Month: May 2019

Would you be prepared for a CMS-sponsored HIPPA compliance review audit? Beginning this year, as part of the Compliance Review Program, nine randomly selected HIPAA-covered health plans and/or clearinghouses, regardless of whether they work with Medicaid or Medicare, will participate in these annual CMS audits.

Fortunately, UHIN helps our payer members meet federal standards through our multiple solutions. For example, with our hosted eligibility, payers provide UHIN with coverage and benefit information which is utilized to create a compliant response to providers seeking eligibility information on patients. UHIN also provides claims validation at various SNIP levels. If errors occur on a submitted claim or report, UHIN can reject the claim or file on the front end, and work with the provider to correctly resubmit their claims. Both examples dramatically increase interoperability and reduce administrative burden for payers, while promoting the timely submission of accurate claims files.

As a federally-recognized standards development organization, UHIN convenes the community to help draft local standards and review national standards. These ongoing community efforts further refine HIPAA transaction standards. The Standards Committee also works to educate our community on the latest information in both local and federal standards.

If you would like more information on our EDI validation editing, or would like to learn more about the Standards Committee, please do not hesitate to contact UHIN’s Customer Service at customerservice@uhin.org.

Are you checking eligibility for Medicare? Studies show $3.00 can be saved in administrative costs per patient simply by checking eligibility electronically. Utilizing eligibility transactions for all payers provides insight into everything from co-pays and out-of-pocket amounts to deductibles and limits. This information can help reduce rejected claims and decrease administrative costs, while increasing efficiency and improving cash flow.

Eligibility and coverage information is available for over 4000 payers, including Medicare, through UHIN. Your UHIN membership includes access to the eligibility tool, through MYUHIN, a one-stop source for UHIN’s offerings.

UHIN’s Eligibility and Coverage connection can be an invaluable tool in helping you save time and money. The direct connection provides 24x7x365 access to thousands of payers including Medicare eligibility information. Medicare’s information includes entitlement and termination dates, Medicare Advantage plan information, Medicare secondary payer information, home health episode information, hospice benefit periods, and preventive benefit information.  Commercial payer information includes information on amounts met towards deductible and out of pocket maximums.

To learn more about electronic Eligibility, please contact UHIN Customer Service at customerservice@uhin.org.