EDI Technical Guides

EDI Technical Guides – Provider Basic Information

EDI Technical Guides given in the blog refer to BUCKEYE COMMUNITY HEALTH PLAN partners in electronic transactions exchange. The following list includes basic technical information for each transaction:

  • Lower case characters on inbound transactions are converted to uppercase on outbound transactions
  • The following delimiters are used for all outbound transactions:
    • * (Asterisk) = Data element separator
    • : (Colon) = Sub element separator
    • ~ (Tilde) = Segment separator
  • All monetary amounts and quantity fields have explicit decimals. The decimal point always appears in the character stream if the decimal point is at any place other than the right end. If the value is an integer, with the decimal point at the right end, the decimal point should be omitted.
  • BUCKEYE COMMUNITY HEALTH PLAN is referred to as BUCKEYE COMMUNITY HEALTH PLAN in applicable Submitter and Receiver segments.
  • The TA1 – Interchange Acknowledgement, is not used.
  • The 997 – Functional Acknowledgement, is generated in response to all inbound batch transactions.
  • The 997 – Functional Acknowledgement, is expected in response to all outbound batch transactions created by BUCKEYE COMMUNITY HEALTH PLAN.
  • Required data elements considered non-critical to BUCKEYE COMMUNITY HEALTH PLAN processing that must be returned on outbound transactions, such as member’s birth date, are returned as they appear on the BUCKEYE COMMUNITY HEALTH PLAN’s files. If one item within a functional group is non-compliant, the entire transaction, ST-SE, is rejected.
  • Data elements required by the IG, but not used by BUCKEYE COMMUNITY HEALTH PLAN can be gap-filled with any valid value to avoid compliance errors.
  • The submitter number will be assigned by Centene and will need to be evident in the following ASC X12N 837 locations: ISA06 and Loop 1000A, NM109
  • The ASC X12N 837 location in which the Payer ID must be present is in Loop 2010BB (Payer Name), NM109.

EDI Academy invites you to learn more about basic HIPAA requirements and advanced mapping practice in health care industry at our educational events conducted all over the country. Please, choose the best place and date here.

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