What are the different adjudication requirements? Doesn’t HIPAA mandate all electronic claims be standard?
HIPAA requires that all electronic claims be submitted in a standard format and comply with all required data elements and those situational data elements that are applicable based on the conditions described in the HIPAA implementation guide. HIPAA does not impact payers’ coverage rules. The Medicare free billing software is being developed to support the submission of Medicare HIPAA compliant claims only. The software will not capture any of the situational data elements that may apply to other payers, but not to Medicare. For example, the professional HIPAA 837 implementation guide has fields for the service authorization exception code and immunization batch number.
Related Questions
- Is an ALC required to comply with the federal HIPAA requirements related to a health care provider’s electronic transmission of confidential health care information and billing data?
- What are the different adjudication requirements? Doesn’t HIPAA mandate all electronic claims be standard?
- What HIPAA standard electronic transactions have been revised to include the NPI?
