HIPAA Codes and Improved Workflow

Every provider seeks to improve workflows and enhance efficiencies, yet many hospitals and physician practices don’t utilize one of the key ways to accomplish that: HIPAA transaction codes for electronic data interchange (EDI).

In our rapid paced revenue cycle environment, immediate information regarding the status of an account or claim leads to the ability to resolve issues in a more efficient and effective manner. That’s exactly what the HIPAA codes provide healthcare organizations, and there are two sets, in particular, on which you really should be focused.

The HIPAA EDI code 276 transaction set to request claim status updates is one of them. This is important, as these electronic requests regarding submitted claims initiate automatic responses delivering the pertinent information you’re looking for with regard to claims status. Not only can this significantly reduce the administrative costs associated with manual procedures to obtain that information, it also enables providers to trigger timely and targeted back office follow-up activities.

HIPAA EDI 835 provides the ability for insurers to electronically make payments, send explanation of benefits (EOB), remittance advice and denials data. Code 835 is designed to provide healthcare provider organizations with quicker communication, delivering remittance advice and denials information almost immediately. Most importantly, this code delivers you the ability to conduct timely denials analyses and make corrections rapidly. As we’ve mentioned many times, denials mean revenue slowdown—even when resolved quickly, so being armed with this information and capability is important.

Yet, as we mentioned above, many US providers find they don’t have the time or resources to fully take advantage of these HIPAA codes and incorporate them into an insurance follow-up strategy for improved back office efficiency and effectiveness. It’s understandable, perhaps, but it would also be unwise to continue this way for very long.

MediRevv can help you make sense of the codes and show you how to incorporate them effectively into your insurance follow-up strategy. If you’d like to learn more, get in touch with us. 


About Cynthia Sherman

Cynthia Sherman

Cynthia leads all aspects of Coding Services at MediRevv, including the day to day management of coding operations and client account management. As Director of Coding she has grown division from a staff of one to forty. She is certified CCS-P (2002) through AHIMA.

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