HIPAA Compliant Electronic Billing

HIPAA Compliant Electronic Billing

PMA is able to create ANSI 837 Professional Claims for sending direct to the payer or through a clearinghouse.

To do electronic billing in the HIPAA format (ANSI 837), you select EMC - HIPAA on the Print Reports screen, then select the receiver, such as California NHIC Medicare, select the patients to process and then click on Print or Print Review. The PMA program then creates an electronic billing data file in the ANSI 837 format, also known as the ASC X12N 837 or HIPAA format. This format calls for the following elements to be included in the data file:

        Submitter - person or company sending the data file
        Receiver - company receiving the data file or part of it (a transaction)
        Payer - the organization that is to pay the claim
        Billing Provider - person or company doing the billing
        Pay-To Provider - person or company who is to receive the payment
        Performing Provider - person who performs the service to the patient

PMA does all this automatically for you and builds the electronic billing data file which, if PMA says that it is error free, you then send to the organization receiving your claims. This process is easier and quicker than printing and mailing HCFA-1500 paper claims and you receive the insurance payment much quicker.

PMA is an approved vendor for the following:

Arkansas Medicare
California Blue Cross
California Blue Shield
California Medicare NHIC (Northern California)
CareVu (clearing house)
Gateway EDI (clearing house)
Indiana Medicare*
Kentucky Medicaid
Louisiana Medicaid
Louisiana Medicare
Maine Blue Cross
Maine Medicare NHIC
McKesson*
Michigan Blue Cross*
Minnesota Blue Cross
Minnesota WPS Medicare*
Missouri Medicare
Oklahoma Blue Cross*
Oklahoma DHS Medicaid
Oklahoma Medicare
Oregon Medicare Noridian 
New Hampshire Medicare NHIC
Pennsylvania Highmark BS 54771    
Pennsylvania Keystone Central 95199
Pennsylvania Keystone East 95056     
Rhode Island Blue Cross*
Rhode Island Medicare*
Tennessee Blue Cross*
Tennessee Medicare CIGNA (ID/NC) 
Texas THIN                 
Virgin Islands Medicare
Washington Medicare Noridian  
Washington Premera Blue Cross                
Washington Regence Blue Cross
Wisconsin WPS Medicare
* indicates in testing

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This page was last updated on 07/11/2006