ElectroniClaim Clearingmagic Direct Connections
It has been over ten years and HIPAA is finally moving away from being the “Clearinghouse Relief Act of 1996.” HIPAA contains three parts, Privacy, Security; and Administrative Simplification. Everyone could understand Privacy. Everyone could understand Security. Administrative Simplification was accompanied by “Implementation Guides” for the “Standard Transactions” that were larger than some encyclopedias. In human terms, Administrative Simplification, means that everyone must use the same formats for electronic equivalents of paper forms used for standard medical business transactions. EDI or Electronic Data Interchange is finally being fully implemented in the industry.
The implementation guides, published by the Government, are actually being enforced by the Federal Government. Medicare and Medicaid Carriers and Fiscal Intermediaries, have been accepting only ANSI EDI transactions since 2003. With the advent of the National Provider ID, the process has gotten simpler. There is now one identifier for each doctor or other medical provider. The ability of payers to force the use of proprietary identifiers is gone.
What does this mean for the average physician practice? It is time to take control of your payment process. The industry has invented a new term for helping doctors and hospitals get paid. It is Revenue Cycle Management. It is unflatteringly called the Clearinghouse Black Hole by some users. A process said to be so dense that not even light can escape. The reality is much different. Clean Claims sent directly to payers get paid on a timely basis. There are fewer and fewer different ways to get claims and other transaction files to payers. The industry seems to be standardizing on secure ftp transfers. The different methods for file transfer are all supported by ClearingMagic. All you need to do is fill out paperwork to get your own submitter id and password and then send a few test claims to get approved for the continued submission of production claims and other transactions.
ClearingMagic scrubs claims for HIPAA compliance prior to submission to payers. It also has the ability to allow legacy id numbers to come into the system and be removed from the files being sent to the payers.