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 →

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 →