EDI Enrollment

Making electronic business documents uniform Standards are what set EDI apart from other electronic methods of transferring data. Before getting into details about administration of EDI standards such as ANSI ASC X12 or UN/EDIFACT, it is important to understand why standards are used. Organizations such as BlueCross and Aetna deal with thousands of health care Read More →

EDI Analysis

EDI Analysis: implementation solutions and cost calculation EDI Analysis is one of the ways to streamline new approach for companies when they still hesitate if EDI implementation is beneficial. Usually companies choose implementing in-house EDI solutions. This approach means taking an existing solution, licensing it, customizing and integrating into a company’s e-business environment or in Read More →

EDI Billing Set-Up

EDI Billing Set-Up Veterans Health Administration (VHA). Associated Insurance Companies and Copying Physician/Provider Secondary IDs and Additional Billing Provider Secondary IDs Patch IB*2.0*320 provides the ability for users to associate multiple Insurance Company entries with each other. Example: If there are 45 Blue Cross/Blue Shield entries in the Insurance Company file, users can make one of Read More →

EDI Myths

Breaking EDI Myths – Considerations, Implementation, Cost And More It’s Halloween time, but we’ll tell you no scary or horror tales. Only true stories about how businessmen avoid EDI implementation. Really…They are missing so many opportunities because of EDI myths we are going to break now. Today we will try to show you that shifting to EDI Read More →

Pay-to Provider IDs

Defining Pay-to Provider IDs  On Billing Forms The Pay-to Provider NPI is not entered or maintained by Billing personnel. The Pay-to Provider NPI is retrieved from the Institution file (#4). Beginning with Patch IB*2*432, the Pay-to Provider Primary ID is the NPI number of the site defined as the Pay-to Provider. The Federal Tax Number is Read More →

Provider ID Set-up

Provider ID Set-up (VA Guidelines) During Provider ID Set-up payers require the use of a variety of provider identifiers on claims submitted for adjudication. Printed claim forms have boxes where these IDs can be printed. The general term, Provider ID, can refer to an ID that belongs to a human being such as an Attending Read More →

Pay-to Provider Set-up

Pay-to Provider Set-up At Veterans Health Administration Pay-to Provider in the VA database is the entity which is seeking payment for a claim (who will receive the payment). Each VA database can have one or more Pay-to Providers. Each VA database must have at least one Payto Provider. The Pay-to Provider does not need to have a physical location. Read More →

Insurance Company EDI Set-up

Insurance Company EDI Set-up At Veterans Health Administration Improper insurance company EDI Set-up and/or provider IDs within VistA can cause claims rejection. With EDI Billing, there are fields in an 837 claim transmission that are autopopulated with the data defined in VistA. This information must be accurate to generate a clean electronic claim. Activate New Payer to Read More →

EDI Process Flow

EDI Process Flow At Veterans Health Administration (VHA) EDI Process Flow above flowchart represents the path that electronic claims follow at Veterans Health Administration (VHA). The objective of electronic billing is to submit completely correct claims. Claims sent electronically reach the payer faster, are processed faster, and are paid faster than claims submitted to the Read More →

Medical Billing Reporting

  Medical Billing Reporting Via Electronic Data Interchange The North Carolina Industrial Commission has contracted with Insurance Services Office, Inc. (ISO) to manage Medical Billing Reporting Via Electronic Data Interchange. ISO will be administering registration of carriers, self-insurers, medical bill review companies and third party administrators as trading partners, EDI testing, and data collection and Read More →