This information is important because of the money associated with the successful execution of these transactions and the value of the time associated between recognizing that a failure has occurred and taking the proper action to continue the process from the failed point forward. My company also provides this service for healthcare providers and we have accumulated data on the behavior of these contractor systems in order to improve the efficiency of our own processes and to determine when an undocumented failure has occurred that affects our customers. Even now, problems occur on a regular basis that involve both vendor and CMS contractor systems that will have a direct impact on how long it takes for you to receive your revenue. These transfer procedures have changed somewhat with the introduction of the HIPAA 5010 transaction sets and it has taken many months for some of the Medicare contractors to work the kinks out of this process on their new systems. Examples include services offered by Ivans or ABILITY Network that specialize in this activity. Sometimes this is performed through their claims processing product and sometimes a separate service is used that involves a secure Internet connection or leased lines to conduct the file transfers. Many healthcare providers have automated the transfer of CMS claim data and related files between their claims processing systems and CMS.

In large measure, the tips in this comprehensive primer also apply to other health insurers.

Kalon Mitchell, president of transactions processing vendor MedTranDirect Inc., walks through the processes of getting paid by Medicare, and how to speed them up.

Cms 835 file format