Jump to content
Invision Community
FORUMS BLOG/NEWS USER BLOGS USER MEDIA ADVERTS   ADD  MANAGE CHAT CLUBS & USER PERSONAL FORUMS LINK EXCHANGE
HEALTH & DISEASES Diabetes Treatment Cancer Treatment Alzheimer's Treatment Crohn's Disease Treatment Cirrhosis Treatment Multiple Sclerosis Treatment Scleroderma Treatment Hair Loss Treatment Infertility Treatment
Sign in to follow this  
davidtrump

Electronic billing

Recommended Posts

Electronic billing
A practice that has interactions with the patient must now under HIPAA (Health Insurance Portability and Accountability Act) send most billing claims for services via electronic means. Prior to actually performing service and billing a patient, the care provider may use software to check the eligibility of the patient for the intended services with the patient's insurance company. This process uses the same standards and technologies as an electronic claims transmission with small changes to the transmission format, this format is known specifically as X12-270 Health Care Eligibility & Benefit Inquiry transaction. A response to an eligibility request is returned by the payer through a direct electronic connection or more commonly their website. This is called an X12-271 "Health Care Eligibility & Benefit Response" transaction. Most practice management/EM software will automate this transmission, hiding the process from the user.

This first transaction for a claim for services is known technically as X12-837 or ANSI-837. This contains a large amount of data regarding the provider interaction as well as reference information about the practice and the patient. Following that submission, the payer will respond with an X12-997, simply acknowledging that the claim's submission was received and that it was accepted for further processing. When the claim(s) are actually adjudicated by the payer, the payer will ultimately respond with a X12-835 transaction, which shows the line-items of the claim that will be paid or denied; if paid, the amount; and if denied, the reason.

Share this post


Link to post
Share on other sites
HEALTH & LEARNING Online Medical Degree Nursing School Online Online Schools to Become a Pharmacist Bachelor Degree Online Master Degree Online Online Courses MBA Degree Online Online School Associate Degree Online

Join the conversation

You can post now and register later. If you have an account, sign in now to post with your account.

Guest
Reply to this topic...

×   Pasted as rich text.   Paste as plain text instead

  Only 75 emoji are allowed.

×   Your link has been automatically embedded.   Display as a link instead

×   Your previous content has been restored.   Clear editor

×   You cannot paste images directly. Upload or insert images from URL.

Sign in to follow this  

×
×
  • Create New...