HCFA form medical Billing

[xoomaster]

Hi everyone,

I have been trying to figure out how to do HCFA electronic transmission, and find out what the format might be?

Any ideas ? Any help is appriciated.

Xoomaster

[Lee Smith]

This topic does not belong in the General Topic, and once I understand what it is you are trying to accompilsh, I will be moving it to its the proper topic.

What is HCFA?

What are the requirements for HCFA.

Lee

[LaRetta]

Lee, this is encompassed with HIPAA regulations. It is document and data-transfer requirements (and coding) for billing Medicaid and Medicare. I believe we have a section on it.

Ah yes, it's under Security - makes sense. Electronic transfer of this kind of data is highly regulated now. Regulations put into effect in 2004, I believe.

Edited October 7, 2006 by Guest

[Lee Smith]

I thought so, I almost moved it there without asking, but then thought I had better verify to be sure.

[Steven H. Blackwell]

See this:

http://www.filemaker.com/downloads/pdf/filemaker_and_hipaa.pdf

Steven

[JerrySalem]

To answer your question directly.

When you submit a HCFA1500 form electronically, the format is called 837. You can get more information from

http://www.wpc-edi.com/

This is supposed to be a national standard. However there are still specific rules for specific states, you should also do a web search for 837, healthcare and your specific state.

Good luck!

Jerry

[xoomaster]

Sorry guys, I did't know where to place the posting either.

HCFA or CMS-1500 form and the new transmission format known as X-12 837 format are all new to me and I have been searching to see if anyone in the FM community has done or is willing to work on projects in this regard.

In summery, it has to do with data transmission, and in this case Billing data for medical encounters.

Xoomaster

Edited October 9, 2006 by Guest

[LaRetta]

There are many intermediary companies which provide the data conduit, EDI, MediSoft and others. Their purpose is to take your data (in various forms) and move it on under strict code compliance. If you search 'medical billing' on web, you should get many hits. You can also ask any non-profit agencies; most states using these clearing houses for electronic transfer. But you do NOT need to use them ... you can usually directly yourself (unless the rules have changed within the last 3 years).

BTW, I haven't forgotten your request ... I'm just on time-critical deadlines at the moment. I'll provide more information (directly via email) mid-week. But you will want to export the data to their specs (field-mapping). Until you know how they need the data, you can't really design it. I have HCFA-1500 for printing and manual mailing (for private insurance) and electronic export of calculation (tab-delimited) for electronic. With new HIPAA regs, there may be more involved now ... I would research this portion thoroughly to be sure you are compliant. But electronic transmittal is piece of cake. The hardest part will be writing the calculation which pads numbers and justifies as needed (if that method is used).

[sandra qu]

But you do NOT need to use them ... you can usually directly yourself (unless the rules have changed within the last 3 years).

Can you elaborate on this? Is this done through FM or a third party software?

I did the search for 'medical billing', and also for 'direct medical billing', but only came upon Windows software that helps with direct medical billing (like EZClaim). I'd like a Mac solution for direct billing, and if FM can do it, all the better.

--san

[kiteknight]

Ms. LaRetta says "I have HCFA-1500 for printing and manual mailing (for private insurance) and electronic export of calculation (tab-delimited) for electronic." I'm sure I'm not alone on this... many physicians that are trying to combine HCFA-1500 with a FMP solution. Can anyone help with information on this topic?

[LaRetta]

I've missed these posts.

Most private insurance companies require hard-copy of HCFA-1500. Most government (Medicaid, TitleXIX etc) use a billing clearing house (an independent company hired to handle the incoming data and make sure it is consistent and correct before forwarding on to Medicaid). You will have to ask your Provider who they use but don't be surprised if they don't tell you but instead simply provide you with the requirements for direct billing. There are also services such as MediSoft. But even back in 1995, I was directly billing to TitleXIX (Medicaid) with no intermediate company. And as late as 2003, I was billing through their clearing houses. HIPAA regs might restrict some of that now and I do NOT know the changes in those regulations.

For manual billing and mailing, you copy the HCFA-1500 from online, paste it onto your form layout, place your fields on top of it and print to test the alignment and, when right, duplicate the layout and (on the new layout), delete the HCFA-1500 so only the fields remain. Then print directly onto HCFA form (AFAIK, most insurance companies accept copies as well). Signatures can be captured (stored in the Employee table in container) and field placed onto the HCFA and, for the Providing Physician, //signature on file is sufficient.

