Preserving Your HIPAA Transaction Files

A few days ago I had a call from a current customer.  They needed help with a project to find claim data that met a certain criteria for additional action.  In this case, a major commercial payer had paid claims late over an extended period of time to healthcare providers all over the country.  This particular hospital had learned at a conference that they could collect the substantial interest on these claims by simply creating a list of the claims that qualified and submitting this list and supporting documentation to the payer.  They had contacted a consultant that was going to assist them with this process.  All they needed was a way to identify these claims and create this list.


One of our products (835Direct) is capable of loading electronic remittances (835s) into a database and mining the data back out in a variety of formats.  It could have been used to examine the remittance data from this payer and produce a spreadsheet of all claims where the difference in the bill date and the payment date was greater than x. However, the software they use to obtain their remittances imported the remittances into a proprietary product for printing EOBs, posting to AR and such, but did not provide the capability of producing this list.  Furthermore, this vendor does not forward the 835 remittances they receive on behalf of the customer on to the customer.  After they are imported, they are archived by the vendor and the customer must pay service fees to obtain their own information in the original 835 format.  This customer is exploring this option, but even if it is worth the expense, it will take additional time to obtain this information. Continue reading

CMS Creates New Process for Late NOE Appeals

If you are associated with a hospice, you are aware of the new rules regarding the timely filing of NOEs.  You can review these rules in my previous article or through this CMS announcement:


By now, you have made it through October claim processing and hopefully you experienced as few late NOEs as possible.  If you did have some late NOEs, you might still be able to recover this lost revenue.

In the original announcement, CMS gave the MACs the authority to process appeals for late NOEs and gave the circumstances where these appeals might be granted.  If an appeal is successful, uncovered charges could be reversed by the MACs.

On 11/6, CMS issued another announcement regarding the appeals process for late NOEs:

As described in the original announcement, whenever an NOE is filed late (entered in DDE over five days after the admission date), the hospice must report the late NOE on the first claim for the initial hospice benefit period.  This is done by reporting the non-covered days with occurrence span code 77, even if the hospice believes that the NOE is late for reasons eligible for an appeal. Continue reading

Hospices Brace for New CMS Five-Day Submission Requirement for the NOE

CMS announced the final rule for hospices regarding the timely filing of the NOE in transmittal 3032 sent out August 22.

In the document, CMS designates that a timely-filed NOE (Notice of Election) shall be filed within five calendar days after the hospice admission date.  This applies to the NOTR (Notice of Election Termination/Revocation) as well.  This regulation is effective for dates of services on or after October 1st.


Previously, there were no regulations regarding the timing of submitting these transactions. The NOE and the NOTR are essentially claims submitted to CMS that do not represent any services being billed, but the execution or revocation of an agreement between the hospice and the beneficiary receiving their services. These agreements are normally executed in the field, away from the office, at the patient’s home or with representatives of their family. The NOE is used to notify CMS that the beneficiary has elected to change their relationship with Medicare and to accept all medical services related to a diagnosis through the hospice only from that point forward, until they elect to change this relationship. Continue reading

MEDTranDirect Introduces All Payer Eligibility

This upcoming weekend, effective 9/29/14, MEDTranDirect is releasing our new All Payer Eligibility Module to selected PayerLink customers.  This new module will allow you to execute eligibility transactions for payers other than Medicare.  This includes all state Medicaid programs and hundreds of commercial payers.


Like the HETS system for Medicare, you can get real time results for these payers in seconds, reducing the errors associated with providing services and submitting claims without verified insurance information. Continue reading

Calculating the Potential Savings of Automating Administrative Transactions


The cost of processing administrative transactions associated with health insurance claims is part of doing business as a healthcare provider and a health plan.  During the last fifteen years, HIPAA has established standards for conducting many of these transactions electronically.  The Affordable Care Act introduced Operating Rules that are making these transactions mandatory for health plans when providers request them.  In 2013, the claim status transactions (276/277) and the eligibility transaction (270/271) became mandatory standards.  In 2014, the 835 electronic remittance and the EFT became available to any provider requesting them from a health plan.  In addition, the ACA requires that these payment transactions occur within three days of each other and that standardized codes are used for certain types of adjustments and remarks. Continue reading

The Impact of ICD-10 on the ANSI 837


Not since the introduction of HIPAA transactions over 15 years ago has there been a project that impacts healthcare data processing like the implementation of ICD-10.  This code set conversion impacts almost every business process for every partner in the exchange of healthcare data.

The fact that this change impacts so many systems and partners in the collection and exchange of healthcare data means that the risk of financial setbacks due to the implementation of these codes is very high. Continue reading

CAQH CORE Offers free EFT Enrollment Tool

On the CAQH CORE web site, there is a tool that allows providers to enroll in EFT with multiple payers in a single step. This link will take you to the site:


After you create an account, you can upload an image of a check, select the payers you want to enroll with from their list, and the enrollment information will be sent to each one. Continue reading

Medicare dial-up connectivity is being eliminated for 717 area code.

EDI trading partners still connecting to Novitas via the former 717 area code modem telephone number will no longer be able to connect for claim submission and report retrieval as of 12:01 AM Eastern Time (ET) on Friday, August 29, 2014.:


The majority of our trading partners have already made these changes,

Inability to connect for claim submission, remittance and/or report retrieval. and we appreciate your assistance with this effort.  Currently, customers still connecting through the 717 area code telephone number may already be experiencing:

  • Decreased connection quality.
  • Frequent connection time-outs.
  • If your modem is more than four years old, you may need to purchase a new dial-up modem in order to connect.

Customers who have not changed to the new connections should speak to their software vendor immediately to resolve any connection issues you are experiencing.   Additionally, trading partners who are located in the 717 area code will need a long distance phone service in order to connect.

MEDTranDirect is an Approved Network Service Provider for Novitas. MEDTranDirect can provide you with a solution! MEDTranDirect provides secure high-speed Internet connectivity to online inquiry services and the Common Working File (CWF).

MEDTranDirect provides a simple and easy to use product “PayerLink” that provides access to: DDE, PPTN, VIPS, HETS, and Claims file transfer.


By Aaron Brandwein – Vice President of Sales and Marketing, MEDTranDirect


Your Medicare dial-up connectivity is being eliminated!

Dial-up connectivity will be eliminated as an EDI data exchange option for uploading claims and downloading ERAs:

These MACs recommend that users on dial-up make the transition as soon as possible to avoid disruption to Medicare service.

MEDTranDirect can provide you with a solution! MEDTranDirect provides secure high-speed Internet connectivity to online inquiry services and the Common Working File (CWF).

MEDTranDirect provides a simple and easy to use product “PayerLink” that allows Internet connectivity for batch claims submission and ERA download.


By Aaron Brandwein – Vice President of Sales and Marketing, MEDTranDirect

What is the Common Working File?

The term Common Working File (CWF) is about as old as any IT terminology in our industry.  I have used it myself since we began the company in 1986.  Despite our common understanding of this concept, I have to admit that I was not really sure what it was, where it was stored, or how it was maintained.  I decided to do a little research. Here are the results.

The CWF is specific to Medicare.  It is a collection of records maintained on behalf of each Medicare beneficiary that covers these four general areas of information:

Entitlement data

Utilization History

Medicare Secondary Payer (MSP)

Health Maintenance Organization (HMO)

This information is stored in a separate record for each beneficiary for each of these data categories.

Although we think of the CWF as a single database, it is actually comprised of 9 databases called Hosts.  Each beneficiary is assigned to only one host.  This is determined by where the person signs up for their SSA benefits.  Here are the host sites and the states that are assigned to each: 

Continue reading