Western Highlands Network

Friday E-Mail Newsletter

Number 78
12/8/2006

The Friday E-Mail is a weekly update for providers by the Services Management Department of Western Highlands Network. Please distribute to all your staff.

WHN Announces New Policy for Electronic Claims Effective July 1, 2007

To improve claims processing efficiency and expedite provider reimbursement, claims submitted to Western Highlands must be submitted either by an ANSI X 12N 837P HIPAA (837) transaction or Direct Data Entry (DDE) effective July 1, 2007.

A number of providers presently submit claims with the 837. The 837 is a HIPAA compliant industry standard commonly included with medical billing systems/software.

The DDE is a new product developed by WHN intended to complement the 837 and/or offer an electronic claims submission method for agencies unable to produce an 837. The minimum DDE PC support requirements are Internet Explorer 6 and high-speed internet access.

The only exception to electronic claims submission is either submitting a claim with coordination of benefits, a void/replace transaction, or a one-time situation that the 837 or DDE is inadequate to submit a claim. The one-time instance is subject to the Director of Claims and Reimbursement approval.

Please contact Western Highlands at billingquestions@westernhighlands.org to request assistance with the 837 or DDE. A technician will respond to your request, discuss best solutions, and assist with establishing the 837 and/or DDE.

Child Case Responsible Providers:

As stated in WHN Communication Bulletin #14, any placement of more than one respite client in the same home at the same time must be approved by services management, not the case responsible provider.

Charlie Schoenheit
Director of Services Management
Western Highlands Network
356 Biltmore Avenue
Asheville, NC 28801
Telephone: (828)258-3511 x2219
FAX: (828) 225-2779
E-Mail: Charlie@westernhighlands.org
Website: westernhighlands.org