EDI COB Center For Celerian Group Companies Customers, Beneficiaries And Providers EDI COB Center Assistance is given for CGS (Celerian Group Companies) contractors regarding EDI Coordination of Benefits issues. EDI COB Center Assistance (Benefits Coordination & Recovery Center) is provided to: All Customers Answers to general questions regarding Medicare Secondary Payer (MSP). Requests for duplicate questionnaires. Beneficiaries Read More →

EDI Coordination of Benefits Basics For Celerian Group Company Medicare Contractors EDI Coordination of Benefits program purposes are to identify the health benefits available to a Medicare beneficiary and to coordinate the payment process to prevent mistaken payment of Medicare benefits. The BCRC (Benefits Coordination & Recovery Center) consolidates the activities that support the collection, management, and reporting Read More →

ASC X12 Implementation Acknowledgement (999) (CAQH CORE Certification) ASC X12 Implementation Acknowledgement (999) must be always returned by CORE-certified organizations. The organization must successfully complete all of the required certification test scripts required by the Phase II CAQH CORE Certification Test Suite to become CORE-certified. The ASC X12 Implementation Acknowledgement (999) can be used only to acknowledge Read More →

X12 Interchange Acknowledgement (250: Claim Status Infrastructure Rule) X12 Interchange Acknowledgement must be returned for real time X12 276 claim status inquiries if the functional group is rejected, or the X12 277 response, to be conformant with this rule. CAQH CORE Rules do not address usage of the X12 Interchange Acknowledgement TA1.  To send real time acknowledgments Read More →

HIPAA CAQH CORE Batch Processing (250: Claim Status Infrastructure Rule) HIPAA CAQH CORE recognizes that every organization has its own record-retention policies and, therefore, does not mandate a strict requirement for retention of response files. However, CAQH CORE recommends that a copy of responses be kept available for a minimum of six months after they Read More →

CAQH CORE HTTP/S (250: Claim Status Infrastructure Rule) Connectivity CAQH CORE HTTP/S is secure and reliable enough to protect the delivery of healthcare information over the Internet. In Phase I development discussions, CAQH CORE solicited input on this topic from its Technical Work Group members and experts within healthcare and other industries, such as financial services. Based on Read More →

CERT Contractor EDI Claims Error Checking CERT Contractor may consider claims sent by providers and Medicare partners having errors. Errors may result for the following reasons: No Documentation Received This results when the provider fails to respond to the request for medical records, or responds to the request untimely. In order to avoid these types of Read More →

CERT Program Primary Objectives And Claims Status CERT Program supports CMS’s primary objectives of ensuring that Medicare contractors are paying claims appropriately, and providers are billing medically necessary services correctly. The error results help identify the areas of greatest vulnerability to the Medicare program, and will assist in directing educational activities to reduce the error Read More →

EDI Claim Selection For CERT Review Basic Principles EDI Claim Selection supposes review the bar coded sheet, included with the CERT letter, to determine what documentation is being requested. Keep a copy of the CERT letter, including the bar coded sheet, on file within your agency. Gather all documentation requested in the letter, and any Read More →

EDI Academy invites you to join HIPAA X12 Online Trainings! * $250 per session per person. * 20% discount for all sessions (email info@ediacademy.com). * 20% discount for groups. * 100+ page course manual, other educational resources. HIPAA EDI 101 – Introduction To The Health Care EDI Environment Wednesday, August 15th, 2018 11:00 AM – Read More →