CMS Ends HIPAA Contingency Plan; Noncompliant Electronic Claims Will Be Rejected Effective Oct. 1
[Posted 09/29/05]

The Centers for Medicare & Medicaid Services (CMS) have announced that effective October 1, Medicare carriers will reject electronic claims that don’t meet the HIPAA transaction and code sets standards.

Although HIPAA transaction and code sets regulations took effect on October 16, 2003, CMS implemented a “contingency plan” that allowed more time for physicians and other health care providers to make the transition to HIPAA-compliant billing systems.

The decision to end the contingency plan was made because most physicians are now submitting compliant claims. In June 2005, 96 percent of physicians were in compliance, compared to only 80-85 percent in 2004.

Need Help Submitting HIPAA-Compliant Claims?
If you need help submitting HIPAA-compliant claims, consider Infinedi, CMA’s electronic clearinghouse partner. Physicians can choose a flat rate monthly service, which permits unlimited electronic claims filing, or opt for a per-transaction payment plan. CMA members receive a discount of 8 to 12 percent. You don’t need special software. Claims can be transmitted 24 hours a day to Infinedi’s web portal via secure FTP, or by modem through a toll-free number. No special software is needed.

The one-time enrollment fee is $175 for members, $200 for nonmembers. Physicians enrolling will be issued a MEDePass digital certificate for secure access to their private business account information stored at Infinedi.

Click here for enrollment information.

Contact: CMA’s legal information line, 415/882-5144 or legalinfo@cmanet.org.