PiMS includes the following HIPAA electronic transactions. These transactions can streamline your business processes and improve productivity and collections.

837 Transactions - Claim Submission Benefits

Although sending claims electronically is now common, it is important to point out how electronically submitting claims has improved the process by reducing the days it takes for a payer to evaluate and pay claims.

PiMS can send both the 837 Institutional and 837 Professional transactions. The 837 Institutional claim is used to send an electronic version of the UB04. The 837 Professional claim is used to send an electronic version of the CMS 1500 form.

PiMS is integrated with Ingenix clearinghouse, ENSHealth, and immediately posts a note if there is a problem submitting a claim. In addition, PiMS will evaluate the payer responses and automatically worklist claims that were not accepted by the payer. If a payer does not acknowledge receipt, PiMS automatically worklists for follow-up.

837 Transactions - Attachments

Coming soon in the last quarter of 2007, PiMS will have the ability to scan documents and send them electronically to the payer. The industry recognizes that this is a major problem and has kept the providers and payers from realizing all the benefits from electronic claim submissions and it is prepared to move quickly for attachments.

276/277 Transactions - Claim Status Requests Benefits

With electronic status requests, you can electronically send a claim status request and get an immediate response. You will know immediately if the payer did not receive the claim, the claim is being reviewed, the claim is being paid or the claim is denied. The process is reduced from minutes to seconds! There is no telephone calls, no waiting, no recording of notes.

PiMS can send the claim request when requested or you can schedule it for x days after the claim is filed. PiMS will automatically interpret the response code and worklist the claim if there is a need for follow-up. A note is posted that indicates the status received. In addition, a history of status requests and responses can be viewed by the biller. What a great time saver!!

835 Transactions - Electronic Remittance Advice

With electronic remittance advices, the payments can be automatically posted to your practice management system. The time is reduced significantly and allows the collection process for the remaining balances to start sooner.

PiMS will batch the payments, adjustments and denials, allowing you to review the payments prior to posting. Also, the payment will be posted to the claim allowing you to report on payments and billed amounts.

HIPAA Resources

• Sponsoring Organization Web-site Address

• Final Rule, Fact Sheet http://www.hhs.gov/news/press/2002pres/20020809.html

• CMS web site for The Health Insurance Portability and Accountability Act of 1996 (HIPAA) http://www.cms.gov/hipaa/

• SAMHSA web site for The Health Insurance Portability and Accountability Act of 1996 (HIPAA) www.hipaa.samhsa.gov

• Department of Health and HumanServices / Administrative Simplification (DHHS) http://www.aspe.hhs.gov/adminsimp

• Health Care Financing Administration (HCFA) http://www.hcfa.gov/medicaid/hipaa

• Workgroups for Electronic Data Interchange (WEDI) http://www.wedi.org

• Joint Healthcare Information Technology Alliance (JHITA) http://www.jhita.org

• Electronic Healthcare Network Accreditation Commission (EHNAC) http://www.ehnac.org

• National Uniform Claims Committee (NUCC) http://www.nucc.org

• National Uniform Billing Committee (NUBC) http://www.nubc.org

• ANSI ASC X12N http://www.x12.org

• Strategic National Implementation Process http://wedi.org/com (click on SNIP')

• Privacy & Security Network http://www.privacysecuritynetwork. com

• Association of Electronic Health Care Transactions http://www.afehct.org

• Phoenix Health Systems (discussion groups & news alert) http://www.hipaadvisory.com;