EDI training schedule for the fall of 2018 EDI Training schedule – online and on-site classes are offered by the EDI Academy for new and advanced EDI learners. We invite individual students and groups of interested staff. EDI Academy is proud to announce the EDI Training class schedule for the fall of 2018. Please let us know if you are interested in registering … Read More →
Data Content Rules (CAQH CORE 154 & 260 Rules) – Health Plans Requirements Data Content Rules (CAQH CORE 154 & 260 Rules) require health plans to address the situation where a patient’s benefit coverage changes from the time of the X12 270 Inquiry to the date of service. True or false? Actually the CAQH CORE … Read More →
CAQH CORE 155 Operating Rules – Batch Response Time Rule CAQH CORE 155 Operating Rules set one hour as the maximum response time for the availability of the ASC X12 Implementation Acknowledgement (999) as specified in CAQH CORE 155: Batch Response Time Rule. But what is the maximum response time for HTTP message after a … Read More →
Flex EDI Program Basic Description And Guidelines For Partners Flex EDI program is used in business relationships o exchange business data or electronic documents, in a structured manner, between trading partners. Flex supports the United Nations rules for Electronic Data Interchange for Administration, Commerce and Transport (UN/EDIFACT) the international EDI standards developed under the United Nations. Business-to-business integration, … Read More →
X12 270 271 Transactions Tracking (CAQH CORE 155 Rule) X12 270 271 Transactions can be tracked throughout a system/application to demonstrate conformance with the response time requirements specified in the CAQH CORE 155 Rule. The CAQH CORE Response Time Rules (CAQH CORE 155 & 156 Rules) require HIPAA covered entities to capture, log, audit, match, and report the date, time, … Read More →
CAQH CORE 154 Rule (Subsection 2.6) – Explicit request for each of the CORE Service Types CAQH CORE 154 Rule requires all CORE-certified entities to be able to support an explicit inquiry about each of the 12 CAQH CORE-required service types. Support means that an entity must be able to receive and respond to an … Read More →
Optum EDI Eligibility Service: Eligibility and benefit verification, Referrals and authorizations, Transaction testing and validation, Remittances Optum EDI Eligibility Service helps to connect to an extensive group of payers to verify patient eligibility and benefit information. The solution integrates with payers to allow you to verify coverage for the patients, identify discrepancies in provider databases to eliminate inconsistencies and identify patient responsibilities to collect … Read More →
Optum Intelligent EDI: The new benchmark for EDI performance Optum Intelligent enables organizations to benefit from higher levels of automation and efficiency by embedding additional functionality into the EDI data stream. With a single solution, providers and facilities can manage the complete lifecycle of their claims, eliminating multiple systems and inefficient processes used to accomplish these business functions in … Read More →
CAQH CORE Eligibility Data Content Rules – Frequently Asked Questions CAQH CORE Eligibility Data Content Rules (CAQH CORE 154 & 260 Rules) do not require that the X12 271 response to an X12 270 inquiry include a specified grouping of Service Type Codes (STCs), so are health plans/information sources prohibited from returning such an STC … Read More →
CAQH CORE 154 X12 271 Response Back Guides CAQH CORE 154 X12 271 response with the health plan name (assuming it is available within the system[s]) in EB05 element of all EB segments sent back in the response has some notes. Since the CAQH CORE 154 Rule does not explicitly identify which EB segments are to carry … Read More →