Claims, benefits the focus for data interchange rules
HCFA will stagger implementation
The Health Care Financing Administration (HCFA) has issued the first of a series of program memoranda instructing its Medicare intermediaries about implementing the electronic data interchange standards recently issued by the Department of Health and Human Services (Transmittal A-00-89). The memo says HCFA will "stagger implementation of these transactions beginning with the claim, coordination of benefits (COB), and remittance advice."
This decision was based on the fact that "these transactions are closely interrelated, since the outbound COB and remittance advice data content relies on the incoming claim, and they are grouped together to facilitate provider and trading partner testing," the memo notes.
Medicare intermediaries are to start analyzing such transactions by April, with final implementation by July.
The new electronic data interchange standards, mandated by the Health Insurance Portability and Accountability Act of 1996, took effect Oct. 16; and must be implemented by October 2002. They require health care providers, plans, and clearinghouses use standard formats for eight data exchange transactions, and a standard set of medical codes when transmitting health care data electronically.
Medicare intermediaries are required to implement five of the standard transaction formats: health care claim and equivalent encounter, remittance advice, COB, eligibility query and response, and claim status query and response.
HCFA plans to send Medicare intermediaries quarterly memos instructing them how to implement the rest of these transactions. These upcoming memos will also include details on replacing the HCPCS (HCFA Common Procedure Coding System) "J" codes with the National Drug Codes and for eliminating the HCPCS local codes.
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