It Pays to Submit HIPAA-Compliant Claims
by Communications Staff
May 10, 2004 -- Effective July 1, health professionals who submit Medicare claims electronically in the format mandated by the Health Insurance Portability and Accountability Act (HIPAA) Transaction Rule will have their claims paid more quickly than those providers who do not.
HIPAA-compliant electronic claims will be eligible for payment 14 days after they are received. Non-compliant electronic claims, along with paper claims, will be eligible for payment 27 days after they are received.
As of October 16, 2003, health professionals and other entities covered under the HIPAA Transaction Rule are required to submit Medicare claims using a standardized electronic format. Among the exceptions to the rule, practices with 10 or fewer full-time employees are not required to file Medicare claims electronically.
The Centers for Medicare and Medicaid Services (CMS) implemented a “contingency plan” allowing covered entities to file non-compliant claims after the October 2003 deadline. Under the CMS contingency plan, non-compliant electronic claims were eligible for payment 14 days after they were received. The agency has now modified its plan, however, to begin treating non-compliant electronic claims as though they were paper claims – thereby facing an additional 13-day time lag in eligibility for payment compared to HIPAA-compliant electronic claims.
For additional information about the HIPAA Transaction Rule, review "A Psychologist's Guide to the Transaction Rule" or access the HIPAA Compliance section.
