The Transactions and Code Sets Standards (TCS), published May 31, 2002, will propel the healthcare industry into an expanded use of electronic transactions for claim submission, remittance, eligibility verification, claim inquiry, and preauthorization of services. For providers who implement these standards, there is huge potential for improved efficiency, cost savings, and increased cash flow.
It is important to note that the TCS does not require you to send claims or receive payments electronically. Individual payers, however, may require that providers perform some electronic functions. CMS has a mandatory electronic billing requirement for some providers.
HIPAA mandates that all providers and all payers who conduct electronic transactions send and/or receive electronic transactions in the ANSI ASCX12N Version 4010 format. HIPAA does not mandate that software vendors upgrade their products to this ANSI standard.