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ARE YOUR CLAIMS PAYMENTS HIPPA COMPLIANT?
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to connect to dozens of payers. Tammy Morris-Adams of the Mayo Clinic says, “We have implemented Electronic Remittance Advices (ERA) from many payers; however, we are reluctant to receive ERAs from payers who continue to use checks. It is difficult and time consuming for our remittance processing staff to identify checks and manually associate them with electronic remit advices. The manual efforts equate to longer outstanding revenue. We are also concerned by the use of non-HIPAA compliant formats and other payer errors. If the X12 syntax is incorrect or missing in the Trace Segment on the EFT, we receive an error through our internal software balancing tool, which causes further manual intervention. Ultimately, the payer community will see an increased acceptance of Electronic Remittance Advices if it improves its payment practices.”
Summary
Providers who accept electronic funds transfers in formats not in the HIPAA implementation guideline will find that they cannot automate remittance processing and are subject to greater risks of fraud and error. As providers plan for increased receipt of electronic remittance information, they should develop a plan for reassociation. Manual reassociation based on bank reports may suffice for one or two payers, but providers should consider how to cope with ERA receipts from dozens of payers. Providers should investigate what payment formats are
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supported by their payers and chose to receive ERA from a health plan supporting CCD+ and CTX. Finally, providers should talk to their bankers about reassociation solutions and the detailed reporting available for all payment formats. Mr. Moynihan can be reached at 818-231- 8332 or james.moynihan@usbank.com
Reprinted with permission: The Journal of Healthcare Administrative Management – Fall 2008
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