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Can I become HIPAA compliant without upgrading my existing PMS? We really think our current system is great, but it cannot transmit HIPAA compliant transactions.
If your current PMS is only capable of transacting HCFA1500 claims, then the HIPAABridge is a perfect solution for you. It is capable of importing claims from your PMS and generating HIPAA compliant claims with minimal setup. It also provides all of the features and functionality necessary to take your HCFA1500 content to virtually any type of ANSI X12N 837 Professional claim.
Don't most of the popular Practice Management System (PMS) vendors have HIPAA compliant software?
Believe it or not, quite a few of them have done absolutely nothing to bring their software into compliance. They have shifted the burden to their customers, requiring them to use a clearinghouse to somehow attain all required forms of compliance. There are other vendors suggesting that their PMS applications are HIPAA compliant, but the reality is, while most of them may be Privacy and Security compliant, they have provided very little or NO additional functionality for Transaction
and Code Set (TCS) compliance.
Most of the PMS applications that we've evaluated could not possibly generate a 837 Professional claim for Ambulance, DME, Home Health, Spinal Manipulation or Vision because they provide no way to enter the required certifications. Even though they may be able to generate a very simple or basic claim, it may only be sufficient for a short while as most of these vendors were not very "forward-looking" at all.
In quite a few cases, these vendors were charging a substantial upgrade fee that actually delivers very little with regards to the actual intent of the new HIPAA compliance law. Most of these vendors provide an upgrade solution that meets the bare-bones (minimal) requirements for their current client base. I suspect that as they receive requests for additional HIPAA functionality, additional fees will follow. It is the nature of the
business, not unlike the often criticized software licensing model that is employed by Microsoft for their different Windows Operating systems upgrades and most of their other popular software. They need to continue generating revenue somehow!
Is your application HIPAA compliant?
Yes, absolutely. HIPAABridge is Privacy, Security and Transaction compliant. Patient Health Information (PHI) is protected from unauthorized access. The application allows for multiple Logins thru its Security component. All 837 Professional claims are validated up thru Level 6 compliance. It is capable of generating virtually any type of Professional claim, including Ambulance, Medicaid, Medicare, Spinal Manipulation, Physical Therapy and Vision because it
provides a way to enter all of the required certifications, and we are currently working on the various certifications for DME and Home Health.
It is very "forward-looking" and already provides for entry of dozens of the new HIPAA data elements that could be required down-the-road by any payer under certain circumstances, to adjudicate your claims.
The 837 Professional Transactions that this application can produce have been certified by EDIFACS, an industry leader in HIPAA Compliance solutions and a leading provider of HIPAA transaction certification.
Click here for an Acrobat PDF document that contains our certification from EDIFACS.
What exactly is HIPAA Level 6 compliance?
Compliance testing consists of 7 levels. The first 6 levels are based on ANSI X12 Implementation Guide compliance requirements. Level 7 is based on specific trading partner Companion Guides.
| Level 1: |
Integrity Testing – Tests for valid segments, segment order, element attributes, verifying that numeric data elements have a numeric value, validation of X12 syntax and compliance with X12 rules. |
| Level 2: |
Requirement Testing – Tests for HIPAA Implementation Guide specific requirements like repeat counts, used vs. unused codes, elements and segments, and required or intra-segment situational data elements. |
| Level 3: |
Balancing – Tests the transaction for balanced field totals, record or segment counts, financial balancing of claims or remittance advice and balancing of summary fields. |
| Level 4: |
Situational Testing – Tests specific inter-segment situations described in the HIPAA implementation guides (i.e. if A occurs then B must be present) |
| Level 5: |
Code Set Testing – Tests for valid Implementation Guide specific code set values. Accepted code set values are: ICD–9CM (International Classification of Diseases, 9th Edition, Clinical Modification), volumes 1-3, HCPCS (Health Care Financing Administration Common Procedure Coding System) except for level III or local codes and CPT-4 (Current Procedural Terminology, 4th Edition) |
| Level 6: |
Line of Business Testing – Specialized testing required by certain health care specialties. For example, hospice care, home oxygen treatment and ambulance service have unique data requirements for submitting claims to a payer. |
| Level 7: |
Trading Partner Testing – Specialized testing between trading partners to ensure that data specific to conducting business between trading partners will process correctly. The Companion Guides deal with the specific requirements for transacting business between partners. |
Can't I just rely on a clearinghouse to make me HIPAA compliant?
Clearinghouses offer a variety of services, one of which is typically to handle data transformation. Even though they might suggest otherwise, they are not equipped to handle some of the internal HIPAA issues you will face during the data transformation, such as extensive "situational" business rule validations and the additional "claim content" requirements that they could not possibly provide during transformation from a HCFA1500 claim to a HIPAA compliant claim under
certain circumstances.
They could not possibly handle any HCFA100 claims for Ambulance, Spinal Manipulation or Vision claims or any type of claim that requires Supplemental Paperwork certifications such as: Admission Summary, Diagnostic Report, Discharge Summary, EOB, COB or MSP, Nursing Notes, Oral Surgery Dental Models, Physical Therapy Notes, Physician Order, Prosthetic or Orthotic Certification, Radiology Films, Radiology Reports, Referral Form, Prescription, Supplemental Data for Claim, Surgical Operative Notes
or Tests & Analysis Reports.
