Medicare EDI

(Electronic Data Interchange)

Volume of Medicare Electronic Claims Received in HIPAA Format September 20 - September 24, 2004 97.88% HIPAA Formatted Claims

HIPAA

The Administrative Simplification provisions of the Health Insurance Portability and Accountability Act (HIPAA) of 1996 require the Secretary of Health and Human Services (HHS) to adopt standards for electronic, health care transactions. For a list of web sites that contain information on administrative simplification provisions of HIPAA use this link.

After 10/16/2003, providers who are not small providers (institutional organizations with fewer than 25 full-time employees or physicians with fewer than 10 full-time employees) must send all claims electronically in the HIPAA format.

Contact your Medicare contractor to begin testing the HIPAA transactions format.

If you use a vendor to send or receive electronic transactions for you, contact them to make sure that they are scheduled to test with Medicare.

We provide free/low cost HIPAA claims billing software. call the number listed for your state for Medicare Part A (including outpatient hospital services)and Medicare Part B.

We also have a list of HIPAA vendors (billing services, clearinghouses, software vendors) who have tested successfully with Medicare on the HIPAA transactions.

Would you like to be notified of major updates or changes to this web site, such as the issuance of new or revised instructions? If so, go to EDI List.