Chapter8-Electronic-Data-Interchage-Transactionsppt：第八transactionsppt电子数据交换.pptVIP

Chapter 8 Electronic Data Interchange: Transactions and Security Learning Objectives Summarize HIPAA requirements for electronic claims. Identify the transactions and code sets to use for insurance claims transmission. Create a successful insurance claim for submission and reimbursement. List HIPAA compliance guidelines for electronic protected health information. Describe necessary components when adopting a practice management system. Explain the difference between carrier-direct and clearinghouse electronically transmitted claims. Learning Objectives (cont’d.) State measures used to secure privacy of electronic mail, Internet, and instant messaging. Describe the use of patient encounter forms, crib sheets, and scannable encounter forms in electronic claims submission. List computer transmission problems that can occur. Name some types of interactive computer transactions. Chapter 8 Lesson 8.1 Electronic Data Interchange (EDI) Used for transmission of health insurance claims Transmitted data is encrypted Improves efficiency of claims submissions Advantages of Electronic Claim Submission No signatures or stamps No searching for an insurance carrier’s address No postage costs or trips to post office No need to store or file claim forms Electronic claims leave an audit trail Improved cash flow Quicker processing time and payment Reduced overhead and labor costs Clearinghouses Claims are checked electronically Claims with missing/incorrect information are rejected Rejected claims are sent back to the provider with a report Batches of acceptable claims are sent to the appropriate payer Corrected claims are reprocessed Advantages of a Clearinghouse Translation of various formats to the HIPAA-compliant standard format Reduction in time of claims preparation Cost-effective method through loss prevention Fewer claims rejections Fewer delays in processing and quicker response time More accurate coding with claims edits Consistent reimbursement HIPAA Transaction and Cod