BlueCross BlueShield Temporarily Will Accept Non-HIPAA Compliant Claims After Oct. Deadline

BlueCross BlueShield of South Carolina temporarily will continue to accept electronic transactions from current submitters in HCFA 1500s (private practice) and UB92 (hospital) formats after the Oct. 16 deadline for compliance with federal rules requiring use of the HIPAA 837 format.

According to guidance from The U.S. Department of Health and Human Services’ Centers for Medicare & Medicaid Services (CMS), penalties will not be imposed on health plans that deploy contingency plans to ensure the smooth flow of healthcare payments after the deadline, provided the health plans have made reasonable and diligent efforts to become compliant and to facilitate the compliance of their trading partners.

BlueCross has 9,000 trading partners across South Carolina, including such healthcare providers as hospitals, physician practices, ambulatory surgery centers, hospices, and home health centers. The company has spent the past few years providing outreach services regarding the Health Insurance Portability and Accountability Act of 1996 (HIPAA), including statewide workshops, visits to provider locations, and mailed news and information bulletins. The company also has encouraged electronic submission of claims, including through its Web site, which results in real-time adjudication and quicker payments to providers.

“BlueCross is prepared for HIPAA, but our assessment of the current state of readiness in the provider community indicates that it is necessary for us to adopt a contingency plan to prevent the possible disruption of cash flow to them,” said David Boucher, BlueCross’ assistant vice president of health care services.

“Of the 9,000 providers, fewer than five percent have tested with us for HIPAA readiness and even fewer have been successful,” said Boucher.

BlueCross’ contingency plan states that the company will be prepared to successfully process all HIPAA compliant standard transactions submitted by its trading partners; that it will temporarily accept non-HIPAA compliance transactions from current submitters but will monitor progress made by these trading partners to determine the appropriate time to require HIPAA compliant transactions only; and that providers seeking to join the company’s networks or to submit electronic transactions to BlueCross for the first time will be required to use HIPAA standard transactions as of Oct. 16.

The administrative simplification rules of HIPAA are intended to reduce the costs and administrative burdens of health care by standardizing electronic transmission of many administrative and financial transactions, including requiring the use of the HIPAA 837 format for submitting claims to any health plan nationwide.