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Getting Started

 

 

What is EDI?

EDI is the computer-to-computer transmission of business data in a standard format, which replaces a traditional paper business document.

Who can use ASK services?

ASK can accept claims directly for these payers at no cost.

TRANSACTIONS BENEFITS

Claims

  • 837P – Professional
  • 837I  - Institutional
  • 837D – Dental

Primary and Secondary

  • Eliminate paper forms
  • Increase your office’s efficiency
  • EDI Edits eliminate claim errors
  • Acknowledgments assure your claims were received
  • Get claims paid faster

Eligibility Inquiry/Benefit

  • 270 – Request

May be done as a Batch or Real Time transaction

  • Electronically verify patient eligibility and benefits
  • Designed to automatically generate and update your management system

Claims Status

  • 276 – Request

May be done as a Batch or Real Time transaction

  • Automatically generate request to check status of claim
  • Check aging status in one transaction

Payment Advice (Remittance Advice)

  • 835
  • Designed for automatic posting to management system
  • Store remittance advice electronically
  • End paper remits

What are the benefits of a Real Time transaction?

  • In real time mode the sender remains connected while the receiver processes the transaction.  The receiver immediately returns a response transaction to the sender.

What are your next steps?

  • Contact your software vendor regarding the support of these transactions.
  • Complete an enrollment form
    • An 835 (electronic remittance) enrollment must be completed for this transaction. 
    • Current trading partners may request additional transactions by completing the Change Form.

Note:  EDI Midwest Clearinghouse offers electronic claims filing to more than 900 additional payers.

  • EDI 101
    • Acknowledgments Manual
    • Code lists (offsite link)
    • EDI Transactions by Payer
    • HIPAA

      What is HIPAA?

      The Health Insurance Portability and Accountability Act of 1996. The Administrative Simplification provisions of HIPAA are intended to reduce the costs and administrative burdens of health care by making possible the standardized, electronic transmission of many transactions that are carried out manually on paper or have several different formats for each.

      There are several transactions that have been standardized as a result of HIPAA. Trading Partners are encouraged to contact their vendors about the possible use of these transactions.

      Note: Effective Monday, October 24, 2016 all Trading Partner Agreements and accompanying Business Associate Riders, entered into between Administrative Services of Kansas, Inc. and a trading partner between the dates of July 1, 2002 and June 30, 2004 are no longer in effect.

    • Implementation Guides (offsite link)
    • Life of a Claim

      Providers submitting claims to a clearinghouse may or may not be sent to the payer the same day. Clearinghouses may impose separate editing prior to submitting your claims to the payer. In this diagram the Trading Partner represents the entity responsible for submitting your claims.

      1. Claim Sent by Trading Partner
      2. Claims received by EDI System and stored in mailbox directory
      3. Transaction identified 837I, 837P, 837D
      4. Claim level editing performed
      5. Acknowledgment sent to TP mailbox
        • Rejected claims will need to be corrected and resubmitted
      6. Accepted claims sent to payer

      Once a file has been submitted by a Trading Partner the Life of a Claim process can not be interrupted.

    • National Provider Identifier (NPI)

      The administration simplification provisions of HIPAA require the Secretary of Health and Human Services (HHS) to adopt a national standard identifier for covered health care providers. The National Provider Identifier (NPI) will be the standard identifier and CMS is developing the National Plan and Provider Enumeration System (NPPES) to identify providers and assign NPIs.

      The NPI is ten-digit number and is used to submit claim transactions to all government and non-government payers. NPI replaced existing provider numbers assigned by these entities and CMS will discontinue the UPIN enumeration process.

      Providers who are required to obtain an NPI include:

      • physicians
      • non-physician healthcare practitioners
      • other suppliers and certified providers such as institutions
      • home health agencies
      • skilled nursing facilities

      Each individual practitioner will receive one NPI. However, an organization provider may obtain an NPI for each of its subparts.

      A subpart can be considered:

      • a separate physical location of an organization health care provider
      • member of a chain
      • an organization health care provider separately licensed or certified

      For additional informational and to complete an application, visit https://nppes.cms.hhs.gov on the Web.

    • Products and Services

      ASK provides products and services for customers in Kansas, Northwestern Missouri, Western New York, and Northeastern New York.