Most of the Supplemental Paperwork information was attached to the paper claim, no longer possible. Now at the very least, a certification must be made in the HIPAA claim that indicates the current disposition of this information, otherwise the claim will most probably be rejected. There is no way to enter these certifications on a HCFA1500 electronic or paper claim so that it can be transformed into a new HIPAA compliant claim.
Even if they were able to accommodate the most simple of claims for you, the clearinghouse solution can be very expensive, as you could be charged a significant setup fee and additional fees for each transaction they process.
Our HIPAABridge is more than just a data transformation tool. It allows you "complete control" over the compliance requirements of your HIPAA transactions, is a much less costly provider of HIPAA transaction compliance, and utilizes a local store-and-forward database giving you a tremendous amount of power for correction and resubmission - not found with a clearinghouse.
Which Practice Management Systems (PMS) are supported by your HIPAABridge EDI application?
HIPAABridge can import claims from some of the most popular PMS vendors, including but not limited to: AdvancedMD,
Advantage, AdvantX, AltaPoint, Alteer, Chiro7000, Chiro8000,
ChiroPLUS, Compulink, CompuMed, Datamedic, E*HealthLine, Eclipse,
EZClaim, EZOffice, GEMMS, Greycat2000, HandyWorks, HomeSys, IDX Systems,
Innovation, IslandMed, Keane, Lytec, Management Sciences, MedAssist,
MedPrime, Medical Manager, MedBil, MediSoft, NexTech, NextGen, OfficeMate, Pepware, PracticeMaker,
PracticePartner, PTOS, QuickPractice, Raintree, SweetSoft, Therapist Helper,
TPS2000, Versyss, VitalWorks. Other Import Processors are currently under development for additional Practice Management Systems and custom Import Processors can be developed for virtually any PMS
upon request at no additional charge.
Can I use HIPAABridge to submit claims even if I don't have a Practice Management System?
Yes. It can be used as a stand-alone claim entry and maintenance application to generate HIPAA compliant claims.
What HIPAA transactions are supported by your application?
HIPAABridge is capable of generating the ANSI 837 Professional claim and processing the 997 Acknowledgement. We are currently working on the 270/271 Eligibility, the 276/277 Claim Status and the 278 Authorization. These other transactions should be available in a future release.
Why is there an annual software maintenance fee?
The new HIPAA law allows for updates to all transactions and code sets once-a-year. This virtually guarantees that there will be at least one maintenance release a year. It also allows for Code Set maintenance 3 times a year. Unfortunately, to maintain compliance, annual maintenance will most certainly be required.
Which insurance carriers can I transmit to and what are the associated costs?
We recommend 2 EDI clearinghouses (transmission intermediaries) that will give you access to over 1000 Payers, with very little or no cost to you. These clearinghouses will not be required to provide any data transformation services, but merely transmit your HIPAA compliant claim transactions to the appropriate Payers.
Click here for an Acrobat PDF document that contains the current list of MCS Payers/Carriers.
Click here for an Acrobat PDF document that contains the current list of FreeClaims
Payers/Carriers.
How is it that they can route my transactions to over 1000 Payers at very little or no cost to me?
After much research on the Internet, we found that these clearinghouses offer the most reasonable terms for transmitting claims to various Payers. One of them does not charge any setup or transaction fees and the other (MCS) only charges a small fee of .15 for government plans (BCBS, Champus, Medicaid, Medicare). I suppose we could charge you for using this service, but we don't. The fact is, you can use any clearinghouse service of your choice to route HIPAA compliant claims, but we found that these "transmission
intermediaries" had the 'best case cost scenario' for delivering these transactions to Payers.
You do not have to use either of these clearinghouses.
Can I submit my claims directly to any Payers using your software?
If you use HIPAABridge to generate your HIPAA compliant claims, you can submit directly to most Medicare B carriers. Just visit our website under the "Customer Login" once you become a licensed user and all contact information is provided. Most Medicare B carriers are currently using Bulletin Board Systems (BBS) to submit your claims and download your responses. We are constantly pursuing Direct-Payer submission to various Payers and hopefully someday we will be able to remove the
clearinghouse from the equation completely.
We have never sent claims electronically, what will we need to get started?
You will probably need Internet access to transmit the HIPAA compliant ANSI X12 claim files that are generated by HIPAABridge. In some other cases, sending your claims may only require a dial-up connection via a modem. If you will be transmitting claims to a government plan (BCBS, Medicare, Medicaid or Champus) most clearinghouses will provide you with EDI contracts and connections for all states and regions. In the case of MCS, if a payer is not currently connected for your state, MCS will make the connection available at no cost to you.
Can I view reports and the status of my claims?
Yes, the clearinghouses we recommend (and most others) have an Internet Portal to view Payer responses so that you will know right away if a claim has been accepted for transmission to the associated Payers.
Can I take a look at the application to see if it will meet my needs?
Click here for an Acrobat PDF document that will provide you with a preview of the application.
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