HIPAA advisary - is your software ready - how to find out for sure

HIPAA advisary - is your software ready - how to find out for sure

John Mason

6/2/2003

It has come to our attention that many O & P Facilites think they are ok as far as their software goes for HIPAA. Yet, some vendors that are saying they are approved are actually NOT approved on all 4 DMERC lists. Some vendors are not on any list at all. MedFlex is on all four lists and we have clients sending production claims in all 4 regions. (I wouldn't bother the list serve except one of our competitors routinely misrepresents this subject, and many people may get burned come October 16th when their electronic billing starts getting rejected)



Also, many people do not understand or have mis-information if they must submit electronically or not to get paid by Medicare. My current understanding of who must submit Medicare claims in HIPAA compliant format by October 16th are:

 

1. Any company that has submitted electronically in the past. It does no good to revert back to paper.

 

and



2. Any company with more than 9 employees (the 10 or over rule)



If you are not running compliant software currently, you may be in techical violation of the April rule which required everyone to either be running HIPAA compliant software from an approved vendor or be in individual testing by April. Obviously, a large part of this industry is in violation right now. The sooner people address this the better chance they will have that a vendor will have the time to help them when the Aug/Sep/October crunch starts. (which is when people will start realizing their exposure is real and begin totally backlogging the approved vendors)



Another scary thing which is actually bringing us a lot of sales, is that some software is HIPAA approved and the vendors are telling people they are, but they are HIPAA approved for Doctors, not the DMERC's. Some of our newer clients found this out and pressed their vendors and found out that they were not intending to become approved for HIPAA DMERC approval and called us to switch them. This type of mistake is a lurking time-bomb for the industry. So please, scan the lists below, see if your all set or not. If your vendor is not on your region's list, it's you who will stop getting paid (and your vendor later I suppose) but why go through that. Get in writing what is your vendors status.



To find out if your vendor is an approved HIPAA vendor just find your region below and check the link or directions to the link:

 

PALMETTO

 

<URL Redacted>

In case the link changes as they update here is how to navigate there:

 

1. www.palmettogba.com

2. HIPAA in the lower left corner

3. General Information on the left

4. DMERC directory of HIPAA billing Vendors (current list is as of 5/8/2003)

 

CIGNA

 

<URL Redacted>

 

In case the link changes you can navigate to that list by:

<URL Redacted> then picking ANSI 837 approved vendor list

 

 

ADMINISTAR

this one is a little different, they use frames so their is no way to give the direct link

start here:

 

1. http://www.adminastar.com/anthem/affiliates/adminastar/dmerc/index.html

 

2. then pick EDI/Electronic Commerce

 

3. then pick HIPAA--Health Insurance Portablity and Accountablity Act

 

4. then pick AdminaStar Federal ANSI 4010 Claims Production-Approved Entities for DMERC Region B

 

This will pull up a spreadsheet like table where you will find your vendor

 

 

Healthnow - the DMERC for the NorthEast

http://www.umd.nycpic.com/ANSI_listing.html

 

This listing is getting old. I have not been able to find a newer one, so if you don't see your vendor on the list, you should call them. Drop me an e-mail if you find out where a newer list is. It's possible they just keep updating this list without changing the date.