Monday, October 24th 2005
Medical Benefits Administration
Information and Technology
We are pleased to announce that as of Monday, August 22, 2005 we
have began processing X12, 837, and 834 E-Claims
are X12, 837 and 834 electronic files and how do they work in your
1: Cost effectiveness.
The new file formats that are widely
becoming the medical standard are becoming even more cost effective,
not only for the administrators, but the physician's offices as
well. Although most clearing houses will continue to charge a
per-claim processing fee (usually 0.25 per claim), they may already
have this capacity and not realize it. Companies running Med Manager
usually process through WebMD, and other applications have similar
Bundles. Using this type of information exchange can greatly reduce
your overhead by reducing personnel hours, computer system
resources, paper, mailing and possible fees for breeches in HIPAA
offices spend over 0.60 per claim in paper, stamps, and personnel)
Accuracy is a must in the medical world as it determines every
aspect of every business involved in the process. For example, if an
inaccurate CPT cope is input in an office and processed by the payer
or administrator, it may go for a month without correction before
that claim is sent in as encounter data and received by the group,
thus affecting everyone's Pay for Performance.
The rate at which 837 files can be exported
from one system and imported into another is phenomenal, and in most
cases, takes none of your valuable time. Web MD, for example,
receives the files for processing from your system, and submits them
to the payer within 12 hours. That file is then processed by the
payer within another 12 hours. On average, filing a paper claim can
take upwards from 6 days, not including postal time, and an
electronic EDI, although processed in 2 days, can take up to 4 days
to be received by the payer if mailed by the US Postal Service.
Within the next 6
months, as we expand and work towards being one of the best Third
Party Administrators and evolve our business into today's world of
information and technology it is possible that paper claims will be
more difficult to use and take longer to process.
4: HIPAA and CMS regulations.
HIPAA and CMS are cracking down on breaches
of compliance. You may feel safe by sending a stack of paper claims,
or an EDI disk via the US Postal service, but you might still be at
risk for compliance if that disk or paper is lost or stolen.
Recently a company lost a backup tape with patient information; the
tape was in a locked room and password protected. Although they were
not fined because they were believed to have taken reasonable steps
to ensure security, the law required they contact every individual
whose information may have been compromised and they be informed of
the situation. You can prevent this from happening to you by
submitting your files through a clearing house. Do know that while
this will not alleviate all compliance issues, once the clearing
house receives your files or retrieves it from your system, the
responsibility lands on them.
For more information
regarding HIPAA compliance please visit
Clearing Houses Medical Benefits
Administration currently has contracts with.
your system can export an 837 file you can submit directly to MBA
If you are currently with one of these
clearing houses, please contact your representative for more
information on processing electronically.
For those that are not set up with a
clearing house I would encourage you to contact one of the above
businesses and consider this service as a valuable business tool to
move you ahead into the 21st century.
You may receive a call from someone at
Medical Benefits Administration in the near future. We will be
contacting as many people as we can to find out what clearing house
you are using, if they can export 837 files directly from their
systems, or if we may send information to one of our contracted
Clearing Houses so they may assist you in making your decisions.
questions or concerns you may contact Information Technology
271-3243 Email: email@example.com