Compliance Trust Badges: Ensuring Data Security & Regulatory Adherence

At Office Puzzle, we prioritize the security and privacy of our users’ data. As a proof of our commitment, we continue holding our Compliance Trust Badges, showcasing our dedication to upholding the highest standards of regulatory compliance. By partnering with Compliancy Group through its program "The Guard," we maintain and monitor compliance with HIPAA, OSHA, & SOC2, ensuring that your sensitive information is protected at all times.

What you should know about HIPAA, OSHA, and SOC 2?

- HIPAA (Health Insurance Portability and Accountability Act): A U.S. law enacted in 1996 to protect sensitive patient health information from being disclosed without the patient's consent or knowledge. It ensures the privacy, security, and confidentiality of healthcare data, and applies to healthcare providers, insurers, and any business that handles protected health information (PHI).

- OSHA (Occupational Safety and Health Administration): A federal agency under the U.S. Department of Labor, responsible for ensuring safe and healthy working conditions for employees by setting and enforcing standards and providing training, education, and assistance. OSHA regulations cover various industries, including healthcare, to prevent workplace injuries, illnesses, and deaths.

- SOC 2 (System and Organization Controls 2): A set of standards developed by the American Institute of Certified Public Accountants (AICPA) for evaluating and reporting on the security, availability, processing integrity, confidentiality, and privacy of a service organization's systems. SOC 2 compliance is critical for businesses that handle sensitive customer data, particularly in the technology and cloud computing industries.

Why HIPAA Compliance Matters?

For companies like Office Puzzle, operating within healthcare and therapy management, HIPAA compliance is non-negotiable. HIPAA regulations are designed to protect the sensitive personal identifiable health information of patients, ensuring confidentiality, integrity, and security. By keeping the HIPAA Trust Badge, Office Puzzle demonstrates our proactive efforts in securing the data, aligning with best practices for health information management.

The Trust Badge system provides transparency for website visitors, showcasing how we actively monitor and maintain compliance with HIPAA and other essential regulatory frameworks. The active date stamping ensures that at any point in time, our monitoring is up-to-date and our commitment to compliance is ongoing. This badge is a visible emblem of our commitment to maintaining compliance with key regulations, including HIPAA (Health Insurance Portability and Accountability Act), OSHA (Occupational Safety and Health Administration), and SOC 2 (System and Organization Controls 2), offering website visitors clear assurance that Office Puzzle operates with stringent compliance standards, further enhanced by active date stamping.


Our team is committed to making compliance a seamless part of our operations. The HIPAA Trust Badge, along with OSHA and SOC 2 badges, solidifies our place as a trusted provider in the industry. Through our partnership with Compliancy Group, we efficiently manage compliance with various regulatory requirements, ensuring that updates or changes in regulations are quickly integrated into our processes, allowing us to focus on what we do best—providing innovative software solutions for therapy providers.

by Editor

Rate Changes for Medicaid in Florida

Important Update: Rate Changes for Medicaid in Florida

As you may have heard, the State of Florida is implementing changes to the Medicaid health plan rates effective October 1st, 2024. While we received this news with less than 3 days’ notice, let’s look on the bright side—after all, higher rates mean more funding to support our vital services! It’s almost like getting a surprise party, but instead of cake, we get… rates!

At Office Puzzle, we want to make sure you have the tools you need to navigate this transition smoothly.

We recommend a straightforward approach: only change the rates once you have finalized billing for the previous month, which includes everything up until September 30th.

And if you’re thinking about updating the rates early, here’s the funny part: even if you do it today, Medicaid won’t pay you the higher rate just yet! So if you want, you can update the rates right now and you will be fine. They will adjust to the correct rates.

To avoid any issues, check out our step-by-step guide on how to manually update your rates by following the instructions below or the quick video tutorial we’ll be providing. This will ensure everything runs smoothly without any surprises!

