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HIPAA requires national uniform methods and uniform codes
for the exchange of electronic information between health
care providers and health plans. The standardization of transactions
will eventually decrease the administrative burden on billing
services for health care providers, health plans, government,
and others. Most vendors will either change their information
systems to recognize the new standard codes and format, or
contract with an electronic health network to translate the
data into the standard transaction format. The list of transactions
is expected to increase over time as other transactions are
adopted.
Note: The data elements contained
in the tool represent those minimally required to transmit
an electronic claim. Other data elements may be required on
a situational basis depending on the circumstances of the
claim.
If you submit claims electronically or send or receive any
of the HIPAA electronic transactions, you will need to comply
with the HIPAA transaction standards. At some point in the
transmission of these transactions, data must be in a HIPAA
compliant format. Even if your PMS vendor or clearinghouse
has told you that they are capable of translating your transactions
to a HIPAA format, you may still have issues if your vendor
has not tested your data, which includes all services/products
with all your payers and or clearinghouse.
I. Introduction
II. Transaction ID # and Medical Procedure Codes
III. Glossary
IV. Required Professional Claims Elements Vendor Discussion
Survey
Patient Information
Provider Information
Payer Information
Service
V. Practice Management Data Content Readiness Indicator
VI. Practice Management Software Self-Assessment Survey
VII. Electronic Claims Awareness Information
VIII. Hierarchical Level Structure
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