HMSA EDI Data Transmission

HMSA EDI Data Transmission and Retrieval Procedures

HMSA EDI Data Transmission procedure for asynchronous data communication:

1. The data is generated by the provider or their representative and set up for transfer to HMSA.
2. HMSA maintains a secure FTP option.
3. HMSA’s asynchronous data communication allows computer systems to communicate with a front end computer that is connected directly to HMSA’s EDI system. Transmissions are accepted 24 hours a day, seven days a week, including holidays.
4. For security purposes, the provider will be required to log into HMSA’s system by entering a login ID and account password (initially assigned by HMSA). Once the login process is completed, HMSA’s computer will receive the claims data. If it is not properly completed, HMSA will not accept the submission for processing and will notify the provider or their representative via a 999 transaction. If the transmission is not successful, the provider should verify, and correct, their claims before re-transmitting to HMSA.
5. The claims data will then be edited at the front end of the HMSA claims systems to ensure that it conforms to the HMSA business edits and the HIPAA 005010 Implementation Guides. If data errors are found during this secondary editing process, the claims containing these errors will be rejected by the EDI system and no further processing will be done on these claims. All LOB’s could be impacted by the reject process. Providers will be notified of the claim/file rejection within three working days. A copy of the “Claims Rejected to Provider” (CRTP), which identifies each rejected claim and its associated error condition(s), will be mailed or made available for electronic pickup (eCRTP). It is the responsibility of the provider to correct any claims with errors that are listed on the control report and to resubmit these claims, if appropriate. It is important to emphasize this procedure so that erroneous conditions are corrected promptly and claims are not delayed for extended periods of time. Since the appropriate edits should be part of your computer program, the incidence of errors should be very low.
6. At the completion of the editing process, the claims will be entered into the claims processing cycle for payment determination.
7. Providers who choose to receive their remittance advice electronically will be able to retrieve it during the transmission after claim data is sent.