837 Healthcare Claim

837 Healthcare Claim Implementation Guides 837 healthcare claim can be compared to an invoice in the merchandising world. However, it is much more complicated than that and some consider it to be the most complicated EDI transaction set. The purpose of this transaction is to submit healthcare billing information from providers of healthcare services to payers, either directly or Read More →

HIPAA

HIPAA for Professionals: Federal Privacy Protection Rules To improve the efficiency and effectiveness of the health care system, the Health Insurance Portability and Accountability Act of 1996 (HIPAA), Public Law 104-191, included Administrative Simplification provisions that required HHS to adopt national standards for electronic health care transactions and code sets, unique health identifiers, and security. At the Read More →

Provider Claim Guidelines

CMS HIPAA Standards Approved CMS HIPAA 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 implementation specifications for Read More →

Version 7030 training

Version 7030 Is Coming – X12 EDI Training Online Schedule 2020-2021 TBD Version 7030 HIPAA EDI training is the most expected educational event in 2020. Follow our news to register for the first training stream. Find the course description below. HIPAA EDI 7030-101 – Introduction To The Health Care EDI Environment & 7030 Introduction to 7030 7030-5010 Major Gaps Read More →

HAP Midwest Health Plan Billing

HAP Midwest Health Plan Billing And Reimbursment Requirements HAP Midwest Health Plan Billing and Reimbursment process will be discribed below in this blog. MDCH contracts with HAP Midwest Health Plan to administer the Medicaid HMO benefits to its enrolled members. Medicaid is considered as payment source of last resort. Some Medicaid members have dual insurance coverage. Read More →

Pharmaceutical EDI Data Integration

Pharmaceutical EDI Data Integration capabilities at McKesson Pharmaceutical EDI Data integration enables configurable pharmaceutical product and data sharing between pharmacy management systems, provider information systems and enterprise resource planning (ERP) systems. McKesson provides data interface solutions for pharmacy customers who are unable to support direct, automated electronic data interchange (EDI) through McKesson Data Exchange module. Solutions allow Read More →

Filing A Healthcare Claim

Filing A Healthcare Claim Requirements For Cigna Vendors Filing A Healthcare Claim should be done as soon as possible. If you’re unable to file a claim right away, please make sure the claim is submitted accordingly. If you are a participating health care provider, submit by 90 days after the date of service If you are Read More →

Clean Claim Requirements

Clean Claim Requirements (Cigna vendors) Clean Claim Requirements were developed with the goal to process all claims at initial submission. Before Cigna can process a claim, it must be a “clean” or complete claim submission, which includes the following information, when applicable: primary carrier explanation of benefits (EOB) when Cigna is the secondary payer prescription for physical Read More →

EDI Claims

Cigna Electronic Data Interchange Claims Process Cigna Electronic Data Interchange vendors securely transmit data electronically to Cigna and gain many benefits of this process. Filing paper claims can be time consuming. When you submit claims to Cigna electronically, including coordination of benefits (COB) claims, your practice can gain many benefits such as: Quicker claims submission, including Dental Health Read More →