Instructions for Completing the Initial System Assessment for Upcoming HIPAA Changes Due Date: (specify date)
|
|
|
- Osborn Allen Andrews
- 8 years ago
- Views:
Transcription
1 for Completing the Initial System Assessment for Upcoming HIPAA Changes Due Date: (specify date) Some major changes to the HIPAA federally mandated regulations are forthcoming. Therefore, it is essential for this local agency to update information about locally operated information systems. The Division of Public Health has conducted a similar assessment of state-operated systems (e.g., HIS, Immunization Registry) and will be responsible for implementing any changes to those systems. Once the local agency systems with potential HIPAA impacts are identified, a more in depth assessment will be conducted for those systems. In addition to system changes, the new HIPAA regulations will also require business process changes. A separate assessment will be conducted to identify those potential impacts within this agency at a later time. The HIPAA changes to be assessed are as follows: Transition from ICD-9-CM to ICD-10-CM on October 1, 2014: ICD-10-CM diagnosis codes must be used on all HIPAA transactions, including outpatient claims with dates of service on and after October 1, Otherwise, claims and other transactions may be rejected resulting in delays and reimbursement impacts. This change does not affect CPT or HCPCS coding for outpatient procedures. Transition from Version 4010 to Version 5010 Electronic Health Care Transactions on January 1, 2012: On January 1, 2012, standards for electronic health care transactions change from Version 4010/4010A1 to Version These electronic health care transactions include functions like claims, eligibility inquiries, and remittance advices. Unlike the current Version 4010/4010A1, Version 5010 accommodates the ICD-10-CM codes, and must be in place first before the changeover to ICD-10-CM. The Version 5010 change occurs well before the ICD-10- CM implementation date to allow adequate Version 5010 testing and implementation time. If providers do not conduct electronic health transactions using Version 5010 as of January 1, 2012, delays in claim reimbursement may result. Initial System Assessment for Upcoming HIPAA Changes: Every effort has been made to try and identify all systems owned and operated by this local agency and the department and/or contact responsible for the system. If you have received this assessment form in error, please contact immediately. For any pre-filled information on the assessment form prior to the Questions and Responses section, the responsible person within the department will need to update any of the pre-filled information that is inaccurate and any incomplete information. Then they will need to answer the questions on the assessment form. Send your completed system assessment to (insert name and contact information) by (insert due date). If you have any questions related to the system assessment, or call (insert name).
2 for Completing the Initial System Assessment for Upcoming HIPAA Changes For each assessment form, complete information in the columns as follows: NOTE: To respond to the Yes and No questions, click on the appropriate Yes or No box. 1. Is this system still in use? 2. If Question 2 is no, was the system replaced? 3. Does this system generate ICD-9-CM (Volumes 1 & 2) diagnosis codes and/or descriptions? 4. Does this system generate ICD-9-CM (Volume 3) procedure codes and/or descriptions? 5. Does this system generate dental procedure codes and/or descriptions (CDT)? If any local agency staff are using the system, answer yes. If there are plans to retire or replace the system, please explain in the Responses section including the timeline for replacement. If the answer is yes, go to Question 3. If the answer is no, go to Question 2. If yes, specify the system name and contact person for the replacement system. If you are the contact person for the replacement system, save the assessment form as a second file, then complete the assessment for the replacement system. If no, the remainder of the questionnaire does not need to be completed. Return the completed form to (insert name and contact information) ICD-9-CM (Volumes 1 & 2) is the current, federally mandated diagnostic coding system that includes codes and descriptions. Answer yes if the system contains any diagnostic information. ICD-9-CM (Volume 3) is the current, federally mandated procedure coding system for inpatient procedures that includes codes and descriptions. It is doubtful that any DPH systems use Volume 3 but verification is requested. Answer yes if the system contains ICD-9- CM procedure information. Answer no if the system does not contain any ICD-9-CM procedure information or contains CPT/HCPCS procedure codes and/or descriptions only. The HIPAA mandates code set for dental procedures is the Code on Dental Procedures and Nomenclature (CDT). Answer yes if the system contains CDT procedure information. Answer no if the system does not contain any CDT procedure information. -2-
