American Health Data Services (AHDS) was formed to take advantage of emerging opportunities in the health care information industry.
Our solid experience in the software development, consulting and support business enables us to bring unique and timely solutions to an industry that can change on a daily basis.
Our premier solution, the AHDS Web Portal, was developed after recognizing the potential to solve an everyday problem for those in the health care industry. Namely, Medicare eligibility verification. Rules and regulations based on HIPAA, that came into effect in 2003, present a new set of challenges for health care providers to perform these verifications using electronic means.
For the past ten years, Brian has run a systems management and development company: MacServe.net
His overall experiences include projects for Mobil Oil in their drilling operations division as a developer & support engineer and developer and Director of Computing Services for Smith Protective Services.
MacServe.net provides all of our code development, systems management, network connectivity and all AHDS systems are located in their highly secure datacenter in Dallas, Texas.
Jim has extensive experience in setting up and managing network connectivity and application protocols for EDI and SNA services. He has managed numerous projects in this field, including working with all of the Medicare (CMS) fiscal intermediaries (FI) to establish and monitor network connectivity between FIs, Medicare and hundreds of health-care Providers.
As the HIPAA mandated EDI transaction sets were being developed, his team was central to guiding the connectivity and testing processes on behalf of the provider community. He was one of the first people to successfully send a 270/271 eligibility transaction.
As part of this training at IBM in EDI mapping and testing of ANSI12 transactions, Jim also has broad knowledge of HIPAA EDI transaction sets. With experience with IBM, IVANS and AT&T Global Network Services (AGNS), Jim is one of a handful of people in the industry with such a broad knowledge-base to draw from.
As account manager for 300+ BCBS and healthcare providers, Jim helped over 150 facilities save over $26 million annually in AGNS leased-line installations exclusively for CMS payer services.
As co-founder and network VP for The Good Health Channel (the precursor to Accent Health), Jim developed customer support processes, video delivery and other systems still used by Accent Health. Accent Health (a former CNN subsidiary) is the nation's largest placement-based health-care media company with over 11,000 physician installations.
Simply presenting a Medicare or Insurance ID card is not a guarantee that your claim will be paid. Co-Pays and Deductibles can vary from day to day. Knowing how much to collect from your patient up-front means a solid cash-flow.
| Percent of Responses | Number of Responses | Reason for the rejections |
|---|---|---|
| 18.41% | 37 | "patient not found" - this means there is no such name or Health Insurance Claim Number (HICN) on file. |
| 1.99% | 4 | "no alpha suffix" - HICNs one of the following character suffix - "A","T","TA","M","M1","J1","J2","J3","J4". |
| 10.45% | 21 | "DOB didn't match HICN" - The DOB on the inquiry didn't match the DOB for the HICN on CMS' file. |
| 1.99% | 4 | "Wrong gender" - The Name, DOB and HICN matched, but the submitted gender didn't match gender on file. |
| 1.99% | 4 | "Benefit inactive" - no entitlement information, - unlawful resident, - deported, - incarcerated, - deceased |
| 14.43% | 29 | "Medicare not Primary Payer" - The primary payer's name, address and membership ID is displayed. |
NOTE: All of these claims, if sent in with the known information, would have been denied by CMS. By doing pre-verification, your staff will get the right information beforehand.
A simple analysis of just one of our customers showed that using our service saved them over $87,000 in a single years time by simply knowing ahead of time to collect the Deductible on CMS claims. Can you leave $87,000 out of your cash flow, having to chase that money later on?
Even with resubmitting corrected claims to CMS, costs are estimated at $10 to $20 per claim. CMS statistics are that 40% of "denied Payment" claims are not resubmitted, primarily because of the correction costs. This is lost revenue to the practice.
The below were returned with valid information and eligibility verified and can be used to submit CMS claims.
| Percent of Responses | Number of Responses | Reason for the rejections |
|---|---|---|
| 50.75% | 102 | "inquiries found" - All the information found matches the inquiry including eligibility of services. |
In 2003 Medicare started testing the HIPAA compliant CMS 270 Inquiry and 271 Response system. In December of 2003 they halted the program.
The reason for the suspension was that the first 270 Real Time process method relied on the 9 different data centers mainframes real time translations of submitted 270s via streaming socket connections and returning 271 response through the same socket. After some high volume testing, it was determined that the data centers were unable to handle the projected volume.
CMS suspended the testing because the IP protocol 270 submissions consumed almost all the processing capabilities of the existing SNA protocol based traffic. It almost shut down the 3270 terminal emulation Direct Data Entry (DDE) access.
This shut down was done with just a small volume of the potential volume generated by:After nearly a year during which time CMS re-designed, tested and finally went into production accepting 270/271 transactions. At 2:38:41 CST October 13, 2005 , American Health Data Services (AHDS) sent AHDS' first CMS formatted 270 inquiry receiving back a 271 document.
AHDS was one of the first organizations to send transactions to Medicare HIPAA Eligibility Transaction System (HETS 270/271) located in Baltimore MD, on a 24/7 basis.
As a result AHDS is one of 4 companies that CMS suggests as a Network Service Vendor to provide connectivity to HETS.
Visit this CMS web site for more information.
As of Tuesday, May 21, 2013 AHDS has sent 15,961,129 transactions.
Future developments of CMS HETS involves discontinuing the access to Eligibility verification via DDE/FISS by Part A providers, i.e. hospitals, etc. that currently also use the DDe/FISS for claim status and claim correction in real time. Download PDF