  1. Go to the Agency Dashboard
  2. Click Configuration
  3. Click Billing
  4. Click Payers
  5. Click on the Payer Name (STATE OF FLORIDA, MEDICAID, FLORIDA MEDICAID, etc)
  6. Look for the Health Plan, it's on the right. Click on the green pencil right next to the name of the Health Plan (Default, Medicaid, etc)
  7. Click the Rates Tab
  8. Find the Billing code you would like to update the rate and enter the new amount (find the changes below)
  9. Repeat step #8 three times since we have 3 rate changes (97153, 97155, 97155-HN)

The video instruction is here:

In case you missed the changes here is a quick summary of them:

Service Description Procedure Code 2022 Rate (Per Unit) 2022 Rate (Per Hour) 2024 Rate (Per Unit) 2024 Rate (Per Hour) Fee Change (Per Unit) Fee Change (Per Hour)
Behavior identification - assessment 97151 $19.05 $76.20 $19.05 $76.20 No change No change
Behavior identification - supporting assessment 97152 $12.19 $48.76 $12.19 $48.76 No change No change
Behavior reassessment 97151 TS $12.19 $76.20 $12.19 $48.76 No change No change
Behavior treatment with protocol modification (Lead) 97155 $19.05 $76.20 $19.17 $76.68 +$0.12 +$0.48
Behavior treatment with protocol modification (Assistant) 97155 HN $15.24 $60.96 $15.37 $61.48 +$0.13 +$0.52
Behavior treatment by protocol (RBT/BCaBA/Lead) 97153 $12.19 $48.76 $12.26 $49.04 +$0.07 +$0.28
Family training by Lead Analyst 97156 $19.05 $76.20 $19.05 $76.20 No change No change
Family training via telemedicine (Lead Analyst) 97156 GT $19.05 $76.20 $19.05 $76.68 No change No change
Family training by assistant 97156 HN $15.24 $60.96 $15.24 $60.96 No change No change

Thank you for your continued partnership as we work together through these changes!

by Editor

Multi-Factor Authentication (MFA)


Multi-Factor Authentication (MFA)

Multi-Factor Authentication (MFA) is a security mechanism that requires users to provide two or more different authentication factors to verify their identity, this adds an extra layer of protection beyond traditional username and password combinations. 

Multi-Factor Authentication (MFA) gained significant popularity in the late 2000s and early 2010s as online security threats escalated. With the proliferation of cyberattacks, including phishing, credential stuffing, and data breaches, traditional single-factor authentication methods like passwords have become increasingly vulnerable. MFA emerged as a robust solution to mitigate these risks by adding an extra layer of security. It gained further momentum as businesses and individuals recognized the importance of protecting sensitive data and accounts. The widespread adoption of smartphones and the availability of authentication apps also contributed to its popularity, providing convenient and reliable methods for implementing MFA. Today, MFA is considered a fundamental security measure for safeguarding digital identities, securing online transactions, and protecting against unauthorized access. 

Types of MFA

There are several types of Multi-Factor Authentication (MFA), each utilizing different combinations of authentication factors to verify a user's identity. Here are some common types:

  • SMS-based MFA: This method involves sending a one-time code to the user's mobile phone via text message. The user must enter this code along with their password to complete the authentication process.
  • Time-based One-Time Passwords (TOTP): Similar to authentication apps, TOTP generates one-time codes based on the current time and a shared secret between the service provider and the user. 
  • Email-based MFA: Sends a one-time code or a link via email for the user to confirm their identity. The user must enter this code along with their password to complete the authentication process.
  • Hardware Tokens: Physical devices, such as key fobs or smart cards, generate unique codes that users input during login. These tokens can be standalone devices or integrated into other objects like USB keys.
  • Biometric Authentication: This method involves using unique biological characteristics, such as fingerprints, facial recognition, or iris scans, to verify a user's identity.
  • Push Notification MFA: When users attempt to log in, a push notification is sent to their registered device. They can approve or deny the login attempt directly from the notification.