3 for Completing the Initial System Assessment for Upcoming HIPAA Changes 6. Does this system generate pharmacy codes (e.g., NDC)? 7. Does this system generate pharmacy codes or prescription information that may be sent electronically to a Pharmacy? (e.g., NCPDP)? 8. Does this system generate Provider Identifiers (NPI) and/or Provider Addresses? Does this system generate any of the following by: electronic, telephone, fax, , paper, etc. COB (837) The Drug Listing Act of 1972 requires registered drug establishments to provide the Food and Drug Administration (FDA) with a current list of all drugs manufactured, prepared, propagated, compounded, or processed by it for commercial distribution. (See Section 510 of the Federal Food, Drug, and Cosmetic Act (Act) (21 U.S.C. 360)). Drug products are identified and reported using a unique, three-segment number, called the National Drug Code (NDC), which serves as a universal product identifier for human drugs. Answer yes if the system contains Pharmacy (NDC) codes. Answer no if the system does not contain any pharmacy codes. The National Council for Prescription Drug Program (NCPDP) creates and promotes data interchange standards for the pharmacy services sector of the healthcare industry. The Telecommunication Standard Implementation Guide Version D.0 is the next HIPAA-named version for pharmacy claims, effective Answer yes if the system contains Pharmacy or prescription information. Answer no if the system does not contain any pharmacy or prescription information. The Administrative Simplification provisions of HIPAA mandated the adoption of a standard unique identifier for health care providers. The National Plan and Provider Enumeration System (NPPES) collects identifying information on health care providers and assigns each a unique National Provider Identifier (NPI). One of the changes that will occur with the implementation of 5010 is Provider Zip Code must be the complete Zip Code (i.e., ). Answer yes if the system contains Provider Identifiers and/or addresses. Answer no if the system does not contain Provider Identifiers and/or addresses. Coordination of Benefits (Dental, Professional, and/or Institutional) ANSI ASC X12N 837 Answer no if the system does not store, process or generate the standard Coordination of Benefits (Dental, Professional, and/or Institutional) ANSI ASC X12N
4 for Completing the Initial System Assessment for Upcoming HIPAA Changes Claims & Encounters (837) Remittance Advice Payment (835) Enrollment & Disenrollment (834) Premium Payment (820) Eligibility Request (270) Eligibility Response (271) Referral & Authorization (278) Claim Status Request (276) Health Care Claims or Equivalent Encounter Information (Dental, Professional, and/or Institutional) ANSI ASC X12N 837 standard Health Care Claims or Equivalent Encounter Information (Dental, Professional, and/or Institutional) ANSI ASC X12N 837 Health Care Payment and Remittance Advice ANSI ASC X12N 835 Answer no if the system does not store, process or generate the standard Health Care Payment and Remittance Advice ANSI ASC X12N 835 Enrollment and Dis-enrollment in a Health Plan ANSI ASC X12N 834 Answer no if the system does not store, process or generate the standard Enrollment and Dis-enrollment in a Health Plan ANSI ASC X12N 834 Health Plan Premium Payment ANSI ASC X12N 820 standard Health Plan Premium Payment ANSI ASC X12N 820 Eligibility for a Health Plan ANSI ASC X12N 270 standard Eligibility for a Health Plan ANSI ASC X12N 270 Eligibility for a Health Plan ANSI ASC X12N 271 standard Eligibility for a Health Plan ANSI ASC X12N 271 Referral Certification and Authorization ANSI ASC X12N 278 Answer no if the system does not store, process or generate the standard Referral Certification and Authorization ANSI ASC X12N 278 Health Care Claim Status ANSI ASC X12N 276 Answer no if the system does not store, process or generate the standard Health Care Claim Status ANSI ASC X12N
