820 Transaction Set Guides (OKMMIS) The 820 Transaction Set is the HIPAA-compliant financial transaction used to transmit care coordination payments. The 820 Transaction Set is generated by the Oklahoma OKMMIS and is distributed to primary care providers/case managers (PCP/CMs) who request electronic capitation reports and participate in the SoonerCare Choice program. The 820 Care Coordination … Read More →
Electronic RA (OHCA) Mandated under HIPAA Requirements 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 … Read More →
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 →