EDI Documents Transmission Standards and Guidelines For Security Health Plan Partners
EDI Documents Transmission guidelines state that Security Health Plan and the affiliated provider may electronically transmit to or receive from each other any of the standard transactions (collectively “documents”). All EDI Documents Transmission shall be processed in accordance with HIPAA standards and EDI Documents Transmission implementation guides for Security Health Plan Partners.
Proper receipt
Subject to the Garbled Transmission and Test Modifications provisions, a document shall not be deemed to have been properly received until that document is accessible to the receiving party at that party’s receipt computer and is found to be a standard transaction. Until a document is properly received, the receiving party shall not have any obligation with respect to such document.
Verification
If verification of a document is required, the receiving party shall, upon proper receipt of such document, promptly transmit a functional acknowledgment to the transmitting party. A functional acknowledgment shall constitute conclusive evidence that a document has been properly received.
Garbled transmission
If any transmitted document is received in an unintelligible or garbled form, the receiving party shall promptly notify the transmitting party (if identifiable from the received document) within two business days. In the absence of such notification, the transmitting party’s records of the contents of the transmitted document shall be presumed to reflect the actual contents of that document. If the transmitting party is unidentifiable, the receiving party shall have no obligation to the transmitting party.
Systems operation
Security Health Plan and the affiliated provider are responsible for ensuring that it or its providers can effectively and reliably transmit and receive documents and shall be liable for the acts or omissions of its providers while transmitting, receiving, storing or handling standard transactions, or performing related activities. If Security Health Plan and the affiliated provider use the same provider to effect the transmission and receipt of a standard transaction, the originating party shall be liable for the acts or omissions of the provider as to such standard transaction.