BC Advantage - 2018 Issue 8

Getting the Right Eligibility Information for Payment Your Rights and Health Plans Requirement

We need timely and accurate patient information to bill health plans and receive appropriate payment. Clinical information is, of course, important. But we also need the "administrative" data - patient demographics and especially the insurance information.   Physician offices create their clinical information, but usually rely on patients for information on their health plan and identification numbers. Just as we have standardized electronic claims transactions and remittance advice transactions under HIPAA, there are standardized electronic eligibility inquiry and response transactions which can (and should) be used by physician offices to communicate with health plans. HIPAA regulation require...

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