This memo is to bring you up to date on the delivery of new electronic billing modules for DOCS. All modules are changing due to HIPAA compliance formatting changes.

Medicare

The Walker & Company program module for formatting Medicare claims to be sent electronically to Palmetto-GBA was approved in December, 2003. The first client to use the program in production began doing so in April of 2004. This program module is complete and ready to be installed on client systems. Although the format in which claim files must be prepared changed completely, the process for sending the files is similar to how it was being done for the National Standard Format (NSF). Current pricing is $975.

Medicaid

The program module for formatting Medicaid claims to be sent electronically to Unisys was approved in June, 2004. Before a client can be in production using this format a Trading Partner Agreement (TPA) must be completed with Unisys and then the provider must conduct an on-line EDI registration. Not only is the format different, but the procedure for sending claim files is now internet based. Therefore, the file to be sent must be transferred from the Unix machine to a Windows machine for submission. The program module for formatting the file and the procedural system for moving the file and sending it over the internet are now both available. Current pricing for both together is $1,850.

Workers Comp

Information on changes to electronic billing for WV Workers Comp is not yet fully available. As of this date, Consultec is still accepting direct electronic claims in the NSF format.

Blue Cross Blue Shield

BCBS is planning to change to a system similar to Medicaid whereby not only will the file format change but the files will have to be submitted via the internet. As of this date we are waiting for a deadline to be published.