Electronic Transactions

Electronic Transactions As Part Of Buckeye Health Plan Partnership Program

Electronic Transactions are used by Buckeye Health Plan to provide its participating providers with the best tools possible to support their administrative needs. Buckeye Health Plan electronic transactions capabilities will speed up the processing and payment of the health care claims.

Electronic Transactions (EDI) support for HIPAA transactions is provided for the health plan by Centene Corporation. Centene is currently receiving professional, institutional, and encounter transactions electronically, as well as generating an electronic remittance advice/explanation of payment (ERA/EOP).

There is no EDI Enrollment form to be filled out, however, prior to submitting claims electronically to BUCKEYE COMMUNITY HEALTH PLAN, providers are encouraged to contact the Provider Relations Department and verify the appropriate provider number(s) are on file. In order for EDI claims to be accepted into the Claim Processing system, the provider number must be on file.

Electronic Transactions Processing Assumptions

Some transactions are created and generated by, or on behalf of, a provider. Others are created by BUCKEYE COMMUNITY HEALTH PLAN either in response to a request received from a provider or as a means to provide pertinent information to providers or contracted vendors. BUCKEYE COMMUNITY HEALTH PLAN has secure options available for exchanging data electronically. All transactions will be submitted in a batch mode.

Electronic Transactions submit to the standards set by The Health Insurance Portability and Accountability Act of 1996 (HIPAA) legislation. It mandates that many of the major health care electronic data exchanges, such as electronic claims and eligibility, be standardized into the same national format for all payers, providers and clearinghouses. HIPAA specifies the electronic standards that must be followed when certain health care information is exchanged. These standards are published in National Electronic Data Interchange Transaction Set Implementation Guides. They are commonly called Implementation Guides (IG) and are referred to as IG throughout the partner implementation guidelines.

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