837 institutional claim

837 Institutional Claim scenario and mapping guidelines 837 Institutional Claim example presented in today’s post shows a standard 837 Institutional claim. As we spoke in our previous post, the 837 Healthcare Claim transaction has three different implementation guides specifically developed for Professional, Institutional and Dental claims. The specifications are geared to meet the individual requirements Read More →

837 professional claim

837 Professional Claim scenario and raw data 837 Professional Claim example mentioned in this post shows a standard 837 Professional claim file. It includes data from the provider of Service indicating the member’s demographic information, diagnosis, services rendered and charges. 837 Professional Claim data will be used by the Insurance Company to determine what benefits Read More →

Tufts Health Plan EDI

835 EDI Transaction  implementation instructions and guides 835 EDI Transaction means Health Care Claim Payment/Advice Transaction that allows providers to receive claim remittance information electronically. The ASC X12N 835 (005010X221 and 005010X221A1) 835 EDI Transaction Set Technical Report Type 3 and errata have been established as the standard for claim remittance transaction compliance. The Tufts Health Plan 835 Read More →

837 EDI

Health Care Claim: general definition, purposes and benefits coordination Health Care Claim 837 transaction is the EDI function that submits health care claim form to the Insurance Company of the patient whom has received care from a Provider of Service. The Health Care Claim form contains specific data related to the Patient, Provider of Service, Insurance Read More →

Tufts Health Plan Claim

Tufts Health Plan claim options and useful notes Tufts Health Plan Claim EDI processing helps providers to submit claims electronically – either directly or through a clearinghouse – and receive electronic remittance from Tufts Health Plan. For quicker payment, fewer rejections and ease of processing, providers can send their Tufts Health Plan claim electronically using the following electronic claim options: Read More →

Tufts Health Plan EDI

Tufts Health Plan EDI mission – electronic solutions for healthcare needs Tufts Health Plan EDI commitment surves for providing clients with the easiest and most comfortable service. From member eligibility status and benefit information to claim submission and clinical information, your office can dramatically improve administrative costs with less paper and less time on the phone. Tufts Health Plan EDI tools Read More →

clearing house

Healthcare Eligibility, Coverage and Benefit Request (270) and Response (271) additional notes concerning batch and timing Healthcare Eligibility, Coverage and Benefit Request (270) and Response (271) EDI transactions were already discussed earlier in the blog. You can find general information about these healthcare EDI transactions as well as the description of the relationship during the Read More →

270, 271 edi

270, 271 EDI relationship: senders and receivers, subscribers and dependents 270, 271 EDI transactions basic information was described in our previous blog post. Today we speak about the relationship between the participants of the 270, 271 EDI transactions process. During 270, 271 EDI exchange provider of service can request more detailed eligibility information other than a patient’s standard eligibility. Read More →