HL7

HL7 Message Notes HL7 Message definition and description were already mentioned in our previous posts. Today we continue to speak about HL7 Message structure. There is a standard HL7 Message notation that is used to document the structure of an HL7 message. This notation consists of 5 rules: All messages start with an MSH Segment Read More →

HL7 standard

HL7 Standard Description HL7 standard is an abbreviation of “Health Level Seven” where “Level Seven” refers to the Seventh OSI layer protocol for the healthcare environment. The 7 OSI levels or layers are: Level 7: Application Layer Level 6: Presentation Layer Level 5: Session Layer Level 4: Transport Layer Level 3: Network Layer Level 2: Read More →

CLEARING HOUSE EDI

Clearing house and it’s role in Healthcare EDI Communication Clearing house is a third party service provider. It takes non-EDI data and translates them to EDI data. Clearing house can also translate EDI to EDI. This is done by taking the received raw data, massaging and scrubbing it. Then data are sent to another document. Clearinghouse can also Read More →

edi considerations

BCBSM EDI Testing Requirements For The Specific Bill Type BCBSM EDI Testing (Blue Cross Blue Shield of Michigan) steps should be done before you will start sending and receiving information electronically. BCBSM EDI Testing files must follow the 837/835 TR3’s and companion document requirements for the specific bill type. BCBSM EDI Testing – Professional Claim files must Read More →

Blue Cross Blue Shield EDI

Blue Cross Blue Shield EDI: Getting Started Guidelines Blue Cross Blue Shield EDI Guidelines described below will be useful for providers, facilities, software vendors or clearinghouses and will help you learn how to reduce costs and save time by sending and receiving Blue Cross Blue Shield EDI information. Blue Cross Blue Shield EDI claims submission tool is: Easy Read More →

targetmarketing

278 EDI Transaction (Response) example – raw data and human readable In our previous posts we have already spoke about 278 EDI Transaction. We mentioned definition and purposes of the 278 EDI Transaction and reviewed 278 EDI Transaction (Request) example. The following is a turn-around from the previous 278 EDI Transaction request. The HRC segment authorizes Read More →

data

278 Transaction example – raw data and human readable The following Raw Data and Human Readable examples of a 278 Transaction request for referral sent by provider Dr. Zoidberg to UMO INSURANCE R US. The document id for this 278 Transaction is 4158609887 found in BHT-03. The subscriber Fred Flintstone who happens to be the Read More →

information

278 Health Care Services Review Information – definition and purpose The 278 Health Care Services Review Information transaction belongs to HIPAA EDI documents. A health organization can send 278 Health Care Services Review Information (patient data, diagnosis or treatment data) for the purposes of requesting a review. Typically the requestor (the sending party) is the Read More →

HIPAA EDI 835

HIPAA EDI 835 transaction and balancing formula description The HIPAA EDI 835 example given in the post is for two institutional claims. It is a remittance advice and it’s submitted by BCBS DISNEY (payer) to UCLA MEDICAL CENTER (payee). BPR-01 = “I” which means “Remittance Advice Only” The payment is for patient Mickey Mouse and Donald Read More →