Creating an export file (for electronic upload) usually means creating a text calculation which turns each billing charge into flat-file padded structure. But you must contact THEM to find out their special requirements; each provider and each clearing house will use different formats. But yes, it can be done in FileMaker quite successfully and it decreases payment turnaround by 2-3 weeks.

LaRetta

[BruceJ]

I created one for billing psych outpatient services that spits out paper claims. Even then, each company has odd requirements about where to put authorization numbers and such. It's a real pain.

I found that electronic billing has to submitted in the format that the clearning house requires. Usually it will take a bunch of calls to get to the right person who you can speak the same language to understand how they want the info sent. I had to wrap my mind arond their old terminology to and re-think it in FileMaker terms.

Now.. one of the main points of HIPPA stuff was to standardize all these inconsistencies on how info is submitted... some would say so taht big brother can better keep track of our medical records so be sure to wear your tin foil hat when designing this thing. I'm also a practicioner and prefer to submit on the old paper 1500's but these will soon be obsolete and the new world order takes over... oh hey... I gotta go there's another balck helicopter hovering outsode my window.

[xoomaster]

You know I was able to create a billing module including new HCFA print and E-submission and billing reports. Let me tell you it has been one of the biggest challanges I have faced and after 6 months of work, I am finally done

There is alot that needs to be monitored when it comes to setting up a billing module. HCFA print out as mentioned above can be customized based on the requirements for each insurance company. It is alot of work though.

My next step is X-12 837 format transmission !

Have you guys have or know of examples of how to set up the X-12 837 format and how to set it up ?

Xoomaster

[kiteknight]

Xoomaster,

I'm working on a similar project. You might check with the site: http://www.wpc-edi.com/content/view/577/1

for the purchase of the specs. I haven't been able to find anything for free online or at the lending library.

[xoomaster]

One problem I have is that I don't really know how well and useful the information is in the files that they are selling, and also if it is going to help me come up with a script for generating X 12 format or if it is more generic and not aimed for developers ?

[kiteknight]

I have the same misgivings about spending $200 for a publication which I don't know will be helpful. I checked with lending libraries in hopes of finding or information something useful but have been unsuccessful.

I have set up an account with a Availity and have been doing some test uploads to their site but I am no where close to a clean claim.

[wave edi]

Hello, this is in response to all of you who have posted about needing help with ANSI 837 Professional format. My name is Aida, and I work with a new software company named Wave-EDI. We convert HCFA 1500 Print Image files to the ANSI 837 Professional format.

Is it possible for Filemaker to ouput in the Print Image format? If it is, Wave-EDI has a ready to implement solution to convert your files.

We already have the technology to convert using the Print Image format, which is just a text file instead of the claim being printed out, it goes to a text file instead.

Also, we have available a 60 day trial program that is fully featured. There is no obligation to purchase and we assist you with setup and free support. Please send us an email if you would like to try it.

If you are interested, please visit our website at http://www.wave-edi.com or email

[email protected]

Thanks,

Aida

Wave-EDI.com

[email protected]

Edited November 8, 2009 by Guest

[normanicus]

Looks like you have a paid for solution here:

http://www.lifesuccess.org/claims.html

This would give the tools to create such a form but would require knowledge and work:

http://quexf.sourceforge.net/

[JerrySalem]

The lifesuccess solutions only makes the hard copy printout. With some work, you can simply duplicate the printout using filemaker objects. or scan a real 1500 and put the image on the layout to printout.

The queXF might be usefull if you are scanning 1500's

The 837 book used to be free. Too bad they charge so much for it. But in the grand scheme of things, it is money well spend. Since there is no chance of getting your solution to work without it.

[Bozkid]

The lifesuccess solutions only makes the hard copy printout.

Actually, that's NOT true. The Life $uccess Institute solution (Mission Health Claims) does make a hard copy printout, one that is built from scratch (it is not a pasted graphic). However, it also prints directly to "red" OCR forms as well as exporting in fixed format for submission to electronic billing providers. At $49 it's a steal. It's a complete solution. And, not only that, it's totally unlocked!

[Oswald Sander]

I'd also like to know the answer. I'm a medical biller myself.