Two years after HIPAA, EDI adoption has increased substantially among providers and payers industry wide. In efforts to further streamline administrative costs, HNE is promoting the direct submission of claims to HNE from providers and their billing offices.
Many providers are investigating electronic health records (EHR) and are simultaneously looking to upgrade their practice management systems. Many of the contemporary practice management systems make it easier for Providers to submit HIPAA compliant claims directly to payers. As a local health plan, HNE believes in direct relationships with providers.
Use of clearinghouses has prohibited the adoption of direct submission on the part of providers by sponsoring the submission of claims through clearinghouses and paying for transaction fees. HIPAA provides for the exchange of electronic information in a standardized manner. Payers no longer need clearinghouses to translate disparate feeds to a common format due to their investment in HIPAA. The internet provides a “free” and “secure” (with the appropriate encryption) communications link to exchange electronic data.
HNE is prepared to invest up to $100,000 between now and March 31, 2007 towards reimbursement of costs where providers implement direct submission of claims to HNE and meet the following conditions:
- Copies of paid receipts for associated costs must be submitted to HNE;
- The cost of products or services eligible for reimbursement does not include personnel costs for staff in the provider’s office;
- This offer is not valid for providers already submitting claims directly;
- Direct submission of claims must be in production by March 31, 2007;
- Each provider or billing service can be reimbursed up to an amount, pre-determined by HNE, based on the claim volume in the table below.
| Number of claims submitted annually to HNE |
Level of reimbursement available |
| <1000 |
$250 |
| 1000 – 3000 |
$750 |
| 3000 – 5000 |
$1500 |
| 6000 – 8000 |
$2500 |
| 8000 + |
$3000 |
HNE offers several technology alternatives for direct submission of Claims:
- FTP transfer via VPN or other secure technology (IT Dept to IT Dept)
- HNEDirect portal claims file transfer (CFT), 997 Response Transaction recently added in Oct 2006
- HNEDirect Direct Data Entry (DDE), recently added in Oct 2006
- New England Health EDI Network (NEHEN), being added in 2007
HNE’s Provider Relations Department can assist you in determining the best technology for your practice to use to submit claims directly to HNE. For further assistance, please contact HNE Provider Relations at (413) 787-4000, ext. 5000.