5 for Completing the Initial System Assessment for Upcoming HIPAA Changes Claim Status Response (277) Is additional information or assistance needed to determine impact? Health Care Claim Status ANSI ASC X12N 277 Answer no if the system does not store, process or generate the standard Health Care Claim Status ANSI ASC X12N 277 Please indicate if additional information or assistance is needed to complete this initial assessment. -5-
HIPAA: AN OVERVIEW September 2013
HIPAA: AN OVERVIEW September 2013 Introduction The Health Insurance Portability and Accountability Act of 1996, known as HIPAA, was enacted on August 21, 1996. The overall goal was to simplify and streamline
HIPAA Administrative Simplification and Privacy (AS&P) Frequently Asked Questions
HIPAA Administrative Simplification and Privacy (AS&P) Frequently Asked Questions ELECTRONIC TRANSACTIONS AND CODE SETS The following frequently asked questions and answers were developed to communicate
HIPAA Frequently Asked Questions Free & Charitable Clinic HIPAA Toolbox May 2014
HIPAA Frequently Asked Questions Free & Charitable Clinic HIPAA Toolbox May 2014 Following is a list of FAQs answered by Ropes & Gray, a law firm focusing on health care practices, on behalf of AmeriCares
Title 40. Labor and Employment. Part 1. Workers' Compensation Administration
Title 40 Labor and Employment Part 1. Workers' Compensation Administration Chapter 3. Electronic Billing 301. Purpose The purpose of this Rule is to provide a legal framework for electronic billing, processing,
SUBCHAPTER 10F ELECTRONIC BILLING RULES SECTION.0100 ADMINISTRATION
SUBCHAPTER 10F ELECTRONIC BILLING RULES SECTION.0100 ADMINISTRATION 04 NCAC 10F.0101 ELECTRONIC MEDICAL BILLING AND PAYMENT REQUIREMENT Carriers and licensed health care providers shall utilize electronic
INTERMEDIATE ADMINISTRATIVE SIMPLIFICATION CENTERS FOR MEDICARE & MEDICAID SERVICES. Online Guide to: ADMINISTRATIVE SIMPLIFICATION
02 INTERMEDIATE» Online Guide to: CENTERS FOR MEDICARE & MEDICAID SERVICES Last Updated: February 2014 TABLE OF CONTENTS INTRODUCTION: ABOUT THIS GUIDE... i About Administrative Simplification... 2 Why
HIPAA Compliance. Saeed Rajput
HIPAA Compliance 1 What is HIPAA 26 cents of each health care dollar is spent on administrative overhead Health Insurance Portability & Account- ability Act - 1996 Public Law 104-191 191 To reform the
HIPAA Transactions and Code Set Standards As of January 2012. Frequently Asked Questions
HIPAA Transactions and Code Set Standards As of January 2012 Frequently Asked Questions Version 20 Rev 11222011 Frequently Asked Questions: HIPAA Transactions and Code Set Standards One of the most prominent
MEDICAL CLAIMS AND ENCOUNTER PROCESSING
MEDICAL CLAIMS AND ENCOUNTER PROCESSING February, 2014 John Williford Senior Director Health Plan Operations 2 Medical Claims and Encounter Processing Medical claims and encounter processing is part of
REVISION, PROCEDURE CODING SYSTEM (ICD-10-PCS) VERSION 2.Ø
NCPDP IMPLEMENTATION TIMELINES AND RECOMMENDATIONS FOR INTERNATIONAL CLASSIFICATION OF DISEASES, 10TH REVISION, CLINICAL MODIFICATION (ICD-10- CM) AND THE INTERNATIONAL CLASSIFICATION OF DISEASES, 10TH
HIPAA. Health Insurance Portability & Accountability Act Administrative Simplification FIVE THINGS YOU SHOULD KNOW ABOUT PAYMENTS AND HIPAA
HIPAA Health Insurance Portability & Accountability Act Administrative Simplification FIVE THINGS YOU SHOULD KNOW ABOUT PAYMENTS AND HIPAA Steve Stone PNC Bank, N.A. October 14, 2009 Five Things You Should
HIPAA Glossary of Terms
ANSI - American National Standards Institute (ANSI): An organization that accredits various standards-setting committees, and monitors their compliance with the open rule-making process that they must
REVISION, PROCEDURE CODING SYSTEM (ICD-10-PCS) VERSION 2.2
NCPDP IMPLEMENTATION TIMELINES AND RECOMMENDATIONS FOR INTERNATIONAL CLASSIFICATION OF DISEASES, 10TH REVISION, CLINICAL MODIFICATION (ICD-10- CM) AND THE INTERNATIONAL CLASSIFICATION OF DISEASES, 10TH
Key Highlights of the Final Rule
Analysis of the Final Rule, January 16, 2009, Health Insurance Reform; Modifications to the Health Insurance Portability and Accountability Act (HIPAA) Electronic Transaction Standards On Friday, January
DRAFT. HIPAA Impact Determination Questionnaire (Gap Analysis)
DRAFT HIPAA Impact Determination Questionnaire (Gap Analysis) INSTRUCTIONS The Impact Determination Questionnaire (IDQ) must be completed to identify all areas that must be addressed in order to meet
ICD-10 Preparation for Dental Providers. July 2014
ICD-10 Preparation for Dental Providers July 2014 What is ICD-10? The International Classification of Diseases (ICD) is a set of codes used worldwide to classify medical diagnoses and inpatient procedures.
