Are Your Claims Being Rejected?

The Texas Medical Association and the American Medical Association report that many medical practices are seeing more of their claims rejected in recent weeks. The conversion to the Health Insurance Portability and Accountability Act (HIPAA) Version 5010 transaction standards on Jan. 1 could be the culprit.

Log on to the Complaints and Disputes page of the AMA's Practice Management Center to register a complaint if your practice has more claims rejections than usual. AMA will take it up with the insurers. Call AMA at (800) 262-3211 if you need more help.

You may also contact the TMA Knowledge Center if you have these issues. Include the name of your practice management software vendor, your clearinghouse, the health plans that are rejecting your claims, and a copy of a claims acceptance report to verify that your claims actually made it from the clearinghouse to the health plan. TMA's Payment Advocacy Department can help if the health plan is causing the delay. Please note that for HIPAA privacy compliance, you must file a one-time business associate agreement with TMA before submitting any protected health information. (Click here to access the business associate agreement.)

Also, please share any email notices you received from your vendors regarding problems they are having with Version 5010 implementation. Vendors are not providing much information, so TMA does not know the extent of the problem and what is being done to address it.

TMA can help you with the conversion to Version 5010. Log on to the TMA HIPAA 5010 Resource Center on the TMA website.

Action, Feb. 1, 2012