EDI

Will it be mandatory for a dental practice to file all insurance claims electronically in October of 2003?  This is for a solo practice who are now doing paper claims.
The answer to your question is qualified.  If you are currently using all paper and NOT filing with Medicare or Medicaid, you are not required to submit electronically.  However, Medicare and Medicaid will NOT allow paper claims as of October 2003.  If you file with Medicare or Medicaid, you will need to file electronically to have your claim processed. (Posted 5/15/03)

I have an electronic billing service for a physician. I have checked with my Clearinghouse. They have told me they are HIPAA compliant. Do I need to do anything else?
I would be cautious. Ask the billing service to provide details of their implementation plan with payers. Ask them for payers that they've tested with. Many billing services that we've seen are not giving the full picture to their clients. Most billing services, however, are on target. I would try to get some assurance in your case. (Posted 5/15/03)

We currently provide our providers the capability of requesting eligibility for certain procedures which only limitation is the maximum amount allowed under the patient's cover. Once we receive the eligibility transaction (still in local format), we reserve that service for the provider and patient requested. If the patient does not receive the service, the provider sends an eligibility annulment transaction which must include the reference number our system sent him in the original eligibility response. We are not sure if we can do this same process using the 270/271 transactions because:

1) We have not find a field where our system reference number can be included in the 271;

2) We have not find a field where our providers can send us back that reference number in the 270 when trying to cancel the previous 270;

3) When receiving the 270 to cancel the original eligibility request, how does the 271 should look like? There are no specifications in the 271 Implementation Guide on how to handle the cancellation request.

What do you suggest?
In reference to your inquiry about the 270/271 for use with cancellations, the HIPAA version of this transaction cannot be used for that business case. That is a non-supported business case for this version of the transaction. Also, in trying to use a standard field in a non-standard case, unfortunately, you are violating the intent of the law.

There are some draft standards being drawn up by WPC, that cover other business usages and you may be able to find a MSG (or other message segments) which could be used to pass reference numbers.

Please look on the WPC-EDI website, for the guides on the 270/271: Unsolicited Health Care Eligibility /Benefit Roster. (Posted 5/15/03)