4 NCAC 10F.0101 is proposed for amendment as follows: SUBCHAPTER 10F REVISED WORKERS COMPENSATION MEDICAL FEE SCHEDULE ELECTRONIC BILLING RULES
1 1 1 1 1 1 NCAC F.01 is proposed for amendment as follows: SUBCHAPTER F REVISED WORKERS COMPENSATION MEDICAL FEE SCHEDULE ELECTRONIC BILLING RULES SECTION.00 RULES ADMINISTRATION NCAC F.01 ELECTRONIC
3 Learning Objectives (cont d.)
1 2 Learning Objectives Summarize advantages of electronic claim submission. Identify the transactions and code sets to use for insurance claims transmission. State which insurance claim data elements
CLAIMS Section 5. Overview. Clean Claim. Prompt Payment. Timely Claims Submission. Claim Submission Format
Overview The Claims department partners with the Provider Relations, Health Services and Customer Service departments to assist providers with any claims-related questions. The focus of the Claims department
ICD-10-CM Training Module for Dental Practitioners. Presented by Workgroup for Electronic Data Interchange
ICD-10-CM Training Module for Dental Practitioners Presented by Workgroup for Electronic Data Interchange Disclaimer This presentation is for discussion and educational purposes only and is not intended
Understanding the HIPAA standard transactions: The HIPAA Transactions and Code Set rule
Understanding the HIPAA standard transactions: The HIPAA Transactions and Code Set rule Many physician practices recognize the Health Information Portability and Accountability Act (HIPAA) as both a patient
Glossary of Terms. Account Number/Client Code. Adjudication ANSI. Assignment of Benefits
Account Number/Client Code Adjudication ANSI Assignment of Benefits Billing Provider/Pay-to-Provider Billing Service Business Associate Agreement Clean Claim Clearinghouse CLIA Number (Clinical Laboratory
HealthStream Regulatory Script
HealthStream Regulatory Script HIPAA Release Date: August 2009 HLC Version: 602 Lesson 1: Introduction Lesson 2: HIPAA Overview Lesson 3: Transactions & Code Sets Lesson 4: Security Lesson 5: Unique Identifiers
The Transition to Version 5010 and ICD-10
The Transition to Version 5010 and ICD-10 An Overview Denise M. Buenning, MsM Director, Administrative Simplification Group Office of E-Health Standards and Services Centers for Medicare & Medicaid Services
Molina Healthcare Post ICD 10 FAQ
Molina Healthcare Post ICD 10 FAQ On March 31, 2014, the Senate voted to approve a bill to delay the implementation of ICD-10-CM/ PCS by at least one year. President Obama signed the bill into law on April
ICD-10 Overview. The U.S. Department of Health and Human Services implementation deadline for compliance with ICD-10, Mandate is October 1, 2014.
ICD-10 Overview ICD-10 is the 10th revision of the International Statistical Classification of Diseases and Related Health Problems (ICD), a medical classification list by the World Health Organization
HIPAA Certification Requirements and E-Commerce Requirements
HIPAA as Strategy Optimizing Financials via Standardized e-commerce Miriam J. Paramore President & CEO PCI: e-commerce for healthcare President, HIPAA Action Work Group of Kentucky (HAWK) www.hawkonline.org
Chapter 5. Billing on the CMS 1500 Claim Form
Chapter 5 Billing on the CMS 1500 Claim Form This Page Intentionally Left Blank Fee-For-Service Provider Manual April 2012 Billing on the UB-04 Claim Form Chapter: 5 Page: 5-2 INTRODUCTION The CMS 1500
ICD-10 Action Plan: Your 12-Step Transition Plan for ICD-10. Written by the AMA CPT Medical Informatics Department
ICD-10 Action Plan: Your 12-Step Transition Plan for ICD-10 Written by the AMA CPT Medical Informatics Department P R A C T I C E T O O L S E P T E M B E R 2 0 1 2 This resource is for educational purposes
Billing and Claim Billing and Claim Submission Boot Camp Submission Boot Camp Beverly Remm Beverly Remm
Billing and Claim Submission Boot Camp Presented by: Beverly Remm Orion Healthcare Technology Billing and Claim Submission Boot Camp Presented by: Beverly Remm Orion Healthcare Technology The presentation
EDI Solutions Your guide to getting started -- and ensuring smooth transactions bcbsga.com/edi
EDI Solutions Your guide to getting started -- and ensuring smooth transactions 00175GAPENBGA Rev. 12/11 This brochure is a helpful EDI reference for both new and experienced electronic submitters. It
EDI Solutions Your guide to getting started -- and ensuring smooth transactions empireblue.com/edi
EDI Solutions Your guide to getting started -- and ensuring smooth transactions empireblue.com/edi 00175NYPEN Rev. 12/11 This brochure is a helpful EDI reference for both new and experienced electronic
To submit electronic claims, use the HIPAA 837 Institutional transaction
3.1 Claim Billing 3.1.1 Which Claim Form to Use Claims that do not require attachments may be billed electronically using Provider Electronic Solutions (PES) software (provided by Electronic Data Systems
Chapter 8 Billing on the CMS 1500 Claim Form
8 Billing on the CMS 1500 Claim form INTRODUCTION The CMS 1500 claim form is used to bill for non-facility services, including professional services, freestanding surgery centers, transportation, durable
Transition to ICD-10: Frequently Asked Questions
This reference document was developed to answer provider questions about the mandated transition to the ICD-10 code sets. It will be updated as additional information becomes available. We encourage you
Health Insurance Portability and Accountability Act (HIPAA)
Health Insurance Portability and Accountability Act (HIPAA) General Education Presented by: Bureau of Personnel Department of Health Department of Human Services Department of Social Services Bureau of
SECTION 4. A. Balance Billing Policies. B. Claim Form
SECTION 4 Participating Physicians, hospitals and ancillary providers shall be entitled to payment for covered services that are provided to a DMC Care member. Payment is made at the established and prevailing
CODING. Neighborhood Health Plan 1 Provider Payment Guidelines
CODING Policy The terms of this policy set forth the guidelines for reporting the provision of care rendered by NHP participating providers, including but not limited to use of standard diagnosis and procedure
August 2014. SutterSelect Administrative Manual
August 2014 SutterSelect Administrative Manual Introduction This SutterSelect Administrative Manual has been prepared as a resource for providers who are caring for members of SutterSelect health plans.
