We are pleased to announce that ADL the approval of most major fiscal
intermediaries for Medicare Parts A and Part B, CMS 837 4010/A1 and CMS 835,
and Medicaid State approvals. Additionally, Claredi has certified our HIPAA Claims
Transmissions.
ADL software supports the National Standard Transaction and Code
sets available for nursing homes to submit claims. As the Intermediaries
implement additional data sets, ADL adds that data to the Transactions.
ADL clients have been using the Standard Transactions as mandated by
the Intermediaries for billing. Non-standard coding sets are not being used.
Transaction / Code Sets
Currently Intermediaries only accept Transaction / Code Sets for Medicare-A,
Medicare-B and Physician Billing. While other Transaction / Code Sets have
been developed, the services from the Intermediaries are not in place.
The current transaction code tables are based upon the May
2000 ANSI ASC X12N HIPAA Implementation Guides. The guides are available
on the Washington Publishing Company
web site.
The following transactions are defined.
| Number | Description | Status |
|---|
| 270 | Eligibility Request | Yes |
| 271 | Eligibility Response | Yes |
| 276 | Claim Status Request | Yes |
| 277 | Claim Status Response | Yes |
| 278 | Claim Review Request | Pending |
| 278 | Claim Review Response | Pending |
| 820 | Premium Payment | Not applicable |
| 834 | Enrollment | Not applicable |
| 835 | Claim Payment | Yes |
| 837 | Professional Claim | Yes |
| 837 | Dental Claim | Pending |
| 837 | Institutional Claim | Yes |
Privacy
ADL software provides for extensive security and protecting the privacy
of patient information:
- Unauthorized users are prevented from logging in.
- Security administrator can limit user read, write, edit, and browse
access to applications. Security can be defined via the employee
job position code.
Security
Operating Systems provide extensive security features and can restrict
unauthorized users from logging into and accessing the system. These
security features are described in documentation provided by
the equipment manufacturers. Each manufacturer offers specific training
courses on how to implement the security features of the Operating
System. Basic functions addressed by the operating system are user passwords
and read/write access to certain files. ADL provides documentation
on how to establish security for our applications.
Identifiers
HIPAA regulations require the use of special identification numbers.
ADL software supports both the EIN and the UPIN numbering methods.
National Provider Identifier (NPI)
The NPI is intended to be a universal identifier, which can be used
to enumerate all types of health care providers, and the supporting
data structure incorporates a comprehensive list of provider types
developed by an ANSI Accredited Standards Committee X12N workgroup.
It is an intelligence-free 8-position alpha- numeric identifier, with
the eighth position being a check digit, allowing for approximately
20 billion possible identifiers.
Employer Identification Number (EIN)
EIN number identifies the employer in health transactions. We selected
the EIN as the national employer identifier standard for use in those
electronic health transactions that require an employer identifier.
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