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 →

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    Getting Started With Arkansas Medicaid HIPAA EDI Transactions Tens of millions of Americans have Medicaid Insurance. Medicaid is insurance provided by the state. Arkansas is one of the Medicaid agencies using EDI. Arkansas has about 500,000 Medicaid members. According to medicaid.gov the managed care organization (MCO) for Arkansas can be any carrier but Read More →

7030

On September 4th, 2019 X12.org updated their home page with the latest 7030 Update. The X12N work group is responsible for 007030 TR3s (Technical-Report-Type 3) also known as HIPAA Implementation Guides. A public review period for each health care EDI Transaction must be conducted before these guides can become official. Below is the latest information Read More →

Electronic Medical Claims

Electronic Medical Claims Program Requirements (Manitoba Health, Healthy Living and Seniors) Electronic Medical Claims Program requires automation integrated with the current office tasks and procedures to maximize the benefits. An electronic medical billing system should provide your office with more rapid input, improved accuracy, faster processing and the ability to report and analyze practice statistics. Read More →

Provider Claim Guidelines

Operating Rules CAQH CORE 270: Connectivity Rule Guidelines Operating Rules CAQH CORE 270: Connectivity Rule requirements must be implemented by all entities seeking CORE Certification, including all other the CAQH CORE Eligibility and Claim Status Operating Rules. Operating Rules CAQH CORE 270: Connectivity Rule  state that the CAQH CORE 270 Rule is applicable only to the public Internet, which is a TCP/IP Read More →

CAQH CORE 270

CAQH CORE 270: Connectivity Rule Authentication Standards CAQH CORE 270: Connectivity Rule (Connectivity & Security Subgroup) evaluated the connectivity implementations used by its members, including what types of submitter authentication methods were being used. The results showed widespread use of both username/password and X.509 client certificate authentication. Though username/password is the base requirement with Phase Read More →

CAQH CORE Connectivity Safe Harbor

CAQH CORE Connectivity Safe Harbor Guidelines CAQH CORE Connectivity Safe Harbor requirements that a health plan must use if requested by a provider are described in CAQH CORE 270 Rule, Section 5, CORE Safe Harbor. The CAQH CORE Connectivity Safe Harbor specifies connectivity methods that application vendors, providers, and health plans can be assured will be supported Read More →