General HIPAA Implementation FAQ
General HIPAA Implementation FAQ What is HIPAA? Signed into law in August 1996, the Health Insurance Portability and Accountability Act ( HIPAA ) was created to provide better access to health insurance,
HIPAA Certification: HIPAA X12 transaction testing and certification
HIPAA Certification: HIPAA X12 transaction testing and certification Third National HIPAA Summit Washington, D.C., October 25, 2001 Kepa Zubeldia, M.D. Topics HIPAA compliance testing Transaction testing
Revenue Cycle Responsibilities. Revenue Cycle. Objectives 4/9/2013
Revenue Cycle Kathryn DeVault, RHIA, CCS, CCS-P AHIMA 2013 Objectives Identify responsibilities within the Revenue Cycle Focus on management of the revenue cycle process Discuss the revenue cycle process
Behavioral Health Services. Provider Manual
Behavioral Health Provider Manual Provider Behavioral Health 1 May 1, 2014 TABLE OF CONTENTS Chapter I. General Program Policies Chapter II. Member Eligibility Chapter IV. Billing Iowa Medicaid Appendix
New ACA Mandate: HIPAA Health Plan Certification Proposed Rules. Christy Tinnes Groom Law Group February 21, 2014
New ACA Mandate: HIPAA Health Plan Certification Proposed Rules Christy Tinnes Groom Law Group February 21, 2014 HIPAA Transaction Rules Background Issued in 2000 and updated since that time Apply to HIPAA
Anthem Workers Compensation
Anthem Workers Compensation ICD-10 Frequently Asked Questions What is ICD-10? International Classification of Diseases, 10th Revision (ICD-10) is a diagnostic and procedure coding system endorsed by the
The following online training module will provide a general overview of the Vanderbilt University Medical Center s (VUMC) technical revenue cycle.
The following online training module will provide a general overview of the Vanderbilt University Medical Center s (VUMC) technical revenue cycle. This Revenue Cycle Overview training will establish a
WEEK CHAPTER OBJECTIVES ASSIGNMENTS & TESTS 19-20 6A medical necessity as it ICD-9-CM Coding. relates to reporting diagnosis codes on claims.
HEALTH INSURANCE & CODING Textbook: Understanding Health Insurance: A Guide to Billing and Reimbursement 11 th edition Website Activities: StudyWARE Online Practice Software linked to the book. SimClam:
HIPAA. Transactions and Code Sets Toolkit. Health Insurance Portability and Accountability Act
Health Insurance Portability and Accountability Act HIPAA HIPAA Transactions and Code Sets Toolkit for Physicians and Other Providers of Professional Healthcare Services Copyright 2003, Margaret\A Consulting,
Section 9. Claims Claim Submission Molina Healthcare PO Box 22815 Long Beach, CA 90801
Section 9. Claims As a contracted provider, it is important to understand how the claims process works to avoid delays in processing your claims. The following items are covered in this section for your
This information is current as of the training dates.
