HIPAA Contingency Basic Guidelines HIPAA Contingency plan was implemented by Medicare on October 16, 2003. HIPAA Contingency allowed providers and other electronic billers to temporarily continue to send pre-HIPAA electronic format claims, claim status requests, and beneficiary eligibility requests, and for CMS to continue temporarily sending remittance advice, claim status responses, beneficiary eligibility responses, and coordination Read More →

Professional Claim Form Basics Professional Claim Form may be electronically submitted to a Medicare carrier, Durable Medical Equipment Medicare Administrative Contractor (DMEMAC), or A/B MAC from a provider’s office using a computer with software that meets electronic filing requirements as established by the HIPAA claim standard and by meeting CMS requirements contained in the provider enrollment & certification Read More →

Institutional Paper Claim Form Guidelines Institutional Paper Claim Form (CMS-1450 form), aka UB-04 at present, can be used by an institutional provider to bill a Medicare fiscal intermediary (FI) when a provider qualifies for a waiver from the Administrative Simplification Compliance Act (ASCA) requirement for electronic submission of claims. It is also used for billing Read More →

Electronic Claims Attachments: Supplemental Medical Documents Electronic Claims Attachments are supplemental documents providing additional medical information to the claims processor that cannot be accommodated within the claim format. Common attachments are Certificates of Medical Necessity (CMNs), discharge summaries and operative reports. They are sent to the Durable Medical Equipment Medicare Administrative Contractor (DME MAC) and/or A/B MAC with Read More →

Electronic Funds Transfer Transaction Provider Requirements Electronic Funds Transfer transaction is the required method of Medicare payment for all providers entering the Medicare program for the first time and for existing providers that are submitting a change to their existing enrollment data but are not currently receiving payments via Electronic Funds Transfer transaction. Once a provider Read More →

Electronic Funds Transfer Basic Requirements Electronic Funds Transfer (EFT) serves for Medicare to send payments directly to a provider’s financial institution whether claims are filed electronically or on paper. All Medicare providers may apply for EFT. Advantages of Electronic Funds Transfer  EFT is similar to other direct deposit operations such as paycheck deposits, and it offers Read More →

Coordination of Benefits HIPAA Basics Coordination of Benefits requirements and basic procedure descriptions subject to the rules of the X12 837 HIPAA Technical Reports Type 3 (TR3s) as the national standard for provider electronic submission of health care claims to payers such as Medicare. It also contains the requirements for electronic transfer of claims from Medicare to Read More →

Health Care Payment: Electronic Remit Advice and Standard Paper Remit Health Care Payment with Electronic Remit Advice (ERA) has a number of advantages over Standard Paper Remit (SPR). The amount payable for each line and/or claim as well as each adjustment applied to a line or claim can be automatically posted to accounting or billing applications from an Read More →

Health Care Payment and Remittance Advice Health Care Payment information is reported within ERA (Electronic Remit Advice) or SPR (Standard Paper Remit). After Medicare processes a claim, either an Electronic Remit Advice or a Standard Paper Remit is sent with final claim adjudication and payment information. One Electronic Remit Advice or Standard Paper Remit usually Read More →

ASCA Waiver Application Guidelines For Providers ASCA Waiver Application guidelines describe some situations when this electronic billing requirement could be waived for some or all claims, but a provider must obtain Medicare pre-approval to submit paper claims in these situations: Any situation where a provider can demonstrate that the applicable adopted HIPAA claim standard does not Read More →