By Phil Sullivan
|The clock is ticking down to January 1, 2012, and IT project managers are struggling with HIPAA X12 5010 compliance. Some HIT vendors are not ready, many payers are transmitting in non-compliant versions and claims scrubbers are choking on translations between vendors, payers and varying transaction set standards. So why is this so important? Adhering to the X12 EDI 5010 requirements allows for larger field size of ICD-10-CM as well as other improvements, and is a critical preliminary step towards achieving success on October 1, 2013 when ICD-10 becomes the standard for documenting diagnoses and procedures. This is the largest and most enterprise encompassing healthcare projects in over twenty years.|
Ras X12 customers gain tremendous benefits by capturing, converting and automating tasks related to payment and remittance transaction sets. For instance, many providers have reported problems with insurance payers transmitting non-standard transaction sets. With the Ras X12 module and 5010 support, customers will be able to test their payers against specification standards.
Ras X12/5010 works with every HIT vendor and every payer.
It is common for healthcare providers to create multiple versions of their 837/5010 EDI Health Care Claim Transactions, one directly from their billing systems, another from their billing scrubber and perhaps a third from their clearinghouses. The edits between these versions can become confusing when trying to QA payer reported errors. Ras customers with X12/5010 can easily track multiple versions of their EDI 837 files prior to transmittal. These transaction sets are maintained in their original X12 format as well as a human-readable format. Keep everything you need in Ras for as long as you need without fear of over-utilizing disk space on your network or within your claims scrubber application.
It’s very simple. Place an X12 837 or 835 Health Care Claim Payment/Advice Transaction (EOB) into a Ras Capture Source. You can also have Ras automatically retrieve transactions directly from your payer’s FTP sites when you use the Ras FTP module.
Don’t worry about which system created these transactions. Ras X12/5010 works with every HIT vendor and every payer.
Once Ras recognizes the data it parses it into a readable format customized to your specifications. In fact, many Ras customers have opted to convert 837 transactions into UB04 formats. This is extremely useful to patient account billing personnel and is an integral component to your electronic patient record. Ras customers can use their 835 data to populate decision support applications for long-term payer analysis. This is critical intelligence your organization needs to determine denial trends between various payers and lines of care.
Now that you have a readable format of your X12 EDI files in Ras, you can automate a number of manual processes. Automate the extraction of 835 denials into an excel spreadsheet and have Ras email the spreadsheet to your billing supervisor. Ras can even automate the printing of your 837 transaction as UB04 paper bill forms.