Obamacare and HIPAA Transactions



 HIPAA legislation introduced the current standards for certain electronic transactions now familiar in the healthcare industry.  These included the healthcare claim (837i and 837p), ERA (835), claim status transaction (276/277) and health plan eligibility (270/271).  These standards were finalized in 2000 and finally enforced by CMS in 2003 (837 and 835).  The intent of this legislation was to improve the efficiency of transaction processing in the healthcare industry by mandating a specific standard whenever these transactions were used.  However, there was one gaping loophole in the legislation that prevented the industry from receiving the full benefit of these standards.  Although HIPAA covered entities, providers and payers, had to use these formats when conducting electronic transactions, they could avoid HIPAA implementation and the associated cost by simply conducting these transactions on paper.  Continue reading

5010 creates challenges for auto posting 835 Remittances

Over the years you may have developed a dependence on the automatic posting of 835s from your major payers to your patient accounting system.  Depending on the number of claims you produce, this service can save you hundreds of hours in data entry time and reduce your error rate.

software costs (1)

With the implementation of 5010, payers are creating their 835 remittancess in the 5010 format as well.  In some cases, you can choose your format for the time being.  In others, switching to the 5010 claim format means a mandatory migration to 5010 835s as well.  Make sure that your auto posting solution can support the 5010 format, preferably, that it can support both 4010 and 5010 at the same time.

It is likely that you will be receiving both formats for a period of time as your payers adjust to 5010 themselves and as you transition from 4010 to 5010 with each payer connection.

The inability to process both file types can put a major stress on your revenue stream. Any delay in posting automatically causes claims to spend unnecessary days in AR and in turn slows secondary claim filing.

Drastically Reduce Remittance Processing Time with 835Direct

Published in MEDITECH bulletin June 2010 issue


One vital element of receivables management and cash flow is the processing of insurance payments.  Timely posting of accurate payment and adjustment information can accelerate cash flow by advancing the patient account to the next stage of billing or collections.  Although HIPAA implemented a standard format for electronic remittance of data, the ANSI 835, a majority of the remittance documentation received by hospitals today is still on paper.

The healthcare industry spends 15% of each dollar on payment processing compared to only 2% in retail industries1.  Of the remittances processed by healthcare facilities, 80% – 90% are still provided on paper.

Paper insurance remittances are generally translated manually into payment and adjustment transactions for each documented account.  This process is very time consuming and prone to error.  In addition, vital details about these payments are often excluded in the interest of time.  For example, charge level denials and other detailed adjustments that are often available in the electronic remittances or on the paper equivalent are often summarized or excluded. Continue reading