Lesson 1 Overview of the 837 and 835

2 Section 1: Overview Introduction How did we get to where we are now? What do electronic transactions mean to you and your coworkers? How is IHS making it easy for you? Where are we now?

3 Whom Do Electronic Transactions Affect? Successful electronic transactions require action from: –Patient Registration –Business Office –Finance

4 Section 1: Overview Introduction How did we get to where we are now? What do electronic transactions mean to you and your coworkers? How is IHS making it easy for you? Where are we now?

5 Why Electronic Transactions? Makes good business sense – Revenue will increase – Cash flow will even out – It supports mission of providing highest quality health care to all American Indians, Alaska Natives, and those served by urban facilities

6 Why Electronic Transactions? (cont’d) Addresses important patient rights issues –Privacy Protects patient records so only the right people have access to them –Accountability System tracks who accesses records and when –Efficiency Reduces time spent on paperwork

7 Why Electronic Transactions? (cont’d) It’s the law –In 1996 Congress passed Health Insurance Portability and Accountability Act (HIPAA) –HIPAA includes section on Administrative Simplification Makes possible electronic transmissions using standard record formats, code sets, and identifiers –No specified date for compliance But members should show “good faith efforts” working toward compliance

8 Transaction and Code Set Standards (Final) Privacy Standard (Final) Security Standard (Final) National Provider Identifier Standards (Final) DHHS Rules Defining HIPAA

9 Focus of Training: 837 and 835 Health Claims & Equivalent Encounter Information or the 837 Health Care Payment & Remittance Advice or the 835 New and Old Formats 837I (Institutional) replacesUB P (Professional) replaces HCFA D (Dental) replacesADA forms 837COB (Coordination of Benefits) Used to submit claims to secondary payers 835replacesNSF forms

10 Section 1: Overview Introduction How did we get to where we are now? What do electronic transactions mean to you and your coworkers? How is IHS making it easy for you? Where are we now?

11 What Does It Mean For You? Site Manager: “Each year it has increased our collections dramatically.” Financial Management Officer: “This really helps identify problems.” Accounting Officer: “You will know exactly what’s going on.”

12 Section 1: Overview Introduction How did we get to where we are now? What do electronic transactions mean to you and your coworkers? How is IHS making it easy for you? Where are we now?

13 How IHS Makes It Easy For You The RPMS tools you need are ready The materials you need are on hand Problem solving is ongoing and best practices are being developed Help is available

14 RPMS Tools Are Ready TransactionTool 837-Third Party Billing and 835-Accounts Receivable Generic Interface Software (GIS) GIS v3.01, p2 & p5 (Optional) 837-Third Party Billing Institutional, Professional and Dental Claim Requests 3 rd Party Billing, v2.5, p6 837-Third Party Billing Provider/Location Taxonomy AUT Patch v98.1, Patch Third Party BillingManually Adding Provider Taxonomy provides instructions to add provider and location taxonomy codes. As a backup, third party RPMS software (3P) uses crosswalk to find taxonomy number. 997 Functional Acknowledgement and Comp Report Macro has been developed to convert error report format into a list of segment lines for easier interpretation. 835-Accounts Receivable Claim Replay, (Remittance Advice) Accounts Receivable, v1.7, p4 835-Accounts Receivable Standard Adjustment/Reason Codes Accounts Receivable, v1.6, p4

15 Materials Are On Hand HIPAA Compliance: Business Transactions (for Area HIPAA Coordinators) Trailblazers Medicare Part A: 837 Testing and Production Procedures (sent to all Area Offices) Trailblazers Medicare Part B: 837 Testing and Production Procedures (sent to all Area Offices) HIPAA 835 Testing and Production Procedures (sent to all Area Offices)

16 What Does It Mean For You? Management Program Analyst: “We want everyone to become HIPAA compliant, and this is a tool to help sites get to that point.”

17 Focus of This Training 837: Preparation for Testing 837: Electronic Claims Submission 837: Reading Error Reports and Making Corrections 835: Testing and Posting the Remittance Advice

18 Problem-Solving Ongoing Regular OIT internal technical meetings OIT holds regular national I/T/U conference call to discuss Area status reports, issues and solutions, and best practices –To participate in this call, notify ITSC Help Desk pdesk/index.cfm

19 Help Is Available OIT Help Desk

20 Section 1: Overview Introduction How did we get to where we are now? What do electronic transactions mean to you and your coworkers? How is IHS making it easy for you? Where are we now?

21 Current Testing Status

22 What Does It Mean For You? Financial Management Officer: “It will be a whole lot easier for everybody.” Accounting Officer: “Just keep on moving forward because you’ll come out successful.”

23 Lessons Learned Electronic transactions are required: –For good business practice –To protect patient rights –By law IHS provides: –RPMS tools –Training materials –Problem-solving and help