Each type of MFA has its advantages and disadvantages in terms of security, usability, and implementation complexity, and the choice often depends on the specific requirements and preferences of the organization or individual implementing it.

At Office Puzzle, we're proud to announce our implementation of Email, SMS, and Time-based One-Time Passwords (TOTP) support. This addition marks a significant stride in fortifying our platform's security and safeguarding the productivity of our users.

by Editor

1099 filling for Therapy providers

In the world of healthcare and therapeutic services, agencies providing Applied Behavior Analysis (ABA), Mental Health, Occupational, and Speech Therapy play a crucial role in enhancing the well-being of individuals. However, behind the scenes, there is an intricate web of compliance requirements, especially when it comes to managing payments for independent contractors. In this blog post, we will explore the compliance landscape for these providers and discuss how the payments feature of Office Puzzle can serve as a valuable tool for maintaining accurate records and simplifying the 1099 filing process.

Understanding Compliance for Independent Contractors:

For organizations in this field, compliance is not just a buzzword; it is a critical aspect of operations. Independent contractors, often engaged by these enterprises, require meticulous management to ensure adherence to tax regulations. The IRS Form 1099 is a key document in this process, serving as a record of payments made to subcontracted providers during the fiscal year.

Challenges Faced by Agencies:

Varied Payment Structures: Independent contractors may receive payments based on hourly rates, sessions conducted, or specific services provided. Tracking these diverse payment structures can be challenging without a centralized system.

Record Keeping: Keeping accurate records of payments made to independent contractors is not only a compliance necessity but also crucial for financial transparency and accountability.

IRS Form 1099 Filings: Filing 1099s accurately and on time is a legal requirement, and any discrepancies may lead to penalties and legal ramifications.

Office Puzzle's Payments Feature: A Compliance Solution

Office Puzzle, a comprehensive office management tool, offers a specialized Payments feature designed to address the unique needs of these organizations.

Streamlining Payment Processes

The Payments feature allows agencies to record invoices derived from the services provided by the independent contractors. Invoices created and recorded in Office Puzzle can be linked to events or visits previously recorded in the system, allowing the organization to categorize and track payments to independent contractors seamlessly. The system will automatically add details such as date and amount and allow users to input payment details, ensuring a centralized and easily accessible record of all transactions.

1099 Reporting

One of the standout features of Office Puzzle is its ability to generate payments reports that contain all the data required for the preparation of 1099 reports. By inputting payments made throughout the year, agencies can effortlessly generate accurate reports needed to prepare 1099 forms for their independent contractors come tax season. This significantly reduces the administrative burden and minimizes the risk of errors in the process.

Secure and Compliant

Security is paramount when dealing with sensitive financial information. Office Puzzle employs robust security measures to safeguard payment data, ensuring compliance with privacy regulations and instilling confidence in agencies and independent contractors alike.

Conclusion

In the fast-paced world of healthcare and therapy services, agencies must embrace tools that not only enhance operational efficiency but also ensure compliance with ever-evolving regulations. The Payments feature of Office Puzzle emerges as a valuable ally for agencies offering a streamlined solution to manage payments, maintain accurate records, and simplify the often-daunting task of 1099 filing for independent contractors.

As agencies navigate the complex landscape of compliance, understanding the IRS regulations governing 1099 reporting is essential. The IRS provides comprehensive information on Form 1099 reporting on their official website. For detailed guidance on filing requirements, deadlines, and other pertinent information, you can refer to the IRS Form 1099 General Instructions available here.

Having a dependable partner like Office Puzzle can make all the difference in fostering success and sustainability. By combining the convenience of modern technology with a commitment to compliance, agencies can confidently navigate the intricacies of payment management and ensure seamless 1099 reporting when tax season arrives.

by Charlie

Leveraging Data Collection

In the realm of ABA and Rehabilitative therapies (Mental health, Mental, OT, PT and Speech), data collection is a vital component of providing effective care. Regardless of the type of therapy, meticulous data collection can make all the difference in achieving positive outcomes for patients. Office Puzzle was designed to streamline and enhance the data collection processes. In this article, we'll explore the crucial role of data collection in therapies and how Office Puzzle simplifies this essential task.

