7030 271 Premium Payment Grace Period Notification: Implementation Purpose and Scope 7030 271 Premium Payment Grace Period Notification implementation guides refer to parties who to send and/or receive electronic grace period information in a standardized transaction. For the health care industry to achieve the potential administrative cost savings with Electronic Data Interchange (EDI), standards have been developed to facilitate consistent Read More →

Certification Test Program (Test Case Activities For CMS A/B MACs, CEDI and other contractors) Certification Test Program requires CMS trading partners to perform certification testing using the CTP and produce reports based on the test results. A test case describes each task that will insure ASC X12 data elements, qualifiers, and data values conform to the TR3 and the Read More →

Version 7030 Review Process Comments And Engagement Version 7030 refers to the next major release of electronic health care administrative transaction standards developed by the Insurance Subcommittee (N) of X12, a national accredited standards committee. Version includes those transactions adopted under HIPAA (as version 5010) as well as those that were not adopted by regulation. Currently the Version Read More →

TR3 Review (X12N Version 7030) – Process FAQs TR3 Review (X12N Version 7030) FAQs and comments heighten industry awareness, provide a foundational understanding of the X12N Version 7030 process and encourage and support bodies and institutions in their participation. Why are the TR3s coming out at different times for review? A staggered approach allows for more focused reviews Read More →

X12N Version 7030 – TR3 Public Review and Comment Process FAQs X12N Version 7030 FAQs are provided to assist parties involved in health care regarding the upcoming industry review of the X12N version 7030 transaction standards. The goal is to heighten industry awareness, provide a foundational understanding of the X12N Version 7030 process, and encourage and support Read More →

270/271 HIPAA Transaction Validation (Pre-Query and Post-Query) (Washington State Health Care Authority) 270/271 HIPAA Transaction validation (Washington State Medicaid’s 270/271 transaction) will perform a pre-query validation to make sure the required Subscribe data elements are preset prior to routing the information to Eligibility and Benefit system. For Subscriber request below data elements can be submitted: Read More →

Medicare FFS Contractors (A/B MAC, DME MAC, CEDI) Medicare FFS Contractors A/B MACs, DME MACs, CEDI or other contractors if designated by CMS are responsible to support the exchange of CMS approved electronic transactions. This support includes testing, certifying, and retention of an audit trail for the electronic data interchange platforms. Medicare FFS Contractors if Read More →

HIPAA Transaction Standards as Designated by CMS HIPAA transaction standards shall be supported by the A/B MACs, DME MACs, CEDI or other contractors if designated by CMS for the electronic data with Medicare providers/submitters/receivers/COB trading partners. ASC X12 Technical Report 3s (TR3s) for mandated HIPAA transactions may be purchased from Washington Publishing Company. The HIPAA-standard Read More →

276/277 HIPAA Transaction Notes (Washington State Health Care Authority) 276/277 HIPAA transaction guides state that when the trading partner submits the 276 request by any one of the specified methods the 276 request will be validated using EDI validator (up to levels HIPAA validation level 1 & 2), translated and will be processed. The positive Read More →