Summa Care 834

Summa Care 834 Eligibility Enrollment and Maintenance Guides All Trading Partners must complete the EDI registration process before sending any transactions to SummaCare. Furthermore, all sponsors are required to file a change in registration with SummaCare when the following occurs: Changes in Clearinghouse, Billing Service, Software Vendor or any Vendor handling the Sponsor’s electronic data Read More →

HIPAA Security

HIPAA Security Requirements For Medicare Trading Partners A/B MACs, DME MACs, CEDI, and other entities contracting directly with CMS are considered service providers to CMS. As such, these entities are part of CMS’ system security boundary and must be in compliance with the Federal Information Security Management Act (FISMA) and are subject to CMS security Read More →

Trading Partner

WCMBP Trading Partner Testing Procedures (Office of Workers’ Compensation Programs) Completion of the testing process is not mandatory prior to submitting electronic transactions to WCMBP. However, it is strongly recommended to ensure proper billing and prompt medical bill processing and payment. Testing is conducted to ensure the following HIPAA compliance levels: Level 1 Syntactical integrity: Testing of Read More →

Clearinghouse EDI

Billing Agents/Clearinghouses responsibilities in the EDI Processing Each billing agent/clearinghouse must have an OWCP provider ID number to submit bills via the WCMBP system, and must provide their OWCP Provider ID number to each provider for whom they are billing. Legacy billing agent/clearinghouses: OWCP provider information will transfer to the WCMBP system. They will receive a Welcome and Registration Read More →