The Significance of Data Collection

Progress Monitoring: The heart of ABA and Rehabilitative therapies is tracking patient progress. Whether it's a child with autism in ABA therapy or a patient recovering from a stroke in OT, detailed data collection allows therapists to monitor and adjust treatment plans in real time. This ensures that the therapy remains effective and tailored to individual needs.

Evidence-Based Decision-Making: Data collection in Rehabilitative therapies and ABA, is not just about jotting down numbers; it's about gathering evidence to make informed decisions. Therapists can analyze this data to identify patterns, strengths, and areas that require adjustments, resulting in more effective therapy strategies.

Compliance and Quality Assurance: Compliance with regulations and quality assurance are non-negotiable. Proper data collection serves as a safeguard, ensuring that therapy services meet all necessary standards and are delivered by qualified professionals. Therapists must meticulously collect and maintain data to ensure that their patients receive the financial support they require for their treatments. Proper data collection not only benefits patients but also contributes to a more efficient and transparent healthcare system, where quality care is duly recognized and compensated.

Communication and Collaboration: For many ABA therapy providers, collaboration is essential. Data collected within the therapy session provides a common language for therapists, caregivers, and other stakeholders to communicate about a patient's progress and adapt the therapy plan as needed.

How Office Puzzle Enhances Data Collection

Office Puzzle understands the importance of efficient data collection in ABA and Rehabilitative therapies and offers several features that simplify this process:

Customizable Data Forms: Office Puzzle provides customizable data entry forms, allowing therapists to tailor data collection to the specific needs of their patients and their plans. This flexibility ensures that the platform can accommodate various therapy types and patient requirements and also coexistence and interaction between those therapies, plans, and services.

Real-Time Data Entry: Therapists can record data in real time during therapy sessions, eliminating the need for manual data entry later. This not only saves time but also reduces the risk of errors. Office Puzzle's technology and its real time simple data collection allows providers to shift their attention to the patient during the session instead of looking at a data sheet.

Secure Data Storage: Office Puzzle stores patient data securely, ensuring compliance with data privacy regulations, like HIPAA. Therapists can access this data when required, knowing it's protected.

Automated Reports: The software generates automated reports, providing therapists with insights into patient progress. These reports can be easily shared with caregivers, enhancing transparency and collaboration.

Comprehensive Analytics: Office Puzzle includes analytics tools that allow therapists to analyze patient data over time. This enables evidence-based decision-making and the adjustment of treatment plans for better outcomes

Progress charts: Office Puzzle offers a diverse array of graphics to its users, derived from the meticulous collection of data and automatic tracking mechanisms. These graphics serve as invaluable tools for users to gauge their progress and master their objectives effectively, and visually depict performance trends over time, allowing users to identify patterns and areas of improvement. Additionally, there are line and bar graphs displaying data on objective completion, enabling users to grasp the distribution of their achievements. Moreover, automatic tracking systems generate timelines, effectively marking significant milestones and showcasing the journey towards mastering specific goals with precision.

Data collection in ABA and Rehabilitative therapies is the foundation for progress, compliance, and quality. With Office Puzzle software, therapy providers can streamline this essential task, allowing therapists to focus on what truly matters: delivering high-quality care and improving patient outcomes. Office Puzzle serves as a valuable ally in the journey of providing ABA and Rehabilitative therapies services, making data collection efficient, accurate, and empowering therapy providers to achieve better results for their patients. Embrace the power of data collection and simplify your practice with Office Puzzle.

by Charlie

The Vital Importance of Mandatory Documentation for Therapy providers

In the world of healthcare, accuracy, compliance, and professionalism are paramount. Whether you're an Applied Behavior Analysis (ABA), Mental, Occupational (OT), or Speech (SP) therapy agency, maintaining detailed and up-to-date records of your providers is not just good practice—it's essential. Here, we'll delve into the reasons why mandatory documentation is crucial for agencies and how Office Puzzle, a specialized practice management software, can streamline this process, ensuring your organization stays in compliance.

