RESUMO

Adapting to the American National Standards Institute (ANSI) 835 Health Care Claims Payment/Advice format--the first nationwide, all-payer electronic standard for healthcare claims--requires an approach tailored to the individual provider's system. Providers have four options for receiving ANSI 835 claims payments. They include: direct transmission from payers, value added network services (VANs), banks with electronic data interchange capabilities, and paper reports. Providers' claims processing systems vary enormously in the formats they use and in their capacities to transmit and receive claims payments electronically. Author Romo reviews factors that providers need to consider when refining internal capabilities and selecting external processors to accept the 835 format.

Assuntos

Redes de Comunicação de Computadores/normas , Administração Financeira de Hospitais/legislação & jurisprudência , Formulário de Reclamação de Seguro/normas , Medicare Part A/legislação & jurisprudência , Contas a Pagar e a Receber , Centers for Medicare and Medicaid Services, U.S. , Administração Financeira de Hospitais/métodos , Medicare Part A/normas , Estados Unidos