN) - final approved identifier
- Provider: A new 8-digit number - proposed but not yet final
- Plan: A new number - not yet proposed
Contact G&G Technologies, Inc. for assistance with your HIPAA EDI Compliance. Our specialists can help you by providing code translators, project management, testing and validation. Remember that, even if you filed for an extension, you must be in the testing phase by April 2003.
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