CMS Claim File Processing – How Long Does it Take?

As published in Health Data Management, Aug 2012 – “Great Primer on Quicker Claims Payments”

Many healthcare providers have automated the transfer of CMS claim data and related files between their claims processing systems and CMS. Sometimes this is performed through their claims processing product and sometimes a separate service is used that uses a secure internet connection or leased lines to conduct the file transfers. Examples include services offered by Ivans or Ability that specialize in this activity.

These transfer procedures have changed somewhat with the introduction of 5010 and it has taken many months for some of the Medicare contractors to work the kinks out of this process on their new systems. Even now, problems occur on a regular basis that involve both vendor and CMS contractor systems that will have a direct impact on how long it takes for you to receive your revenue.

My company also provides this service for healthcare providers and we have accumulated data on the behavior of these contractor systems in order to improve the efficiency of our own processes and to determine when an undocumented failure has occurred that affects our customers.

This information is important because of the money associated with the successful execution of these transactions and the value of the time associated between recognizing that a failure has occurred and taking the proper action to continue the process from the failed point forward.

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