837P Inbound Claim

837P Inbound Claim Guidelines For Providers And Clients

837P Inbound Claim notes by BUCKEYE COMMUNITY HEALTH PLAN serve as technical companion guides to assist application developers during the implementation process. The given information about 837P Inbound Claim is only intended to supplement the adopted IG’s and provide guidance and clarification as it applies to BUCKEYE COMMUNITY HEALTH PLAN.

EDI Registration

Prior to submitting claims electronically to BUCKEYE COMMUNITY HEALTH PLAN, providers are encouraged to contact the Provider Relations Department and verify the appropriate provider number(s) are on file. In order for EDI claims to be accepted into the Claim Processing system, the provider number must be on file. Anyone wanting to exchange Health Information electronically directly with BUCKEYE COMMUNITY HEALTH PLAN must complete and submit a Trading Partner Agreement form.

Data Flow

BUCKEYE COMMUNITY HEALTH PLAN has secure options available for exchanging data (837P Inbound Claim) electronically. All transactions will be submitted in a batch mode. For each batch transaction received, BUCKEYE COMMUNITY HEALTH PLAN will return a 997 – Functional Acknowledgement. This file acknowledges the receipt of the file and reports any data compliance issues. BUCKEYE COMMUNITY HEALTH PLAN also expects to receive a 997 – Functional Acknowledgement transaction when the trading partner receives any outbound batch transaction.

BUCKEYE COMMUNITY HEALTH PLAN has created an Audit Report for any health care claim transaction (837I and 837P) received. This is not a HIPAA-mandated report; however it summarizes the number of claims received and any claims that were rejected due to invalid information.

A batch request or inquiry transaction, 270, 276, 278 results in the creation of the response transaction, 271, 277 or 278 respectively. BUCKEYE COMMUNITY HEALTH PLAN will post the responses in a reasonable amount of time for the requestor to retrieve. Finally, some transactions can be submitted interactively. BUCKEYE COMMUNITY HEALTH PLAN only creates a 997 – Acknowledgement for an interactive request transaction if it fails the compliance check. Otherwise, the appropriate response transaction serves as the acknowledgement of the receipt of the transaction.

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