Electronic Claims

Do's and Don'ts of Electronic Claims

Do: Use the patient account numbers to differentiate between patients with similar names.
Do: Use correct numeric locations of service code, current valid CPT, of HCPCS procedure codes.
Do: Print an insurance billing worksheet or perform a front-end edit (online error checking) to look for and correct all errors before the claim is transmitted to the third-party payer.
Do: Request electronic-error reports from the third-party payer to make corrections to the system.
Do: Obtain and cross-check the electronic status report against all claims transmitted.

Don't: Bill codes using modifier -22 electronically unless the carrier receives documents (called attachments) to justify more payment.

Internet Resources for Electronic Claims

AAFP's Center for Health Information Technology and resources from the Practice Management site of the American Academy of Family Physicians.

Coding Gateway site to many resources from the American Health Information Management Association (AHIMA).

Electronic Billing & EDI Transactions From the Centers for Medicare and Medicaid Services.

HIPAA Administrative Simplification Enforcement Tool Available online from the Centers for Medicare and Medicaid Services - CMS.

Links to State Insurance Departments From the National Association of Insurance Commissioners.

TRICARE Military Treatment Facilities (MTF) Locator

TRICARE Providers Site includes billing information.

Workers' Compensation related links From the North Carolina Industrial Commission, maintained by Robert W. McDowell.

Journals

Advance for Health Information Professionals Biweekly magazine for health professionals.

CIO Magazine In addition to online articles, contains an extensive set of links to other web resources.

Federal Register Available online from the Government Printing Office.

Healthcare Informatics Online Includes a section on Financial issues, including coding and payment systems.

Healthcare IT News Covers technology and the business of health care.

Journal of the American Health Information Management Association Selected articles are available online.

Agencies, Organizations and Associations

American Academy of Professional Coders - AAPC

American Medical Association

Blue Cross Blue Shield Association

Healthcare Information and Management Systems Society - HIMSS

Microsoft and Microsoft Healthcare Users Group

National Electronic Billers Alliance

North Carolina Healthcare Information and Communications Alliance, Inc. - NCHICA A "nonprofit consortium of over 200 organizations dedicated to improving healthcare by accelerating the adoption of information technology."

Office of Inspector General, Department of Health and Human Services.

VeriSign Online security services.

Workgroup for Electronic Data Interchange - WEDI A membership organization promoting health related electronic commerce.