MEDICARE PART A CLAIMS

HOSPITALS
For Home Health & Hospice Providers, please click here
For Skilled Nursing Providers, please click here

Hospitals are under pressure to improve the quality of care while simultaneously facing declining reimbursement, and increased risk and margin pressure. With more complexity, and expected moves toward pay-for-performance ahead, maximizing revenue cycle efficiency is a business imperative for every hospital.

DDE

RAPID Network provides Direct Data Entry (DDE), an online system that is part of the Fiscal Intermediary Standard System (FISS), to give Medicare providers access to information of beneficiaries and claims.

Key functions

• Access the Common Working File (CWF) via HIQA (Health Insurance Query Access) to find information on beneficiary entitlement, eligibility and other insurance.

• View a variety inquiry files, i.e. diagnosis codes, revenue codes, American National Standards (ANSI) reason codes, HCPCS codes and ICD-9 Inquiry tables.

• Key in and send claims.

• Correct, adjust and cancel claims.

• Correct claims originally submitted on paper.

• Determine DRG for Inpatient Hospital Claims.


Electronic Claim Files

Electronic claim file transactions for 835/837, 276/277, and 997 files can be performed using FTP/SFTP. The RAPID Network also supports the use of scripts and batch services for automation and integration into billing systems.

Key functions

• Access the Common Working File (CWF) via HIQA (Health Insurance Query Access) to find information on beneficiary entitlement, eligibility and other insurance.

• View a variety inquiry files, i.e. diagnosis codes, revenue codes, American National Standards (ANSI) reason codes, HCPCS codes and ICD-9 Inquiry tables.

• Key in and send claims.

• Correct, adjust and cancel claims.

• Correct claims originally submitted on paper.

• Determine DRG for Inpatient Hospital Claims.