Why Mandatory Documentation Matters

  • Regulatory Compliance

Applied Behavior Analysis, Mental, Occupational and Speech (SP) therapy agencies are subject to stringent regulations, which require them to maintain comprehensive documentation of their providers. These regulations serve several critical purposes:

a. Legal Compliance: Staying in line with local, state, and federal regulations is vital for avoiding fines, legal troubles, or even losing your agency's license or credentials with health insurance providers. Mandatory documentation helps prove that you are adhering to all necessary guidelines.

b. Quality Assurance: Mandatory documentation ensures that all providers meet the required qualifications and certifications. This, in turn, enhances the quality of services offered to clients.

  • Credential Verification

Documenting the credentials, licenses, certifications, and training of your therapy providers is essential for verifying their qualifications. This verification process not only helps in meeting regulatory requirements but also builds trust with clients and their families.

  • Risk Management

Agencies face various risks, including legal liabilities and reputation damage. Mandatory documentation can mitigate these risks by providing a clear record of each provider's qualifications and compliance with agency policies and procedures.

  • Billing and Reimbursement

Accurate documentation of providers' qualifications and certifications is crucial for billing and reimbursement purposes. Insurance companies and government agencies often require detailed documentation to ensure that services rendered are eligible for reimbursement.

How Office Puzzle Can Help

Office Puzzle is a specialized practice management software designed specifically for behavioral, occupational, mental, and speech therapy agencies. One of its standout features is the Human Resources documentation module, which can greatly assist agencies in managing mandatory documentation effectively.

  • Expiration Date Tracking

Office Puzzle allows you to easily track expiration dates for licenses, certifications, and other mandatory documents. By inputting these dates into the system, you can set up automatic reminders, ensuring that you are always aware of when a provider's credentials are due for renewal.

  • Automatic Reminders

One of the most significant benefits of Office Puzzle's Human Resources documentation feature is its ability to send automatic reminders. When a provider's credential is about to expire, the software can send notifications to both the provider and agency administrators. This ensures that you never miss an important renewal date, reducing the risk of non-compliance.

  • Streamlined Compliance

With Office Puzzle, you can maintain a centralized repository of all provider documents, making it easy to access and update information as needed. This centralized approach simplifies the compliance process, saving your agency time and effort.

  • Enhanced Accountability

By utilizing Office Puzzle, agencies can establish a culture of accountability among their providers. When providers are aware that their documents are being tracked and monitored, they are more likely to stay proactive about renewing their credentials.

Mandatory documentation is not just a regulatory requirement; it's a vital component of running a successful and compliant therapy agency. With the help of Office Puzzle's Human Resources documentation feature, agencies can streamline the process of tracking expiration dates, sending automatic reminders, and staying in compliance. By leveraging this powerful practice management software, therapy agencies can focus more on providing high-quality services to their clients, while the administrative burden of mandatory documentation is effectively managed. Don't risk the integrity and reputation of your therapy agency—invest in robust documentation management today.

by Charlie

Streamlining Session Note Creation, Review, and Approval

In the dynamic world of therapy, where every session holds the potential for significant progress, efficiency is paramount. For therapy providers, the ability to streamline session note creation, review, and approval processes is a game-changer. This is precisely where Office Puzzle, a practice management software with workflow and document approval capabilities, shines. Let's explore how Office Puzzle can empower therapy providers to deliver high-quality therapy while closely monitoring patient progress.

