Horsham, Pa. - NextGen Healthcare Information Systems Inc., a subsidiary of Quality Systems Inc. has completed a pilot project with Empire Medicare Services, a fee-for-service Medicare contractor, and the Workgroup for Electronic Data Interchange (WEDI) Foundation to facilitate the use of electronic attachments between a health plan and its providers.The pilot program, which was funded for Empire Medicare Services and WEDI by the Centers for Medicare & Medicaid Services (CMS), tested the use of electronic claims attachments in accordance with HIPAA's transaction code sets, including ANSI 275 and 277.
Using the integrated claims, clinical and imaging products provided by NextGen Healthcare, Empire Medicare Services electronically requested additional information from participating providers to complete the full claims cycle from the initial 837 transaction to the 275 claim attachment submission.
The use of Logical Observation Identifier Names and Codes (LOINC) codes within each request was used to specify the information being requested and provided the level of detail necessary for the provider to successfully adjudicate the claim. Each LOINC code was mapped to the existing information in the provider's system, such as EMR documents, scanned images and lab results, to produce the electronic attachment.
NextGen Healthcare recently presented the results of the pilot project at the Second Annual Claims Attachment Forum, which was sponsored by the Association for Electronic Healthcare Transactions (AFEHCT), WEDI, Health Level Seven (HL7) and ASC X12.
Source: NextGen Healthcare Information Systems
