If there are any doctors on this forum,
could you please explain the billing cycle
you have with the insurance companies.
From what I understand the process should
be like this:
1. Doctor provides some treatment
2. He passes his papers to some person,
let's call it "coder"
3. That person converts the treatment
details to standard codes
4. Let's say we have 837 hipaa
transaction, coder either puts these codes
on the paper form or "somehow" creates a
hipaa data file on his computer with these
codes as a part of it.
5. In case of electronic document, it is
being sent either to the clearinghouse or
to the insurance company directly
6. On the other side the file gets
validated and either sent back with the
failed acknowledgment or successful
acknowledgment is sent back.
7. Then doctor gets paid based on the
transaction he sent
my questions are:
1. In case of electronic transaction - is
doctor charged by insurance company for
each transaction or he can send as many
invalid transactions as he wants?
2. What programs are used to create hipaa
files, to manage all the forms etc.?
3. Who exactly sends the file - program
internally, or somebody has to submit the
files manually?
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Schizophreniahealth
This page was last updated on June 11, 2008
