EDI 837 Common Ground Healthcare Cooperative Highlights EDI 837 Common Ground Healthcare Cooperative transaction requires efficient and accurate electronic transaction processing. To promote this EDI partners should note: Each user is assigned a 6-digit EDI Direct Trading Partner ID. Logon User Name is 8 characters. Logon User ID (password) is 9 characters. All dates are in the CCYYMMDD format. Read More →

Xerox EDI Trading Partner Testing Procedures Xerox EDI Trading Partner testing requires trading partners to engage in two phases of testing for each payer/transaction type. Find below Xerox EDI Trading Partner testing steps. Go to the Xerox EDI Direct website to download the applicable Companion Guides which details Payer Business Edits and requirements. Each Trading Read More →

Xerox EDI Direct Testing Requirements And Guidelines Xerox EDI Direct testing is required in order to submit claims in the X12 standard format. A majority of payers have additional business requirements in addition to the X12 standard. The business requirements could be due to system limitations or utilized to properly adjudicate a claim. Therefore, Xerox EDI Direct testing Read More →

Transmission Responses: Interchange Level Errors, Transaction Set Level Syntax Results and 999-Implementation Acknowledgement Transmission Responses (acceptance/rejection reports) provide information about the validity of EDI transaction format syntax and implementation guide compliance. The type of report returned depends on the edit level that is invalid. A transaction contains four levels where edits are present. The edit level in which Read More →

CAQH CORE 250 Claim Status Infrastructure Rule Certification CAQH CORE 250 Rule states that an entity that processes X12 270/271 eligibility transactions, and does not process claim status transactions can become Phase II CORE-certified.  Phase II CAQH CORE Operating Rules do not require an organization to conduct, use or process the X12 276/277 claim status transactions Read More →

CAQH CORE 156 Rule Transactions Tracking: How should the X12 270/271 transactions be tracked? CAQH CORE 156 Rule Transactions tracking can be done throughout a system/application to demonstrate conformance with the response time requirements specified in the CAQH CORE 156 Rule. The CAQH CORE Response Time Rules (CAQH CORE 155 & 156 Rules) require HIPAA covered entities to capture, log, Read More →

  CAQH CORE 156: Real Time Response Time Rule Basic Guidelines CAQH CORE 156: Real Time Response Time Rule indicates that the number of responses returned within the specified timeframe gives a better indication of the information source’s capabilities. Averages can be skewed by outlier responses. Providers do not have to be certified by CAQH CORE to Read More →