Welcome to this training on Billing Basics for Washington State Local Health Jurisdictions. This training will help you understand basic principles and processes needed for billing private insurance. This
Premera Blue Cross Medicare Advantage Provider Reference Manual
Premera Blue Cross Medicare Advantage Provider Reference Manual Introduction to Premera Blue Cross Medicare Advantage Plans Premera Blue Cross offers Medicare Advantage (MA) plans in King, Pierce, Snohomish,
Recommendations from Past Reports: E Prescribing Standards
Recommendations from Past Reports: Recommendation Report Implemented? HHS should ensure that e prescribing standards are not only appropriate for Medicare Part D but also for all types of prescribers,
Compliance Alert. New requirement for health plans: HIPAA Health Plan Identifier (HPID) August 29, 2014
Compliance Alert New requirement for health plans: HIPAA Health Plan Identifier (HPID) August 29, 2014 Quick Facts: Health plans need to obtain a unique health plan identifier number (HPID). For insured
ARIZONA FOUNDATION FOR MEDICAL CARE ANSI X12 837 V.5010 COMPANION GUIDE. 1 Arizona Foundation for Medical Care
ARIZONA FOUNDATION FOR MEDICAL CARE ANSI X12 837 V.5010 COMPANION GUIDE 1 Arizona Foundation for Medical Care TABLE OF CONTENTS EDI Communication...3 Getting Started...3 Testing...4 Communications...4
California Division of Workers Compensation Medical Billing and Payment Guide. Version 1.2.1
California Division of Workers Compensation Medical Billing and Payment Guide Version 1.2.1 Table of Contents Introduction -----------------------------------------------------------------------------------------------------------------iii
Transitioning to EDI HIPAA 5010 and ICD-10
Transitioning to EDI HIPAA 5010 and ICD-10 Challenges & Opportunities October 17, 2010 Outline I. HIPAA 5010 EDI Changes HIPAA 5010 Overview Transactions Affected CORE Certification II. III. IV. ICD-10
EDI Solutions Your guide to getting started -- and ensuring smooth transactions anthem.com/edi
EDI Solutions Your guide to getting started -- and ensuring smooth transactions anthem.com/edi 00175CEPEN (04/12) This brochure is a helpful EDI reference for both new and experienced electronic submitters.
HIPAA 5010 Issues & Challenges: 837 Claims
HIPAA 5010 Issues & Challenges: 837 Claims Physicians Hospitals Dentists Payers Last update: March 22, 2012 Table of Contents Physicians... 4 Billing Provider Address... 4 Pay-to Provider Name Information...
April 10, 2008 Montana Healthcare Programs Update
April 10, 2008 Montana Healthcare Programs Update THE FOLLOWING INFORMATION UPDATES AND REPLACES THE PROVIDER NOTICE DATED MARCH 10, 2008. NEW OR REVISED INFORMATION IS MARKED WITH A CHANGE BAR IN THE
A. CPT Coding System B. CPT Categories, Subcategories, and Headings
OST 148 MEDICAL CODING, BILLING AND INSURANCE COURSE DESCRIPTION: Prerequisites: None Corequisites: None This course introduces CPT and ICD coding as they apply to medical insurance and billing. Emphasis
CoreSource, Inc. HIPAA Transaction Electronic Data Interchange (EDI) Implementation Guide. For Health Care Providers
CoreSource, Inc. HIPAA Transaction Electronic Data Interchange (EDI) Implementation Guide For Health Care Providers Version Number: 1.1 Issued: March 26, 2008 HIPAA Transaction Electronic Data Interchange
California Division of Workers Compensation Medical Billing and Payment Guide 2011 Version 1.1 1.2
California Division of Workers Compensation Medical Billing and Payment Guide 2011 Version 1.1 1.2 Table of Contents Introduction ------------------------------------------------------------------------------------------------------------------------------
REIMBURSEMENT OVERVIEW WEB TOOLS AND RESOURCES HIPAA REQUIREMENTS FOR ELECTRONIC TRANSACTIONS
3 CLAIMS, BILLING & REIMBURSEMENT OVERVIEW All claims must be submitted in accordance with the requirements of the provider contract, applicable member s contract, and this Sourcebook. You may not seek
FAQs on the Required National Provider Identifier (NPI)
FAQs on the Required National Provider Identifier (NPI) Provided by the National Community Pharmacists Association (NCPA) and the National Council for Prescription Drug Programs (NCPDP) At-A-Glance: Important!
ELECTRONIC HEALTH RECORDS
ELECTRONIC HEALTH RECORDS Understanding and Using Computerized Medical Records CHAPTER TEN LESSON ONE Privacy and Security of Health Records Understanding HIPAA HIPAA: acronym for Health Insurance Portability
How To Get A Blue Cross Code Change
OVERVIEW 1. What is an ICD Code? The International Classification of Diseases (ICD) code set is used primarily to report medical diagnosis and inpatient procedures. ICD codes are mandated by the Centers
Health Insurance Portability and Accountability Act December 2002 No. 7 PHC 1920
HIPAA insight Health Insurance Portability and Accountability Act December 2002 No. 7 PHC 1920 The information in HIPAA insight applies to billing vendors, Medicaid HMOs and other managed care programs,
Molina Healthcare of Ohio, Inc. PO Box 22712 Long Beach, CA 90801
Section 9. Claims As a contracted provider, it is important to understand how the claims process works to avoid delays in processing your claims. The following items are covered in this section for your
Is your medical management provider ready for ICD-10?
