Medical service provider electronic billing responsibilities

Medical service providers shall submit electronic medical bills and supporting documentation to the organization unless the health care provider is exempt. 1. A medical service provider is exempt from the requirement of electronic submission of medical bills if: a. The provider submits fewer than fifty bills per calendar year; or b. The provider can sufficiently demonstrate electronic medical bill implementation will create an unreasonable financial hardship and can provide supporting documentation, such as financial statements or other documentation which reflect the financial hardship. The exemption process must be initiated by the medical service provider. Granting an exemption lies solely within the organization's discretion and is not subject to appeal. 2. The organization shall identify and maintain an electronic billing source to enable the transaction of these services. 3. All medical service providers shall submit the most current version of the following electronic medical bill processing standards: a. Professional billing - ASC X12 837P; b. Institutional/hospital billing - ASC X12 837I; or c. Dental billing - ASC X12 837D.