Timely Filling Guidelines For Claim Resubmission/Corrections All resubmitted/corrected claims need to be received by WellFirst Health within the filing limit outlined in your provider agreement. The first day of the filing limit for resubmissions/corrections begins with the date upon which WellFirst Health notifies the providerthat a claim has failed processing or was denied. You will find … Read More →
Timely Filling Guidelines For Initial Submission (WellFirst Health) The initial submission of a claim is subject to the timely filing guidelines outlined in your agreement with WellFirst Health. If a claim is rejected for improper submission, resubmission must be completed by the provider within the filing limit outlined in your agreement with WellFirst Health. Retain … Read More →
Submitting corrected claims (WellFirst Health) WellFirst Health recognizes that it is sometimes necessary to submit a corrected claim (e.g., changes or corrections needed to codes, dates of service, etc. due to error. Steps for submitting a corrected claim are: Create a new claim with the corrected claim detail(s). Include all lines billed on the original … Read More →
WellFirst Health EDI Claims Acknowledgement Process WellFirst Health provides acknowledgment of electronic claim submissions through the 277 Claims Acknowledgement (277CA) transaction or the Confirmation Reports Portal. If a provider’s office enrolls to receive 277CA responses, a response file will be generated for each electronic 837claim file WellFirst Health receives. Confirmation reports show all claims accepted in … Read More →
WellFirst EDI Claims Processing Guidelines WellFirst Health requires providers to use the correct and complete member number. Families share the first nine digits of their subscriber number. The remaining two digits signify the individual member (i.e. spouse, dependents, etc.). Using the correct member numbers on the claims submitted to WellFirst Health will help to ensure … Read More →
Electronic Data Interchange (EDI) For Providers WellFirst Health WellFirst Health offers HIPAA-compliant electronic transactions to providers to meet consistent documentation, handling and privacy standards as well as for efficiency. Eligibility and Benefit Inquiry and Response (270/271) The most timely and accurate way to confirm a member’s benefits and coverage amounts is to submit an eligibility … Read More →
SARS EDI Documents: STATAC (STATEMENT OF ACCOUNT) The STATAC message is used by the SARS to send daily and detail transaction listings to traders with deferment accounts that are registered to have their FAN (Financial Account Numbers) linked to an EDI profile. STATAC provides traders the ability to reconcile their declarations against their transactions categorised … Read More →
REQDOC (REQUEST FOR DOCUMENT) SARS Explained The REQDOC message is used to request the last successful CUSRES of an entry. The LRN and or MRN must be provided in the REQDOC. A CUSRES will be sent to verify if the request can be fulfilled or not followed by the CUSRES in question if available. Note … Read More →
PRODAT (PRODUCT DATA) Message SARS Overview Tariffs are amended on a regular basis and get published in the Government Gazette. Agents then need to update their master files with the amended information in order to supply the correct tariff information on declarations. This is a time consuming, tedious capturing and checking effort. With the introduction … Read More →
CUSCAR: Customs Cargo Report (SARS EDI Guides) The CUSCAR message is used for supplying manifest information to SARS electronically. For each CUSCAR message received, SARS will return a CUSRES message with either a Status 6 (Rejected), Status 8 (Accepted) or Status 9 (Duplicate). Illustration below shows the relationship between EQD and SGP segments. To learn … Read More →