Solutions for HealthCare EDI

HIPAA EDI 276 & EDI 277  HealthCare Status Request

Imagine that you are a clinic administrator and you are in charge of claims processing for the entire clinic. You have thousands of outstanding claims and you need to know the status of each claim. Let’s look at the options available from one of the most technologically aware insurance carriers/payers (Medicare) and let’s review what these options actually mean for a clinic administrator: 

Providers can call the provider help lines for their local carrier/intermediary and ask to speak to a customer service representative. While this option is possible, its time consuming and mind-numbing

• Providers can enter data via Interactive Voice Response (IVR) telephone systems operated by Medicare contractors. Again, this type of approach works well for very small one practitioner offices but if there is any volume, its very time consuming
• Providers can enter claim status queries via direct data entry screens maintained by Medicare contractors. Again, this type of approach works well for very small one practitioner offices but if there is any volume, its very time consuming
• Providers can wait to receive the payment and monthly statement (either paper or an electronic Health Care Claim Payment/Advice (835). For large technologically savvy providers the electronic Payment Advice is much better but of course it doesn’t speed payment processing times as it is provided only periodically.
• Providers can send an EDI Health Care Claim Status Request (276 transaction) electronically and receive an EDI Health Care Claim Status Response (277 transaction) back from Medicare. The response will be integrated into the provider’s claims management system so updates can be viewed without any manual intervention.

 

We are SoftCare Health Care believe that the correct approach for providers is the implementation of an automated EDI request and response. We are not alone in this belief. Medicare states “The electronic 276/277 process is recommended since many providers are able to automatically generate and submit 276 queries as needed, eliminating the need for manual entry of individual queries or calls to a contractor to obtain this information. Submission of 276 queries and issuance of 276 responses should be less expensive for both providers and for Medicare. In addition, the 277 response is designed to enable automatic posting of the status information to patient accounts, again eliminating the need for manual data entry by provider staff members”

 

More Information on HealthCare Claim Status Solutions from SoftCare

Download the WhitePaper "EDI 276/277 – Health Care Claim Status – Speeding the Revenue Cycle

 

 

EDISoftware FileTransfer Software IntegrationTools  Portals SharedServices EHR Interoperabilty WhitePapers  HIPAA Home