Solutions for HealthCare EDI

HIPAA EDI 278  HealthCare Services Review (Coorination of Benefits)

Imagine that you are at the dentist and you need a new crown put on a troublesome tooth. In the old days, your doctor would accumulate the appropriate paper work; create a letter and the letter to your insurance provider to request authorization to provide the crown. After paperwork is shuffled back and forth, the decision is finally made that the crown will be covered and that you must pay 20% of the total bill. The elapsed time from initial visit to approval could be months. With the use of an EDI Health Care Services Review (278), the approval process is greatly reduced while ensuring that both your dentist and your insurance company have appropriate documentation while ensuring that you only have to pay your part of the bill.

We at SoftCare Health Care believe that the increased use of Electronic documents in the Health Care Management cycle is the key requirement in the implementation of a successful and effective e-business strategy for Healthcare as it saves time and effort to pre-authorize procedures. In particular, the EDI 278 Health Care Services Review document allows a provider the ability to request and receive information back from a payer for referrals, certification, preauthorization and coordination of benefits of the following:

• Health care services

• Health care admission

• Extend certification

• Certification appeal

The key from the provider and payer’s perspective is to be able to provide information on if a service is covered prior to a patient being serviced in a timely manner which also reduces the cost to determine authorization. The EDI 278 response provides a response/action code back to a provider for a specific patient on a requested service or set of services. 

More Information on HealthCare Claim Status Solutions from SoftCare

Download the WhitePaper "EDI 278 Health Care Services Review (COB) - The Healthcare Application That Binds

 

 

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