[ printer frinedly version ]

As you are aware, the HIPAA Transaction and Code Set (TCS) standards under the Administration Simplification Compliance Act (ASCA) take effect for most health plans and providers on October 16, 2003. TCS standardizes or “conforms” electronic health claims processing between payers and providers by requiring that each transaction submitted and accepted be in a particular format and contain certain codes and data elements. The intended purpose of the standardization is to streamline the electronic claims processing function between payers and providers, further reduce the volume of paper transactions and promote a more effective and cost-efficient system for payers, providers and consumers, alike.

While the deadline for TCS compliance is October 16, 2003, the Insurance Commission is increasingly aware that some claims handling clearinghouses, and well as some providers, may not be ready by this implementation date. Those clearinghouses and providers may need to manually file claim forms that require manual processing by insurance entities for a short time. The chance exists that the manual processing of claims could result in a delay of claim payments therefore, causing an increase in complaints to the Insurance Commission. We here at the Commission are prepared to take into consideration the difficulty of electronic compliance when analyzing complaints and complaint trends. However, we strongly suggest that compliance be a matter of priority.