 Electronic Claim Filing Requirements
In 2009, HIPAA mandated that the healthcare industry use standard formats for electronic health care transactions.
Because the standard claim file format (837p, version 4010) could not support the upcoming ICD-10 code set changes, the Department of Health and Human Services mandated the conversion of all electronic health care transactions to the HIPAA-compliant 837p 5010 version by January 1, 2012.
The 837p 5010 claim file format provides for the expanded ICD-10 code length, and, in simple terms, provides a language that allows two different computers to speak the same billing/coding language.
As a result of ICD-10 and this federal mandate, HNS no longer accepts print image claim files (text files), or 837p claim files in the 4010 format.
HNS strongly encourages all physicians to submit their electronic files to HNS in the required HIPAA compliant 837p 5010 format, directly from their practice management software system. However, HNS offers an alternative for those physicians whose practice management software systems cannot produce the required 837p file. Please review the section titled "Office Ally™".
HNS Electronic
Claim Filing Requirements
HNS can only accept electronic claim files in the required 837p 5010 format, submitted in one of the following ways:
- Directly to HNSConnect® from your practice management software;
- Directly to HNS from Office Ally™ (if your software cannot produce the 837p file.)
If you are unsure of the type of electronic claim file you are submitting to HNS, please contact your HNS Service Representative immediately.
HNS will continue to accept HIPAA compliant 837p 5010 claim files submitted directly to HNSConnect® from your practice management software.
For those of you who are currently submitting claims files to HNS via the 837p 5010 format, you do not have to make any modifications to the manner in which you are sending your electronic claim files to HNS.
HNS cannot accept electronic claim files from Office Ally™ from physicians whose software can produce the required 837p file.
HNS will accept electronic claim files from Office Ally™
HNS can no longer accept print image (text files) or 837p 4010 claim files.
To assist those of you whose software cannot produce the 837p file, HNS has contracted with a clearinghouse, Office Ally™. Office Ally™ will convert your non-standard print image or 837p 4010 claim file to the HIPAA compliant 837p 5010 file format and transmit these files to HNS. There will be no cost to you for this service.
The decision to contract with Office Ally™ was made, in part, because many HNS practices already utilize Office Ally™ for clearinghouse services, and also because of Office Ally's™ commitment to transmit your other commercial claim files at no cost to you. Office Ally's™ business model is based on charging the payor (or in this case, HNS), versus charging the physician, for their services. Additionally, Office Ally's™ system is user-friendly; there is no set up fee, Office Ally™ does not require you to sign a contract and offers 24/7 customer support.
Providers submitting the required 837p 5010 claim file to HNS may not submit claim files to HNS via Office Ally™ .
Enrolling with Office Ally™ is fast and easy!
Click here for information on how to enroll, and for HNS Payor ID numbers needed to submit your HNS claims through Office Ally™.
HNS will continue to accept claims manually entered into HNSConnect®
The federal mandate applies only to electronic claim file formats. Providers who are manually entering claims via HNSConnect® may continue to do so.
New CMS 1500 Claim Form
Required for paper claims (secondary claims, corrected claims and claims with attachments)
ALL paper claims, regardless of date of service, must be submitted using the new CMS 1500 claim form (version 02/12). This revised form must be used for all paper claims, including secondary claims, corrected claims and claims with attachments.
There are important new requirements associated with the revised claim form and compliance to these new requirements is vital in preventing rejections or denials of your claims. To assist you with complying with these new changes, HNS has created a section of our website regarding the Revised CMS 1500 Claim Form which includes important information about this revised form, including an image of the new claim form, instructions for use, as well as a list of all changes on the form.
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