Are you prepared to submit your claims using Electronic Formats?
Exchanging transaction data (administrative, financial, etc.) electronically can help you perform multiple tasks efficiently and in a cost effective manner.

The EDI (Electronic Data Interchange) technique is one method of standardizing data exchange with different entities. EDI does not require paperwork and frequently eliminates many of the errors associated with paper processes. More importantly, EDI reduces the administrative and financial overhead associated with the following tasks:


Checking Patient Eligibility

Instead of calling a DHMH to see if a patient has medical coverage, a provider’s office can now check the status of an individual in an instant by simply checking through the Internet . This is made possible by using the HIPAA generated 270 message inquiry that requests information about a patients’ eligibility, and the 271 message response that replies to the inquiry with a status (covered or not covered).

Requesting Authorization for Services
There are often situations in which a provider must obtain an authorization before rendering services to a patient. Rather than requesting this approval through a time-consuming mail or fax process, providers can now obtain authorizations electronically using a HIPAA transaction called the 278. 

Filling a Claim for Payment

Traditionally, paper claims- whether professional, institutional or dental - were always submitted manually. With HIPAA, providers now have the option of submitting a HCFA (used for sending claims from independent physicians), UB92 (used for sending claims from medical institutions, e.g. hospitals), or ADA (dental) claims electronically. The HIPAA transactions that make this possible are the 837P, 837I, and 837D.

Checking Claim Status

After submitting a claim to DHMH, electronically or manually, a provider can now check its status electronically, HIPAA uses the 276 for providers to make inquiries about the claim status, and a 277 to send back the response (i.e. accepted, rejected).