The Heart of Therapy: Session Notes

Session notes are the lifeblood of therapy. They are the tangible records of each patient's journey toward their goals, documenting strategies, observations, and outcomes. These notes serve multiple critical purposes:

  1. Individualized Treatment Plans: Session notes are the basis for developing and fine-tuning individualized treatment plans. They help therapy providers tailor interventions to meet the specific needs and goals of each patient.
  2. Progress Monitoring: Regularly updated session notes enable therapy providers to closely monitor patient progress. This data-driven approach allows for timely adjustments to treatment plans, ensuring optimal outcomes.
  3. Communication and Collaboration: Session notes facilitate communication among the therapy team, patients, and other stakeholders. They provide a clear picture of a patient's progress and inform decisions regarding interventions and support strategies.
  4. Documentation for Insurance and Compliance: Accurate and well-maintained session notes are essential for insurance claims and compliance requirements. They provide the necessary evidence of services rendered and progress made.

Office Puzzle: Simplifying Session Note Management

Now, let's delve into how Office Puzzle can revolutionize the way therapy providers create, review, and approve session notes:

  1. Streamlined Data Entry: Office Puzzle simplifies the process of entering session data. With customizable templates and intuitive interfaces, therapists can quickly input relevant information, reducing the administrative burden.
  2. Workflow Automation: The software's workflow capabilities enable therapy providers to create structured processes for session note review and approval. It ensures that the right individuals are involved at each step, enhancing collaboration and accountability.
  3. Document Approval: Office Puzzle's document approval feature allows for efficient review and approval of session notes. Supervisors and authorized personnel can easily review and provide feedback, ensuring accuracy and compliance.
  4. Version Control and Audit Trails: The software maintains version control and audit trails for session notes, providing a clear history of changes and approvals. This transparency enhances accountability and simplifies compliance reporting.

The Importance of Streamlined Session Notes

Efficient session note management is not just about administrative convenience; it's about elevating the quality of care provided to patients:

  1. Improved Focus on Patients: By reducing administrative burdens and automating workflows, therapy providers can dedicate more time and attention to their patients. This leads to more meaningful interactions and therapy sessions.
  2. Real-Time Progress Tracking: Office Puzzle enables real-time progress tracking through up-to-date session notes. This allows for immediate adjustments to treatment plans based on data-driven insights.
  3. Enhanced Collaboration: Streamlined session note processes promote collaboration among therapy teams, fostering a cohesive approach to patient care.
  4. Compliance and Documentation: Accurate and compliant session notes are crucial for insurance claims and regulatory requirements. Office Puzzle ensures that these critical elements are met consistently.

In conclusion, Office Puzzle is a powerful ally for therapy providers looking to optimize their workflow for session note creation, review, and approval. By simplifying these processes, therapy providers can focus on what truly matters: delivering high-quality therapy and closely monitoring the progress of their patients. It's not just about efficiency; it's about enhancing the impact of therapy and improving the lives of those it serves.

by Charlie

Importance of Swift Billing & Payment Collection for ABA Providers

In the realm of Applied Behavior Analysis (ABA), where dedicated professionals work tirelessly to provide essential services to individuals with autism and other developmental disorders, efficient financial management often takes a backseat. However, it's crucial for ABA providers to recognize the vital role that swift billing and payment collection play in enhancing cash flow and overall profitability. Let's delve into why this aspect deserves our utmost attention.

  1. Timely Billing Reduces Revenue Lag:

The ABA industry typically operates on a billing cycle basis, with services rendered today often invoiced at a later date. This can lead to a considerable lag between service delivery and revenue recognition. By promptly submitting claims and bills to insurance agencies, ABA providers can significantly reduce this revenue lag, ensuring a more predictable cash flow.

  1. Minimizing Payment Delays:

Insurance agencies have their own processes and timelines for evaluating claims and disbursing payments. Delays in billing or incomplete submissions can exacerbate these delays, affecting your organization's ability to cover operational expenses, pay staff, and invest in growth. Timely billing helps minimize these payment delays, ensuring that funds are available when needed.

