Oklahoma Health Care Authority HIPAA RA Guides Providers receive a weekly remittance advice (RA) for any claims submitted the previous week. The RA identifies claims that are paid, denied, in process or adjusted. The RA includes the client ID number, the provider number, the Internal Control Number (ICN) of the claim processed, the date(s) of … Read More →
OHCA Crossover Claims Requirements It is important to remember that providers must include the correct Medicare identification number for a claim to crossover automatically. The following information concerns crossover claims: If a provider does not receive the OHCA payment within 60 days of the Medicare payment, claims that did not crossover should be submitted electronically. … Read More →
Oklahoma Medicaid TPL Billing Procedures When submitting all claims, the amount paid by a third party must be entered in the appropriate field on the claim form or electronic transaction. If a third-party payer made payment, an explanation of payment (EOP), explanation of benefits (EOB), or remittance advice (RA) is not required for electronically submitted … Read More →
TPL Claim Processing Requirements (Oklahoma Medicaid) Providers are required to bill all other insurance carriers prior to billing the OHCA, except for programs that are secondary to the OHCA. The TPL Unit is available to assist with determining other insurance resources and maintaining the most current member TPL files. Billing Documentation Requirements The OHCA must … Read More →
Electronic Remittance Advice Transaction An electronic RA is available by using the X12 835 transaction as mandated under HIPAA. The 835 transaction is available to all OHCA providers and contracted trading partners that have requested electronic RAs. The 835 is a financial transaction that functions as an electronic means of posting accounts receivable. The 835 … Read More →
Remittance Advice (RA) (Oklahoma Healthcare Authority) OHCA providers receive a weekly remittance advice (RA) for any claims submitted the previous week. The RA identifies claims that are paid, denied, in process or adjusted. The RA includes the client ID number, the provider number, the Internal Control Number (ICN) of the claim processed, the date(s) of … Read More →
Medicaid Electronic Payments Via SoonerCare The provider has two (2) primary methods of receiving payment from SoonerCare: system-generated checks and electronic funds transfer (EFT). These payments, along with the remittance advice, are produced during the financial cycle. The remittance advice, which details each provider’s claims and financial transaction activity during the period, is made available to … Read More →
EDI Clean Claim Definition And Guides A clean claim is defined as a claim received by Louisiana Healthcare Connections for adjudication, in a nationally accepted format in compliance with standard coding guidelines, and which requires no further information, adjustment or alteration by the provider of services in order to be processed by Louisiana Healthcare Connections. … Read More →
Billing With Individual NPI Number (Louisiana Healthcare Connections) Providers must bill with their individual NPI number in box 24Jb and group or pay to NPI# in box 33a. The servicing location information in box 32 must be completed when it is different than the billing provider information in box 33. The provider NPI may be … Read More →
Billing Requirements For Providers (Louisiana Healthcare Connections) Physicians, other licensed health professionals, facilities and ancillary provider’s contract directly with Louisiana Healthcare Connections for payment of covered services. It is important that providers ensure Louisiana Healthcare Connections has accurate billing information on electronic file. Providers should confirm that the following information is current in Louisiana Healthcare Connections … Read More →