CGS EDI

CGS EDI: Benefits For Partners There are advantages to providers who conduct business with Medicare electronically. Some of those benefits include: No more paper claims. EDI (submitting claims to CGS electronically eliminates paperwork, so your staff can accomplish more in less time). You will also save money on postage and claim forms. Earlier payment floor. Electronic Read More →

Correct Billing Procedures

Health Partners Plans Correct Billing Procedures Health Partners Plans has identified the most common electronic errors that occur and compiled a list of helpful hints. All Health Partners Plans (Medicaid) claims must be submitted with the Member’s 9 digit Health Partners Plans ID number. All Kidz Partners (CHIP) claims must be submitted with the 10 digit Read More →

Incorrect EDI Billing Procedures

The most common electronic errors Health Partners Plans has identified the most common electronic errors that occur. Find below the incorrect billing procedures: DO NOT submit claims with the Member’s 10 digit access number or their Social Security number. DO NOT submit Kidz Partners (CHIP) claims with the member’s Social Security number only. DO NOT Read More →

Claims Processing

Health Partners Plans EDI Claims Processing Electronic Data Interchange (EDI) is the sending and receiving of information using computer technology. Any standard business document that one company would exchange with another; such as a purchase order, invoice, shipping schedule, inventory inquiry, and claim submission; can be exchanged via EDI between the two parties, or trading Read More →

EDI Claims

Health Partners General Requirements for the Electronic Claims Submission Process (837 Professional Claims) Find below Health Partners Plans general guidelines for 837 Professional Claims Submission. Only loops, segments, and data elements valid for the HIPAA 837 Professional (005010X222A1) Technical Report Type 3 will be translated. Deviating from the Technical Report Type 3 and submitting invalid data will Read More →

837 Institutional

General Business Requirements for the 837 Institutional 5010A2 Claims Submission Process (Health Partners Claims) These mapping guidelines will address a variety of issues that will facilitate the Electronic Media Claims Processing for the 837 Institutional (005010X223A2). Coding Guidelines Use most recent ICD-9, CPT, HCPC, and Revenue codes. Always check for 4th and 5th digit code Read More →

837 Institutional Claims

General Requirements for the Electronic Claims Submission Process (837 Institutional Claims) EDI Claims guidelines facilitate the Institutional Claims Submission Process. Only loops, segments, and data elements valid for the HIPAA 837 Institutional (005010X223A2) Technical Report Type 3 will be translated. Deviating from the Technical Report Type 3 Guidelines and submitting invalid data will cause files to Read More →

276/277 Health Care

276/277 Health Care Claim Status Request and Response The purpose of generating a 276 Claim Status Request is to obtain the current status of the claim(s) within the adjudication process. A claim is located by supplying Health Partners Plans the following information: Member ID Provider ID Member Name and Date of Birth Member Gender. A service start Read More →

Eligibility Inquiry & Response

270/271 Eligibility Inquiry & Response Companion Guidelines (Health Partners) The companion guidelines explain the procedures and requirements necessary for Trading Partners of Health Partners Plans, Inc. to transmit the following HIPAA standard transaction: 270/271 Eligibility Inquiry & Response. The information is conveyed within the framework of the ASC X12N Implementation Guides adopted for use under HIPAA. Read More →

HIPAA Transactions

HIPAA Transactions and Code Sets Frequently Asked Questions (Health Partners Plans) HIPAA FAQs is one of the resources for information regarding Health Partners Plans Health Insurance Portability and Accountability Act of 1996 (HIPAA) Administrative Simplification implementation. Q: Does Health Partners Plans require certification/testing with providers? A: Health Partners Plans does not require providers to certify with Read More →