CAQH CORE 250: Claim Status Infrastructure Rule Guides CAQH CORE 250 Rule for operating rules for the eligibility and claim status transactions adopts all the Phase I and II CAQH CORE Eligibility and Claim Status Operating Rules except those requirements pertaining to the use of Acknowledgements. Entities seeking CORE Certification must implement all of the CAQH CORE Eligibility and Claim Read More →

CGS EDI Enrollment Provider Guidelines CGS EDI Enrollment form (commonly referred to as the EDI Agreement) should be submitted when enrolling for electronic billing. It should be reviewed and signed only by the providers to ensure each provider is knowledgeable of the enrollment request and the associated requirements. Providers that have contracted with a third Read More →

CGS EDI Program: Advantages and myCGS Portal CGS EDI Program offers advantages to providers who conduct business with Medicare electronically. Some of those benefits include: No more paper claims: EDI (submitting claims to CGS electronically eliminates paperwork so your staff can accomplish more in less time. You will also save money on postage and claim forms. Earlier payment Read More →

Rejected HIPAA Claims Basic Guides (CGS Administrators, LLC) Rejected HIPAA Claims are claims that are in a rejected status and has failed one of the set validations. Find below some ANSI Claim Rejections. More ANSI Claim Rejections examples can be found in the previous posts. X222.262. 2310B. NM109.030 This Claim is rejected for Invalid Information for a Rendering Provider’s National Read More →

Top 10 ANSI Claim Rejections Examples Top 10 ANSI Claim Rejections occur at multiple locations within the electronic EDI claim. Suppliers are strongly encouraged to review all aspects of a claim denial. Find below Top 10 ANSI Claim Rejections. X222.087. 2010AA. NM109.050 This Claim is rejected for relational field due to Billing Provider’s submitter not approved for electronic claim Read More →

ANSI Claim Rejections Examples ANSI Claim Rejections occur at multiple locations within the electronic EDI claim. Suppliers are strongly encouraged to review all aspects of a claim denial. Find below top 10 ANSI Claim Rejections. X223.423.2400. LX01.030 – This Claim is rejected for the Service line number greater than maximum allowable for payer. 2400.LX01 must be > 0 and Read More →

Celerian Group Company EDI Connection Basics Celerian Group Company EDI team in an effort to ensure minimum downtime/interruption of services promotes effective immediately provision of the business information. How Many Lines Can Be Billed On An Electronic Claim? Part A and HHH: The Service Line Loop is located in the 2400 loop. Only 449 iterations of the 2400 loop Read More →

3M EDI Advanced Ship Notice Guides (TD Segment- Carrier Details) 3M EDI Advanced Ship Notice transaction set uses hierarchical levels or “HL loops”. At present, 3M sends either the Shipment/Order/Item or the Shipment/Order/Tare/Item structure. The Shipment/Order/Tare/Item structure is only used if 3M is also providing the SSCC-18 serial number and bar coded label. Find some TD Read More →

3M EDI Customer Ship Notice Requirements 3M EDI Customer Ship Notice (856 Ship Notice/Manifest transaction set) allows 3M to send shipment notification to vendor company electronically via EDI. 3M EDI Customer Ship Notice transaction set uses hierarchical levels or “HL loops”. At present, 3M sends either the Shipment/Order/Item or the Shipment/Order/Tare/Item structure. The Shipment/Order/Tare/Item structure is only used Read More →

Health Care Claim 837 (Gold Coast Health Plan) Guideline Health Care Claim 837 notes and guidelines promote efficient, accurate Gold Coast Health Plan electronic transaction processing. Each user is assigned a 6-digit EDI Direct Trading Partner ID. Logon User Name is 8 characters. Logon User ID (password) is 9 characters. All dates are in the CCYYMMDD format. Read More →