Is your medical management provider ready for ICD-10? ICD-10 codes will replace all current ICD-9 codes Customized solutions. Consultative partnerships. Healthy outcomes. What are ICD-10 codes? ICD-10-CM
Introduction to ICD-10: A Guide for Providers. Centers for Medicare & Medicaid Services
Introduction to ICD-10: A Guide for Providers Centers for Medicare & Medicaid Services 1 Table of Contents Compliance Date: October 1, 2014» What is ICD-10?» Why ICD-10 matters» Why transition to ICD-10»
Overview on Claims Submission Requirements, Electronic Billing Options, and Provider Website Features
Overview on Claims Submission Requirements, Electronic Billing Options, and Provider Website Features Magellan Direct Submit Electronic and Contracted Claim Submission Clearinghouses Webinar Session for
Molina Healthcare of Puerto Rico (MHPR) Non-Participating Provider Information
Molina Healthcare of Puerto Rico (MHPR) Non-Participating Provider Information Please refer to Carta Normativa 15-0326 Re Transicion for details regarding the ASES-established Transition of Care and Reimbursement
Compensation and Claims Processing
Compensation and Claims Processing Compensation The network rate for eligible outpatient visits is reimbursed to you at the lesser of (1) your customary charge, less any applicable co-payments, coinsurance
Transitioning from ICD-9-CM to ICD-10-CM. Tidewater Physicians Multispecialty Group Williamsburg, VA
Transitioning from ICD-9-CM to ICD-10-CM Tidewater Physicians Multispecialty Group Williamsburg, VA February 22, 2014 Our Agenda Some guidelines for this morning s presentation Our Transformational Point
Initial Preventive Physical Examination
Initial Preventive Physical Examination Overview The Medicare Prescription Drug, Improvement, and Modernization Act (MMA) of 2003 expanded Medicare's coverage of preventive services. Central to the Centers
Legislative & Regulatory Information
Americas - U.S. Legislative, Privacy & Projects Jurisdiction Effective Date Author Release Date File No. UFS Topic Citation: Reference: Federal Various Louis Enahoro 2/20/14 LI-485 HIPAA, Electronic Commerce
Covered Entity Charts
Covered Entity Charts Guidance on how to determine whether an organization or individual is a covered entity under the Administrative Simplification provisions of HIPAA 2 Background: The Administrative
California Division of Workers Compensation Medical Billing and Payment Guide 2010 2011
California Division of Workers Compensation Medical Billing and Payment Guide 2010 2011 1 Table of Contents Introduction ------------------------------------------------------------------------------------------------------------------------------
Harbor s Payment to Providers Policy and Procedures is available on the Harbor website and will be updated annually or as changes are necessary.
Original Approval Date: 01/31/2006 Page 1 of 10 I. SCOPE The scope of this policy involves all Harbor Health Plan, Inc. (Harbor) contracted and non-contracted Practitioners/Providers; Harbor s Contract
What is your level of coding experience?
The TrustHCS Academy is dedicated to growing new coders to enter the field of medical records coding while also increasing the ICD-10 skills of seasoned coding professionals. A unique combination of on-line
Imagine that your practice could submit
What the HIPAA Transactions and Code Set Standards Will Mean for Your Practice If there s a silver lining to the HIPAA regulations, it s here. These standards can save your practice time and money. David
Status Active. Reimbursement Policy Section: Anesthesia Services Policy Number: RP - Anesthesia - 001 Anesthesia Effective Date: June 1, 2015
Status Active Reimbursement Policy Section: Anesthesia Services Policy Number: RP - Anesthesia - 001 Anesthesia Effective Date: June 1, 2015 Anesthesia Policy Description: Definitions: This policy addresses
professional billing module
professional billing module Professional CMS-1500 Billing Module Coding Requirements...2 Evaluation and Management Services...2 Diagnosis...2 Procedures...2 Basic Rules...3 Before You Begin...3 Modifiers...3
Frequently Asked Questions about ICD-10-CM/PCS
Frequently Asked Questions about ICD-10-CM/PCS Q: What is ICD-10-CM/PCS? A: ICD-10-CM (International Classification of Diseases -10 th Version-Clinical Modification) is designed for classifying and reporting
Qtr 2. 2011 Provider Update Bulletin
West Virginia Medicaid WEST VIRGINIA Department of Health & Human Resources Qtr 2. 2011 Provider Update Bulletin West Virginia Medicaid Provider Update Bulletin Qtr. 2, 2011 Volume 1 Inside This Issue:
FMH Benefit Services, Inc.
