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Contingency Plan
Medicare and USAble Administrators End HIPAA Contingency Plan for
Electronic Claims
On August 4, 2005, CMS announced in Medlearn Matters (MM3956) that Medicare
would be ending its HIPAA Transactions and Code Sets (T&CS) contingency
plan for claims on October 1, 2005. USAble Administrators will follow the lead
of Medicare and end its HIPAA contingency plan on that date as well.
The HIPAA Law, written in 1996, contains Administrative Simplification
provisions that require HHS to establish standards for the nation's health care
industry to improve its efficiency and effectiveness by using electronic data
interchange (EDI). The original deadline for adopting all standards relating to
HIPAA EDI was October 16, 2002. As that date approached it became clear that
many in the industry would not be able to make that deadline. Congress passed
another law that allowed HIPAA-covered entities to apply for a one year
extension to become compliant with HIPAA Transactions and Code Sets
requirements. USAble Administrators had met all HIPAA requirements by the
original deadline. However, we chose to apply for the extension to allow us to
continue working with our trading partners while they completed their
compliance projects.
A year later, as the industry approached the extended deadline of October 16,
2003, there were still some covered entities that had not been able to achieve
HIPAA compliance. CMS, as the enforcer of the HIPAA Transactions and Code Sets
requirements, did not want to disrupt the flow of health-care information and
the payment for that health care, established a contingency plan that allowed
providers to continue submitting NSF-format electronic claims to Medicare, if
they were making good faith efforts to become compliant. We also wanted to keep
the electronic transactions flowing so we too implemented a HIPAA contingency
plan allowing providers to continue submitting NSF claims until they had
sufficient time to become compliant.
As of September 1, 2005, USAble Administrators had over 99.9% of our providers
submitting HIPAA-compliant transactions. If you are among this very large
majority, with the ending of the contingency plan you will see no change in
your claims filing procedures or payments. However, if you are one of the less
than 10 providers that still submits NSF-formatted electronic claims directly
to us, please be advised that as of October 1, 2005, those claims will be
rejected.
You do still have options to come into HIPAA compliance. You may still update
your systems to produce HIPAA-compliant claims. Or, you may enlist the services
of a health-care clearinghouse to convert your NSF claims to the HIPAA-required
ANSI formats. We offer Advanced Health Information Network (AHIN) as a free
clearinghouse service for claims being filed with Arkansas Blue Cross and Blue
Shield, Health Advantage, BlueAdvantage Administrators, USAble Administrators,
Medicaid, Arkansas Medicare Parts A and B and claims being routed to any other
Blue plan. There is a 10 cent per claim fee for any other commercial carrier's
claims being handled by AHIN. If you are interested in more information on
selecting AHIN as your clearinghouse, or if you are ready to complete testing
of HIPAA-compliant claims, please contact our EDI Services Division at (501)
378-2419 or toll-free at (866) 582-3247.
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