TMHP EDI Overview and Advantage of Electronic Services (Texas Medicaid & Healthcare Partnership) TMHP EDI program and the Health and Human Services Commission (HHSC) encourage providers to submit claims and other requests electronically. Providers can participate in the most efficient and effective method of submitting requests to TMHP by submitting through the TMHP Electronic Data Interchange (EDI) Read More →

HIPAA 837 Transaction IEHP Business Scenarios (Examples) and Frequently Asked Questions HIPAA 837 Transaction IEHP Business Scenarios described will be useful for partners Submitting HIPAA 837 Transaction to IEHP. Example 1- IPA Submitting Institutional Encounter Data Encounter data must be submitted by IPAs for all covered services provided to assigned Capitated members. Covered services include PCP visits Read More →

IEHP EDI Functional Acknowledgement/Reports (837 Health Care Claim: Professional Transaction) IEHP EDI Functional Acknowledgement/Reports – TA1 – Interchange Acknowledgement – enables the receiver to notify the sender when there are problems with the interchange control structure. As the interchange envelope enters the EDFES, the EDI translator performs TA1 validation of the control segments/envelope. The sender will only receive a Read More →

837 Health Care Claim: Professional Transaction based on ASC X12 Technical Report Type 3 (TR3) 837 Health Care Claim: Professional Transaction may be transmitted any day of the week to IEHP from a customer’s business partner. The transaction provides data on Medicare Advantage / Part D data. Technical Infrastructure and Procedures Business partners transmitting 837 Health Care Read More →

CMS Net Provider EDI (Children’s Medical Services Network Provider Electronic Data Interchange) CMS Net Provider EDI is a web-based tool that enables approved CCS and GHPP providers and Medi-Cal Managed Care Plans to electronically access the status of Requests for Services/Authorizations.  Providers and plans have access to view service authorizations, have the ability to print service authorizations, denial Read More →

SelectHealth EDI Claims Submission – Basic Transactions SelectHealth EDI Claims can be sent electronically through an Electronic Data Interchange (EDI) instead of submitting claims by mail. Claims submitted electronically are typically more accurate and allow to reimburse more quickly. EDI is more than just claims, however. Through EDI transactions, you can also receive remittance advice, eligibility, and Read More →

EDI Online Webinars (Instructor-Led Courses) EDI Online Webinars by the EDI Academy – we invite you to join our All Industries and HIPAA Online Webinars. See EDI Online Webinars schedule for winter-spring 2019 below. https://ediacademy.com EDI 101 – Introduction To EDI  Webinar Times: 11:00 AM – 12:30 PM EST – 2019 Dates: Jan 14, 2019 — Mar 04, 2019 Read More →

Response Files Operational Procedures Response Files like 999 Functional Acknowledgement file will be generated within one business day. To verify if the file was accepted or rejected at this level, look for the IK5 and AK9 segments. If these two segments are followed by an ‘A’ the file was accepted. If these two segments are followed by an Read More →

HIPAA EDI Training 2019 Dates HIPAA EDI Training classes are taught by highly-qualified EDI professionals. All of them have at least 10 years of industry experience. January 31-February 1st, 2019 May 16-17, 2019 September 19-20, 2019 December 5-6, 2019 Classes typically run from 9:30 AM to 4:00 PM Registration Fee: Early – Bird $1,500. Late Read More →

Advanced EDI Training  – EDI Academy Certification Advanced EDI Training is provided by the EDI Academy for professionals who are not new to EDI and have passed basic training classes as well as for specialists who need more real-world practice. More information about Advanced EDI Training course, 2019 Schedule and registration fees can be found on ediacademy.com. Section One: Advanced Read More →