FMH Benefit Services, Inc. HIPAA Transaction Electronic Data Interchange (EDI) Implementation Guide For Health Care Providers Version Number: 2.0 Issued: October 28, 2003 FMH Benefit Services, Inc. a division
ICD-10 Frequently Asked Questions For Providers
ICD-10 Frequently Asked Questions For Providers ICD-10 Basics ICD-10 Coding and Claims ICD-10 s ICD-10 Testing ICD-10 Resources ICD-10 Basics What is ICD-10? International Classification of Diseases, 10th
Basics of the Healthcare Professional s Revenue Cycle
Basics of the Healthcare Professional s Revenue Cycle Payer View of the Claim and Payment Workflow Brenda Fielder, Cigna May 1, 2012 Objective Explain the claim workflow from the initial interaction through
HIPAA Tool Kit. For Discussion Purposes Only
HIPAA Tool Kit What's Inside 1. HIPAA Education 2. UNICARE HIPAA Resources 3. HIPAA Web Sites 4. HIPAA Assessment Check List For Hospitals and Physicians 5. Comparison Of Top 25 Current EOB Messages To
RONALD V. MCGUCKIN AND ASSOCIATES Post Office Box 2126 Bristol, Pennsylvania 19007 (215) 785-3400 (215) 785-3401 (Fax) childproviderlaw.
RONALD V. MCGUCKIN AND ASSOCIATES Post Office Box 2126 Bristol, Pennsylvania 19007 (215) 785-3400 (215) 785-3401 (Fax) childproviderlaw.com HIPAA The Health Insurance Portability and Accountability Act
Physician, Health Care Professional, Facility and Ancillary Provider Administrative Guide for American Medical Security Life Insurance Company
Physician, Health Care Professional, Facility and Ancillary Provider Administrative Guide for American Medical Security Life Insurance Company Insureds 2009 Contents How to contact us... 2 Our claims process...
California Division of Workers Compensation Electronic Medical Billing and Payment Companion Guide
California Division of Workers Compensation Electronic Medical Billing and Payment Companion Guide Version 1.0 2012 Preface California Electronic Medical Billing and Payment Companion Guide Purpose of
Georgia Medicaid ICD-10 Presentation. June 2015
Georgia Medicaid ICD-10 Presentation June 2015 Agenda Objectives ICD-10 Updates ICD-10 Importance ICD-10 Policy Updates ICD-10 and Patient Care ICD-10 Resources Interactive Voice Response System (IVRS)
State of Nevada Department of Health and Human Services (DHHS) Division of Health Care Financing and Policy (DHCFP)
Hewlett Packard Enterprise for HIPAA Compliant Electronic Transactions Nevada Medicaid Management Information System (NV MMIS) State of Nevada Department of Health and Human Services (DHHS) Division of
The HIPAA Standard Transaction Requirements: How do Health Plans Comply?
The HIPAA Standard Transaction Requirements: How do Health Plans Comply? April 17, 2014 As most employers are aware, the federal government has released a good deal of guidance related to various provisions
HIPAA 5010 It is important to prepare now Deanna Stohl ETP Contracting and Relations e-business Interchange Group Blue Cross Blue Shield Michigan
HIPAA 5010 It is important to prepare now Deanna Stohl ETP Contracting and Relations e-business Interchange Group Blue Cross Blue Shield Michigan August 31, 2011 1 Housekeeping Please place your phones
Below are some frequently asked questions that may assist your practice.
Dear Providers: With the recent announcement in the delay for the implementation for ICD-10-CM/PCS we wanted to provide an update on Blue Cross and Blue Shield of Vermont s (BCBSVT) implementation. We
NewMMIS POSC Job Aid: Professional Claims Submission with MassHealth
This job aid reviews the process of submitting an electronic professional claim in the Provider Online Service Center (POSC). For specific billing information, providers should refer to the relevant Billing
The following is a description of the fields that appear on the results page for the Procedure Code Search.
Fee Schedule Legend Updated: 9/21/2015 The following is a description of the fields that appear on the results page for the Procedure Code Search. Procedure Code the five-character procedure code as listed
Road to 10: The Small Physician s Route to ICD-10. Implementation Guide
Road to 10: The Small Physician s Route to ICD-10 Implementation Guide ICD-10 Implementation Guide for Small and Medium Practices 1 Version 2.0 18 August 2014 Table of Contents 1. Introduction... 2 Introduction