Mandated Electronic Claims Filing – Some Insurance Carriers Mandate Electronic Claims Filing


They’ve been talking about it forever but it looks like it might finally have arrived. Insurance companies are starting to mandate electronic submissions of insurance claims. We’ve gotten our first notice that medical insurance claims must be sent electronically in 2007.

Many insurance companies have been trying to encourage providers to submit insurance claims electronically for years. They’ve offered perks such as quicker payments, less requirements for authorizations, and other benefits to the providers. They’ve also had provider reps visit provider’s offices to see why they are not submitting claims electronically and offer suggestions for methods to get their office capable of sending their claims electronically.

Now we are actually seeing companies that are saying they will no longer accept claims on paper CMS 1500 or HCFA 1500 forms. Fidelis Care of New York is one of the plans that is stating they will no longer accept any claims on paper in 2007. They state they are at over 80% electronic claims and they are not accepting any more paper claims in 2007. If you are a participating provider in Fidelis Care and you try to submit your claims on paper, they will be returned to you with a letter. They are advising you to contact your provider rep and they will help you find a method to submit your claims electronically.

Fidelis Care is one of the first insurance companies that I’ve seen that is actually returning any paper claims. Excellus BCBS keeps track of how many claims each provider submits on paper and if the number is over a certain amount per month, they send a provider representative out to speak to the provider about why they are not submitting claims electronically, but they don’t return the claims – yet. New York Medicare states that all providers are suppose to submit claims electronically, but they allow enough exclusions that an office can get around it.

I think that many companies will begin to follow suit with Fidelis Care of New York. It is a huge money saver for the insurance company to receive claims electronically. More and more companies will begin to return claims to providers if submitted the old fashioned way, on red and white paper forms!

Copyrite 2007 – Michele Redmond

Leave a Reply