About the HIPAA Claim Status Checker

The HIPAA Claim Status Checker is a program to electronically inquire about the status of health insurance claims and designed to be used by providers of health care services.

Providers usually send either directly or through clearing houses the bills for services that they rendered to the carrier of the insurance policy since the vast majority of their patients are insured. Most states have prompt payment laws urging the carriers of payers as they are called, to pay outstanding claims within 30 days. But often the payment is delayed through incomplete or missing information or other circumstances that pend the payment. Providers up to now had to use personnel who spend most of the day being on-hold trying to talk to a customer service representative of the payer trying to find out why a certain claim has not been paid. This time consuming and often frustrating task leads often to unpaid bills and write-offs, severely cutting into the profit of providers apart from paying the billing specialists on staff. A whole industry arose around unpaid claims in that there are companies buying unpaid and outstanding claims at a discount to pursue the payment and relieve the provider of the tedious task to collect the money.

The HIPAA act of 1996 was the first attempt to create nationwide rules to enact administrative simplification and make the process of information exchange between providers and payers more efficient by employing electronic data exchange (EDI). This technology was already used in the banking and long distance phone call industry to tremendous advantage. Whenever you go to an ATM machine to withdraw money there will be electronic transactions from the machine to the owner of the machine and then to the issuer of the card. Within a few seconds  nowadays one get cash in practically any place on earth. The government through its National Bureau of Standards is the guardian of the rules and details of the different EDI transactions for each involved industry.

The original HIPAA act described the 276 as the transaction set for the claim status request and the 277 for the claim status response. But it did not specify the necessary infra structure such as transport protocols and even now, nearly 20 years after the HIPAA act there is only spotty usage of these protocols. Things changed with the Affordable Care Act (ACA or Obamacare) which adopted the rules developed by the Coalition for Affordable Quality Healthcare (CAQH) which is a consortium of healthcare industry providers and insurers. They devised and prescribed mechanisms to transfer claim status information in real-time between two computers.These new CORE standards will greatly enhance the efficiency of billing and getting paid once they are widely adopted.

The HIPAA Claim Status Checker allows to create electronic claim status requests, to send them to the payer and to receive and interpret the response.