Healthcare Cost Savings

Healthcare Cost Savings Using Electronic Data Interchange CAQH, a nonprofit alliance, is the leader in creating shared initiatives to streamline the business of health care. The 2019 CAQH Index shows that the average cost to conduct transactions manually is higher than the cost of electronic transactions for care providers and health plans. Providers can use Read More →

EDI Transactions medicare

Steps of an EDI Transaction: United Healthcare Scenario Example EDI transactions start with an inquiry from the care provider and conclude with a response from the payer. The inquiry is submitted by supplying certain required data fields, such as member ID number, date of birth and Payer ID. This inquiry can go directly to the Read More →

EDI training

How EDI Works and Helps Care Providers (United Healthcare Guides) Electronic Data Interchange (EDI) is the automated transfer of data between a care provider and a payer. The benefits to care providers include quicker turnaround of information, reducing administrative expenses and avoiding claim processing delays. Using EDI allows payers and care providers to send and Read More →

Medicare Crossover

Medicare Crossover: United Healthcare Explained Medicare Crossover is the process by which Medicare, as the primary payer, automatically forwards Medicare Part A (hospital) and Part B (medical) including Durable Medical Equipment (DME) claims to a secondary payer for processing. It is a standard offering for most Medicare-eligible members covered under UnitedHealthcare Commercial plans. Enrollment is automatic for Read More →

Medicare Electronic Data Interchange

How to Enroll in Medicare Electronic Data Interchange Guidance for CMS standard Electronic Data Interchange (EDI) enrollment form to be completed prior to submitting Electronic Media Claims (EMCs) or other EDI transactions to Medicare. The Centers for Medicare & Medicaid Services (CMS) standard Electronic Data Interchange (EDI) enrollment form must be completed prior to submitting Read More →

HIPAA EDI

Advocating for Interstate Compact Legislation in 2022 A legislative summit was held on August 24 and 26 for states interested in introducing legislation for the Audiology and Speech-Language Pathology Interstate Compact (ASLP-IC) in 2022. Attendees heard from ASHA and the Council of State Government as well as legislators in states where the ASLP-IC passed in Read More →

HIPAA EDI Rule

HIPAA: Electronic Data Interchange (EDI) Rule: ASHA Explained The HIPAA rules clearly expect that the response to the EDI rule will be based on the needs and resources of the provider. As long as all electronic transmissions are EDI compliant, the method of response is left up to their discretion. Providers can submit claims directly Read More →

HIPAA EDI Rule

HIPAA: Electronic Data Interchange (EDI) Rule (ASHA) The EDI rule is very technical and based on the X12N EDI data transmission protocol standard. Although rare allowances are made, the rule requires that any covered entity who electronically transmits data must use this, and only this format in doing so. The EDI rule is a set Read More →

Administrative Simplification Compliance Act

Administrative Simplification Compliance Act Basics Section 3 of the Administrative Simplification Compliance Act (ASCA), Pub. L. 107-105 and the implementing regulation at 42 CFR 424.32, require that all initial claims for reimbursement from Medicare be submitted electronically, with limited exceptions. The ASCA amendment to section 1862(a) of the Social Security Act prescribes that “no payment Read More →

HIPAA EDI Acronyms

HIPAA EDI Acronyms and Definitions Learn basic HIPAA EDI acronyms and definitions to understand the terminology used in health care CMS guidelines. EDI – Electronic Data Interchange – the process of using nationally established standards to exchange electronic information between business entities. HIPAA – Health Insurance Portability and Accountability Act of 1996 – legislation that mandated that Read More →