  1. Mitigating Denials and Rejections:

Insurance claims are subject to a host of regulations and requirements. Failing to bill accurately and promptly can result in claim denials or rejections, which not only hinder cash flow but also demand additional administrative effort to rectify. By submitting clean, error-free claims on time, ABA providers can reduce the likelihood of denials and rejections.

  1. Enhanced Financial Stability:

A steady cash flow derived from swift billing and payment collection contributes to the financial stability of ABA providers. It ensures that you have the funds to cover operating costs, invest in technology and training, and expand your services to meet growing demand.

  1. Improved Profitability and Growth Opportunities:

Ultimately, the impact of timely billing and payment collection is reflected in the bottom line. ABA providers who prioritize these processes experience better profitability, which can be reinvested into the business to improve service quality, expand reach, or offer more comprehensive care options.

  1. Client Satisfaction:

A less obvious benefit is the positive impact on client satisfaction. When ABA providers have stable finances and can dedicate more time to their clients, it fosters a better overall experience. Clients can focus on progress and positive outcomes, rather than potential disruptions caused by financial instability.

  1. Office Puzzle Billing Feature with Clearing House Integration:

One effective way to achieve swift billing and payment collection is by leveraging advanced software solutions tailored to the healthcare industry. Office management systems like Office Puzzle, with integrated clearing house capabilities, can significantly streamline the billing process. These solutions:

  • Automatically generate and submit claims to insurance agencies, reducing manual data entry errors and saving time. [Reference: Healthcare IT News - "The Benefits of Integrated Billing Solutions”]
  • Provide real-time status updates on claims, helping ABA providers track the progress of their submissions. [Reference: Medical Economics - "Why Real-time Claims Processing Matters”]
  • Identify potential errors or discrepancies in claims before submission, minimizing the risk of denials. [Reference: RevCycleIntelligence - “How Integrated Revenue Cycle Management Prevents Billing Errors”]
  • Integrate with insurance companies' systems, facilitating faster payment processing and reducing payment delays. [Reference: Journal of AHIMA - "The Role of Clearinghouses in Revenue Cycle Management”]

In conclusion, the importance of swift billing and payment collection for ABA providers cannot be overstated. It's not just about financial management; it's about ensuring that your organization can continue to provide high-quality care and grow sustainably. By embracing efficient billing practices, ABA providers can secure their financial health while making a positive impact on the lives of the individuals they serve. Integrated office management solutions like Office Puzzle play a pivotal role in achieving these goals.

by Editor

Understanding 835 and 837 files in Billing

The healthcare industry relies heavily on accurate and efficient billing processes to ensure the smooth flow of financial transactions between providers and payers. Two essential components of this process are the 835 and 837 files. These files play a crucial role in healthcare claims and remittance. In this article, we will explore what 835 and 837 files are, how they work, and their significance in the healthcare billing process.

What is an 837 File?

An 837 file is an electronic claim submission document used by healthcare providers to submit claims for reimbursement to payers. It contains comprehensive information about the services provided to patients, along with associated diagnosis and procedure codes. The 837 file is the format in which providers send billing information to payers electronically.

Key components of an 837 file include:

  1. Patient Information: Demographic details of the patient, such as name, date of birth, and insurance information.
  2. Provider Information: Information about the healthcare provider, including their NPI and contact details.
  3. Service Details: Descriptions of the services rendered, including CPT (Current Procedural Terminology) codes and ICD-10 (International Classification of Diseases, 10th Edition) diagnosis codes.
  4. Payer Information: Details about the insurance payer responsible for processing the claim.
  5. Claim Totals: Summaries of the charges, payments, and adjustments related to the claim.

Once the healthcare provider submits the 837 file to the payer, the payer processes the claim, which may result in the creation of an 835 file that provides information on the payment and any adjustments made.

What is an 835 File?

