Author Topic: General question on Electronic Claim forms  (Read 1135 times)

paxfaux

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General question on Electronic Claim forms
« on: September 03, 2010, 10:18:25 AM »
I work almost exclusively with New York State Medicaid claims.

NYS Medicaid providers are instructed to bill electronically using the 837I, 837P, 837D or NCPDP 5.1 claim forms. 
http://www.emedny.org/hipaa/emedny_transactions/transactions.html

I was under the impression that these were the only HIPAA acceptable claim forms to bill any insurance carrier electronically.  Is that not true?

I am mostly concerned with outpatient clinic billing.  I came to this site hoping to find advice about filling out the 837I claim form.  After reading some on Solutions-Medical-Billing.com, it seems that people are using something called the UB04 to bill institutional claims.  I thought maybe that was just a paper claim form, but it seems like it may be an electronic claim form?

Here are my questions

1) Are the 837I, 837P, 837D and NCPDP 5.1 the only HIPAA acceptable electronic claim forms to bill healthcare claims on?

2) If there are other HIPAA acceptable electronic claim forms, can different insurance carriers require providers to bill electronically using different forms?

4) Is the UB04 a paper or electronic claim form?

3) The 50/10 version of the 837I will only allow you to identify the referring provider once at the header level.  Is it ok to include ordered services from different physicians on the same claim form when I can only identify one of the ordering physicians?


Michele

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Re: General question on Electronic Claim forms
« Reply #1 on: September 04, 2010, 11:57:33 AM »
The UB04 form is a paper form, but it can also be billed in electronic format.  I believe it is the 837I format as well.  We have billed NYS Medicaid electronically in the UB04 format for an outpatient drug and alcohol facility.  I'm not sure if the 837I, 837P, 837D and NCPDP 5.1 are the only HIPAA acceptable electronic claim forms to bill healthcare claims in.  The rest of your questions seem to be electronic specific that I would think you would need to check with your vendor.  

Michele
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paxfaux

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Re: General question on Electronic Claim forms
« Reply #2 on: September 13, 2010, 09:36:15 AM »
In your billings for the outpatient drug and alcholol facility, did you ever have an instance when you needed to bill services for the same recipient, performed on the same day that were ordered by different physicians?

Michele

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Re: General question on Electronic Claim forms
« Reply #3 on: September 13, 2010, 09:54:02 AM »
What are the services?
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