Medicare EDI Enrollment

New Medicare EDI Enrollments The Medicare EDI Enrollment process provides for collection of the information needed to successfully exchange EDI transactions between Medicare and EDI trading partners and also establishes the expectations for both parties in the exchange. This agreement must be executed by each provider that submits/receives EDI either directly to or from Medicare Read More →

EDI Enrollment

EDI Enrollment Procedures (CMS) A/B MACs and CEDI are required to furnish new providers that request Medicare claim privileges information on EDI. A/B MACs and CEDI are required to assess the capability of entities to submit data electronically, establish their qualifications, and enroll and assign submitter EDI identification numbers to those approved to use EDI. Read More →

HIMSS-OMB-Blog_Updated

EDI Enrollment and Registration (AKA Trading Partner Agreements) Medicare FFS’ Trading Partner Agreement is comprised of two forms: 1) EDI Registration and 2) EDI Enrollment. The forms are identified under CMS form 10164 and can be accessed at: EDI Registration EDI Enrollment A/B MACs and CEDI must use these two forms, or their own organization Read More →

EDI Forms Solution

EDI Forms Solution (Pennsylvania Bureau of Workers’ Compensation’s (BWC) strategy) This blog describes the strategy to implement EDI Forms Solution. Please note that the BWC claim forms referred to in the below sections refer to only the following four forms: EDI Form Description LIBC-495 NOTICE OF COMPENSATION PAYABLE LIBC-496 NOTICE OF WORKERS’ COMPENSATION DENIAL LIBC-501 NOTICE OF Read More →

BWC Testing

Testing Procedures Completion BWC Testing Completion is the final step of testing between direct-filing Trading Partners and/or EDI Transaction Partners and BWC. During this step direct-filing Trading Partners and/or EDI Transaction Partners will be given formal approval by BWC to proceed with its system updates to their respective production environments. Additional test cycles will need to be conducted if direct-filing Read More →

EDI Claims Codes

EDI LIBC-495 (Notice of Compensation Payable – BWC) EDI LIBC-495 verifies if the Claim Administrator has implemented the changes that would result in the generation of the Notice of Compensation Payable (LIBC-495) based on the following EDI transaction/maintenance type codes: SROI IP SROI PY SROI AP SROI RB SROI 02 SROI CA SROI PD SROI IP 1. Read More →

EDI Notice testing

EDI Notice Stopping Temporary (LIBC-502) (BWC EDI testing procedures) We continue a series of posts regarding Commonwealth of Pennsylvania Department of Labor & Industry (BWC) EDI testing procedures. Find below guidelines for Generation of EDI Notice Stopping Temporary Compensation Payable (LIBC-502). The purpose of this process is to verify if the Claim Administrator has implemented the changes that would result in the generation Read More →

LIBC-496

Generation of Notice of Compensation Denial (LIBC-496) In this blog we continue a series of posts regarding Commonwealth of Pennsylvania Department of Labor & Industry (BWC) EDI testing procedures. Generation of Notice of Compensation Denial (LIBC-496) purpose is to verify if the Claim Administrator has implemented the necessary changes to their system that would trigger the generation of the Notice of Compensation Denial (LIBC-496) based Read More →

Invalid Event Sequence

Invalid Event Sequence (BWC EDI Errors) Invalid Event Sequence results in filer submitting an EDI transaction outside sequencing guidelines.  You should check the claim in WCAIS or the last ACK received to determine the current claim status then use the Relaxed Rules document, Claim Status Reference Sheet, and the Event table for further sequencing rules. Also refer to section 4 of this document for next steps.  Filer should always consult the WCAIS claim Read More →

Invalid Data

Invalid Data Relationship (BWC EDI Data Errors) Invalid data relationship and match data value not consistent with value previously reported, no match on database is one of the widespread EDI errors. This means Claimant’s name, DOI, SSN, DOB, Employer FEIN, Insurer FEIN, Claim Admin FEIN, JCN, or Claim Admin Postal Code either doesn’t match a previously submitted transaction, doesn’t match an existing profile, or doesn’t match an existing claim. You should use Read More →