      These products are designed to help Trading Partners increase the number of transactions they send electronically.

      • EDI Midwest– Learn how to send claims to over 900 additional payers.
      • ABILITY | PC-ACE® – Learn more about free claims filing software available from ASK.
  • Guidelines for Choosing a Vendor

    Provider Guidelines for Choosing a Vendor

    Before selecting a vendor, you must examine your business needs to identify the services needed from a vendor. Consider what services you want to provide from internal operations and what services you wish provided by a vendor.

    To receive better vendor proposals, create a written description of components of your practice that need vendor support and a description of a support needed. Requirements to consider include the following:

    • Future growth of the practice Workload
    • Payer analysis Referral tracking Fee schedules
    • Appointment scheduling Medical records
    • Interconnections with physicians/hospitals and other networks Word processing needs
    • Electronic billing (formats and versions supported) HIPAA compliance
    • Multiple practices/locations High volume/low volume billing Specific bill types
    • Management reporting
    • Hardware/software requirements/compatibility with existing equipment Data storage needs

    Vendor Selection

    Once you have determined your goals and requirements, begin the vendor selection process. Selecting a vendor must be as objective and quantitative as possible. Areas to be evaluated should include technical functionality, flexibility, and customer service.

    These steps may be used as guidelines for providers to start the vendor selection process:

    1. Develop a list of potential vendors:
      • Ask other providers of comparable size/specialties: what vendors they use for what services how satisfied they are
      • Ask a consultant
      • Attend standards conferences
      • Follow trade magazines
      • Investigate web pages
    2. Call or write the vendors selected/recommended to discuss the organization’s needs and request a proposal.
    3. Tell the vendors how the proposals should be structured so that the various proposals can be more easily compared.
    4. Attend demonstrations of at least 2-3 vendors and pay close attention to:
      • How individual requirements will be met?
      • Ease of understanding
      • Ease of features – data entry, search features, editing/compliance-checking features, help features, error correction features.
      • Security disaster recovery plans, controls and audits
      • Daily procedures
      • Reporting/Tracking features
    5. Check vendor references and ask specific questions such as:
      • How long has the business been in operation?
      • How long has the system been in place?
      • What is the quality of the training and ongoing support?
      • Is there a user’s group in place?
      • What formats are used/supported?
      • Have you experienced any problems with the system?
      • Have you experienced any problems with the vendor?
      • How long it takes to get up and running?
      • Are you happy with the system/vendor and would you recommend it/them today?
      • Is there anything else I should know or ask before making my decision?
    6. Make site visits to the vendor as well as other clients of similar size and bill mix that has been running the system for some time.

    Evaluating Proposals

    Vendor proposals should be evaluated on several levels including company reputation/history, system functionality, flexibility, overall costs, and support provided.

    Providers should create a checklist that compares the vendor proposals against their original requirements by assigning a relative weight to each requirement and then rating the vendor’s ability to meet each requirement based on their written proposals. Although some aspects of each checklist will be highly individual, the following are some of the elements that should be considered:

    Overall Cost:

    1. Software cost
    2. Hardware cost (types as well as quality)
    3. Licensing fees
    4. Training cost
    5. Installation costs
    6. Upgrade charge
    7. Cabling
    8. Phone Lines (leased line/toll charges)
    9. Remodeling/furniture
    10. Forms
    11. Conversion costs
    12. Electricity costs
    13. Supply costs (diskettes, CD’s, tapes, paper, and printer ink)
    14. Annual hardware maintenance
    15. Annual software maintenance
    16. Cost of custom program changes
    17. Cost of continuous software support
    18. Evaluate hardware differences
    19. Evaluate quality of training and support
    20. Evaluate system documentation
    21. Consider the staff size of the vendor
    22. Determine flexibility (whether the package is proprietary, whether the software can be easily modified, whether the vendor can accommodate changing payer requirements, and if so, at what cost)
    23. Determine overall system convenience including hours of customer service, technical support and connection times
    24. Assess future risks and the vendor mitigation of such risks through system trial periods and source codes placed in escrow

    Negotiating with vendors

    Once a vendor has been selected, the provider must negotiate the final costs, services, and implementation dates to be provided by the vendor. All agreements reached between the two parties should be obtained in writing.

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