Electronic
Data Interchange (EDI)
EDI,
electronic submission of Medicare Part B claims eliminates mailroom
processing and manual data entry. The Medicare claims processing system can
usually pay electronic claims faster than pa- per claims. Generally, electronic
claims can be paid on the 14th day after submissions, but paper claims cannot
be paid earlier than the 27 th day after submission.
EDI saves
the physician time and money through more accurate, faster processing of claims
and reduced
postage costs. Physicians should contact the local Medicare carrier for
information about EDI.
The claim
is electronically transmitted in data “ packets ” from the physician ’ s
computer modem to the carrier ’ s modem over a telephone line. The carrier
checks ( “ edits ” ) the data for required information. Claims that pass these initial
edits, commonly known as front-end edits or pre-edits, are then processed according
to Medicare policy and guidelines. Claims with inadequate or incorrect information
do not pass the initial edits. They are rejected and are not paid because they
lack sufficient in- formation to make a payment decision.
After
successful transmission, an acknowledgement report is generated and is either
transmitted back to the physician or placed in an electronic mailbox for the
physician to download. This report con- firms that the file was received and
lacks format errors. Once the claims are processed another report is generated
that indicates the number of claims accepted and the total dollar amount
transmitted. Additionally, this report lists claims that were rejected, as well
as, the reason(s) for being rejected. The physician should review this report
carefully. At this point, the physician can make necessary corrections to the
rejected claim(s) and resubmit them.
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