HIPAA online course

Medical Associates Health Plan Payer Specific Business Rules Submitters may send a 276 claim status request on claims filed electronically (via an 837 Health Care Claim) or on paper. MAHP/HC does not distinguish between paper and electronic claims when issuing a 277 response. Date ranges returned on the 277 response (DTP03) are those submitted on Read More →

Claim Requests

Claim Requests for Reconsideration, Provider Disputes and Corrected Claims (Sunshine Health Guidelines) Provider billing department will need to submit to the appropriate payer to prevent payment delays. The provider should use the same date of service guidance on the first page to determine the correct payer. Corrected claims must be submitted within 90 days from the date Read More →

Claims Filing Deadlines

Sunshine Health Electronic Claims Filing Deadlines Original claims (first time claims) and corrected claims must be submitted to Sunshine Health within 180 calendar days from the date services were rendered or compensable items were provided. When Sunshine Health is the secondary payer, claims must be received within 90 calendar days of the final determination of Read More →

Mapping Guides: EDI Claims

Sunshine Health Electronic Claims Guidelines It is important that providers ensure Sunshine Health has accurate billing information on file. Provider should confirm with the Provider Relations department that the following information is current in Sunshine Health files: Provider name (as noted on current W-9 form) National Provider Identifier (NPI) Tax Identification Number (TIN) Taxonomy code Physical Read More →

wellfirst edi

Electronic Data Interchange (EDI) For Providers WellFirst Health WellFirst Health offers HIPAA-compliant electronic transactions to providers to meet consistent documentation, handling and privacy standards as well as for efficiency. Eligibility and Benefit Inquiry and Response (270/271) The most timely and accurate way to confirm a member’s benefits and coverage amounts is to submit an eligibility Read More →

EDI learning

SARS EDI Documents: STATAC (STATEMENT OF ACCOUNT) The STATAC message is used by the SARS to send daily and detail transaction listings to traders with deferment accounts that are registered to have their FAN (Financial Account Numbers) linked to an EDI profile. STATAC provides traders the ability to reconcile their declarations against their transactions categorised Read More →

EDI webinars

REQDOC (REQUEST FOR DOCUMENT) SARS Explained The REQDOC message is used to request the last successful CUSRES of an entry. The LRN and or MRN must be provided in the REQDOC. A CUSRES will be sent to verify if the request can be fulfilled or not followed by the CUSRES in question if available. Note Read More →

EDI Education

PRODAT (PRODUCT DATA) Message SARS Overview Tariffs are amended on a regular basis and get published in the Government Gazette. Agents then need to update their master files with the amended information in order to supply the correct tariff information on declarations. This is a time consuming, tedious capturing and checking effort. With the introduction Read More →

EDI webinars online

CUSCAR: Customs Cargo Report (SARS EDI Guides) The CUSCAR message is used for supplying manifest information to SARS electronically. For each CUSCAR message received, SARS will return a CUSRES message with either a Status 6 (Rejected), Status 8 (Accepted) or Status 9 (Duplicate). Illustration below shows the relationship between EQD and SGP segments. To learn Read More →

SANCRT

SARS EDI Messages: SANCRT (International Movement Of Goods Governmental Regulatory Message) The Issuing Authority will submit permits electronically to SARS as soon as they have been issued. Permits will be sent according to the UN/EDIFACT SANCRT message format. An electronic permit received by SARS may have one of the following three statuses: Original (A new Read More →