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 →

EDI training online

UN/EDIFACT Message Data Mapping Guide (continued) The guidelines given below refer to each UN/EDIFACT message used in SARS EDI business communication. The first two portions were given in the previous blog posts. Find below the descriptions of more data elements. UNH MESSAGE HEADER (Mandatory 1) Specification of the beginning of each individual message and unique identification of the message. Read More →

EDI Mapping

SARS Mapping Guidelines: Interchange Header Segment Elements (Continued) Application Reference (0026) element may be used only if the interchange contains one message type. A reference to the specific systems’ application that will process all the messages in the interchange can be made here. Processing Priority Code (0029) Code denoting the processing priority for the interchange as assigned by Read More →

Mapping requirements

Mapping requirements for Interchange Header Segment (Sender, Recipient, Date, Time of Preparation) We continue to describe mapping guidelines for SARS EDI Documents. In the previous blog, we started speaking about Interchange Header Segment. Find below the next data elements description. Interchange Sender (S002) Sender identification (0004) Identifies the sender of the interchange by either name or a Read More →

mapping guides

South African Revenue Service (SARS) Mapping guides: UNB, Interchange Header (Mandatory) UNB, Interchange Header represents the specification of the beginning of a message interchange. It identifies the message syntax, the parties to the transmission, including details of password, communication, control, application and test conditions. The segment must always be used in a transmission and must Read More →

UN/EDIFACT

UN/EDIFACT Data Elements (SARS Explained) Each data segment has a specific position within the sequence of segments in a message. Segments can appear on their own or as part of a group. A data element is the smallest unit of information in a segment. Two or more data elements may be grouped together to form Read More →

HIPAA Claims Guide

EmblemHealth HIPAA Claims Guidelines All providers who are part of an EmblemHealth-contracted medical group – and individually credentialed providers who have a non-contracted provider as part of their group and share a TIN, NPI, or specialty/taxonomy code – are considered contracted providers for the purposes of claim payments and are considered “Substitute Practitioners.” Claims for Substitute Practitioner Read More →