An 835 file, often referred to as an Electronic Remittance Advice (ERA), is an electronic document that provides detailed information about the payments and adjustments made by a healthcare payer (such as an insurance company or Medicare) to a healthcare provider. Essentially, it serves as a remittance advice that explains how a claim was processed and paid. Key information contained in an 835 file includes:

  1. Payment Details: This section includes the payment amount, payment method (e.g., electronic funds transfer), and payment date.
  2. Claim Information: It provides data related to the specific claim being paid, such as the claim number, patient information, and service details.
  3. Adjustments and Denials: Any adjustments or denials made to the claim are documented in this section. It explains why certain services were not covered or were partially paid.
  4. Provider Information: Details about the healthcare provider receiving the payment, including their name, National Provider Identifier (NPI), and address.
  5. Payer Information: Information about the healthcare payer responsible for processing the claim, including their name, payer ID, and contact information.

The 835 file is crucial for healthcare providers to reconcile their accounts receivable, understand the payment rationale, and address any discrepancies in payments.

The Relationship Between 835 and 837 Files

The 835 and 837 files are interconnected in the healthcare billing process. Here's how they work together:

  1. Claim Submission: Healthcare providers use the 837 file to submit claims electronically to payers.
  2. Claim Processing: Payers receive the 837 file, process the claim, and determine the appropriate reimbursement.
  3. 835 Generation: If the claim is approved, the payer generates an 835 file, which is sent back to the provider. This 835 file explains how the claim was processed and the payment details.
  4. Reconciliation: Healthcare providers use the information in the 835 file to reconcile their accounts and ensure they received the correct payment for services rendered.
  5. Resolution: If there are discrepancies or denials, providers can use the information in the 835 file to address these issues with the payer.

Office Puzzle ensures that agencies comply with HIPAA requirements while optimizing their billing management. One of the features of our platform specializes in the creation of 837 files and the ability to upload 835 files to the platform in the raw. The system identifies claims and batch issues that can hinder payment accuracy, as well as prevents specific denial issues.

by Editor

HIPAA Compliance with Compliancy Group

Office Puzzle has taken all necessary steps to prove its good faith effort to achieve compliance with the Health Insurance Portability and Accountability Act (HIPAA).

Office Puzzle is an innovative software company specializing in tailored solutions for behavior and mental health professionals. Its software solutions are designed to streamline workflows, enhance patient care, and ensure data security, empowering professionals to focus on their core mission.

Through the use of Compliancy Group’s proprietary HIPAA solution, The Guard™. Office Puzzle can track their compliance program and has earned their Seal of Compliance™. The Seal of Compliance is issued to organizations that have implemented an effective HIPAA compliance program through the use of The Guard.

HIPAA is made up of a set of regulatory standards governing the security, privacy, and integrity of sensitive healthcare data called protected health information (PHI). PHI is any individually identifiable healthcare-related information. If vendors who service healthcare clients come into contact with PHI in any way, those vendors must be HIPAA-compliant.


Office Puzzle has completed Compliancy Group’s Implementation Program, adhering to the necessary regulatory standards outlined in the HIPAA Privacy Rule, Security Rule, Breach Notification Rule, Omnibus Rule, and HITECH. Compliancy Group has verified Office Puzzle’s good faith effort to achieve HIPAA compliance through The Guard.

“At Office Puzzle, we recognize the paramount importance of safeguarding sensitive healthcare data in today’s dynamic business environment. Our partnership with Compliancy Group signifies our unwavering commitment to the highest standards of HIPAA compliance, ensuring that our clients can trust in the security and integrity of their information,” said Hailu Jardines, CEO of Office Puzzle. “In the realm of behavior and mental health, the confidentiality, and security of sensitive data are of paramount importance. Our partnership with Compliancy Group underscores our unwavering commitment to upholding the highest standards of HIPAA compliance. This ensures that our clients, who are dedicated to the well-being of individuals, can have complete trust in the security of their data.“

Clients and patients are becoming more aware of HIPAA compliance requirements and how the regulation protects their personal information. Forward-thinking providers like Office Puzzle choose the Seal of Compliance to differentiate their services.

* The original source for this article came from The HIPAA Journal

by Editor