Ukucubungula Izimangalo Zezokwelapha

Uma unesithakazelo ekubeni umthengisi wezokwelapha, nansi isifundo ekucubunguleni izimangalo zezokwelapha.

Izinhloso zezifundo

Injongo 1: Izimangalo ze-Billing ze-Bill

• Chaza i-837-P
• Chaza i-837-I
• Thola izigaba ze-Transaction Set Set
• Chaza indlu yokuhlanza

Injongo 2: Izimangalo Zephepha Lokukhokha

• Thola izinhlobo ezahlukene zokukhokha zamaphepha
• Gcwalisa ifomu le-CMS-1500 noma le-UB-04
• Ukungeniswa okulungile kwesicelo sephepha

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Izimangalo ze-Electronic Billing

I-Medicare , i- Medicaid , kanye nezinye izinkampani zomshuwalense zamukela izimangalo ze-elektroniki njengendlela yokuqala yokukhokha. Inguqulo ye-elektroniki ye-CMS-1500 ibizwa ngokuthi i-837-P, i-P imele ifomethi yobuchwepheshe. Inguqulo ye-elektroniki ye-UB-04 ibizwa ngokuthi i-837-Mina, mina ngimela ifomethi yesakhiwo.

Ukuphumelela ukufaka izimangalo zika-elektroniki, izikhwama zezokwelapha kumele ziqonde izidingo zezinhlobo ezehlukene zama-inshuwalense ezihambisa izimangalo. Ukuthunyelwa kwe-837 ngayinye kuthumela ifayela le-data kumshuwalense okuthiwa yi-Transaction Set. I-Transaction Set ihlelwe yizigaba:

1. I-Header Transaction
2. Imininingwane Yomhlinzeki Wokukhokha
3. Imininingwane yabhalisele
4. Imininingwane yesineke
5. Imininingwane yesicelo
6. I-Transaction Trailer

Yize kungabalulekile kubalandeli ukuthi baqonde amasethingi wokuthengiselana, kubalulekile ukuthi into ngayinye ingene ohlelweni lokukhokha ilandela imihlahlandlela efanele yokuvimbela amaphutha nokucela ukulahlwa.

Indlu yokuhlanza iyinkampani ezokwamukela zonke izimangalo zakho futhi izithumele nge-elekthronikhi kubakhokhi bomshuwalense wokucubungula. Baphinde bahlele endaweni ukuze bahlole amaphutha kwisimangalo sakho ukuze basize ukugwema ukubambezeleka ekukhokhiseni.

Inzuzo enkulu yokukhokhiswa kwe-electronic noma ngabe usebenzisa i-clearinghouse noma uyayikhokhisa yini ukuthi uzosheshisa izicelo zakho zokucubungula. Ukukhokhwa kwephepha kungathatha izinsuku ezingu-45 ukucubungula ngenkathi ukukhokhelwa kwe-elektroniki kungathatha izinsuku ezingu-7 kuya kwezingu-21.

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Izimangalo Zamaphepha Ekhokhayo

Ukukhokhwa kwephepha akuyona ukukhetha kokuqala kwezindleko zezokwelapha zokukhokhisa kodwa ngezinye izikhathi umsebenzi odingekayo. Yiqiniso, inqubo yokufaka izicelo ze-elekthronikhi ilula kakhulu futhi isheshe iqhathaniswe nenqubo yezincwadi zokukhokha kwephepha.

Noma nini lapho kusetshenzwa ukukhokha kwephepha, gcina lokhu engqondweni:

• Khetha ifomu lokukhokha elifanele: Kubalulekile ukuqonda nokusebenzisa ifomu lesimangalo sezokwelapha. Khetha phakathi kwe- CMS-1500 namafomu okumangalelwa kwe- UB-04 .
• Qinisekisa ukuthi ifomethi ilungile: Abanye abakhokha bamukela izinguquko ezimnyama nezamhlophe ezifakwe amakhophi wezokwelapha kodwa inqubo engcono kakhulu ukuhambisa inguqulo yokuqala ebomvu nelomhlophe. Kuye okhokhayo, uma ifomu lokufaka isicelo sokuqala lingasetshenzisiwe, isimangalo singase singene kwisistimu yaso ngokudala ukubambezeleka noma ukuphika ekukhokheni.
• Faka idatha enembile endaweni efanele: Hlola nomkhokhi womshuwalense ngamunye ukuthola ukuthi iyiphi idatha edingekayo. Qinisekisa ukuthi yonke idatha ifakiwe ngendlela efanele futhi ngokunembile emasimini afanele.
• Faka imibhalo efanele: Ngezinye izikhathi ukukhokhwa kwephepha kudinga amaphepha afanele athunyelwe ngefomu lesicelo.

Okuningi

Isifundo 4: Medicare, Medicaid, and Other Payers

Ukuqonda okuyisisekelo se-Medicare, Medicaid, Tricare, kanye nabakhokhisi bomshuwalense wezebhizinisi