EDI Testing and Approval Requirements (Prevea360 Health Plan) EDI testing and approval require a minimum of two test cycles and test files. The first test file must be a full population file. This means it must contain all subscribers and dependents currently enrolled in the group for which the test file is being submitted. It … Read More →
834 Full File Submission Information (Prevea360 Health Plan) 834 Full File Submission is not allowed if the number of enrolled members is greater than 500. Change Only file submission will need to be utilized. This excludes the initial full eligibility file for production go-live and quarterly audit files. A full file is defined as BGN08 = … Read More →
Change Only File Submission Information (Prevea360) Change Only File Submission Information method is required to be used when the enrolled number of members is greater than 500. A Change Only file is defined as BGN08 = 2 and Member Level Detail Loop 2000 INS01 <> 030. Loop 2300, Health Coverage Dates, DTP01 = 348 should … Read More →
834 File Requirements (Prevea360 Health Plan) 834 File will be used as an audit file to make sure the records for both parties are in sync prior to moving to production. While Prevea360 can accept both full enrollment files and change only files, it prefers to receive change only/event only files on an ongoing basis for groups … Read More →
Prevea360 Health Plan EDI 834 Implementation Guides EDI 834 Transactions must be submitted in the proper order to ensure correct processing. For example, an add transactions must be submitted on a file and processed prior to a termination transaction being submitted for a given member. It is recommended that the full population is submitted in … Read More →
EDI 834 challenges and pitfalls (Caliber Health) EDI 834 includes vital information that can become a major impact on the sponsor, the payer, and especially the member. Ensuring the EDI 834 file processing goes smoothly is very critical. Here are some EDI 834 challenges and pitfalls Caliber Health have seen over the years. Common Issues in Processing EDI … Read More →
EDI 834 Enrollment And Maintenance File (Caliber Health) EDI 834 is the Benefit Enrollment transaction type found in the X12 transaction set directory. It is used by government agencies, employers, and health plans to enroll and maintain membership in a healthcare benefit plan and can be processed utilizing Healthcare EDI software. The EDI 834 spec is … Read More →
EDI Claims Reporting Requirements (Iowa DWC) The DWC will work with the DWC Vendor to provide initial and ongoing training and guidance to trading partners who need assistance regarding the proper reporting of claim information via EDI. It is imperative that trading partners become familiar with the Iowa EDI Claims Release 3.1 Event Table to … Read More →
Iowa DWC EDI Partnership Basic Requirements Iowa DWC EDI Partnership program includes a Request for Proposal (RFP) process to contract for a Vendor (DWC Vendor) to facilitate EDI Claims filing for Iowa’s workers’ compensation carriers and self-insured employers and/or their claims administrators. In the context of EDI, claims administrators, carriers, self-insured employers, and/or their contracted vendors … Read More →
Evolution of the EDI Claims Reporting Standards In the 1970s, various state legislatures began questioning how their workers’ compensation systems were working compared to other state systems, and in the 1980s the International Association of Industrial Accident Boards and Commissions (IAIABC) created a Statistics Committee, whose task it was to identify, compare, and standardize injury … Read More →