Mandatory electronic submission of claims – Some insurance companies require the electronic submission of claims

They’ve always talked about it, but it looks like it’s finally here. Insurance companies are beginning to mandate the electronic filing of insurance claims. We received the first notification that health insurance claims must be submitted electronically in 2007.

Many insurance companies have been trying for years to encourage providers to submit insurance claims electronically. They have provided benefits such as faster payments, fewer authorization requirements, and other benefits to the providers. They also had provider representatives tour the provider’s offices to see why they are not submitting claims electronically and to suggest methods to enable their office to submit their claims electronically.

Now we actually see companies saying they no longer accept claims on paper CMS 1500 or HCFA 1500 forms. Fidelis Care of New York is one of the plans that say they will stop accepting paper claims in 2007. They say they have more than 80% electronic claims and will no longer accept paper claims in 2007. a participating provider of Fidelis Care and you try to submit your claims on paper, you will receive them back by letter. They advise you to contact your provider representative and they will help you find a method to submit your claims electronically.

Fidelis Care is one of the first insurance companies I’ve seen that actually returns paper claims. Excellus BCBS keeps track of how many claims each provider submits on paper and if the number exceeds a certain amount per month they send a representative from the provider to talk to the provider about why they are not submitting the claims electronically, but they don’t give the claims back – not yet. New York Medicare states that all providers are supposed to file claims electronically, but they allow enough exclusions for an office to get around it.

I think many companies will follow the example of Fidelis Care from New York. It is a huge money saver for the insurance company to receive claims electronically. More and more companies will return claims to providers if they are submitted the old fashioned way, on red and white paper forms!

Copyrite 2007 – Michele Redmond

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