Security Health Plan EDI Data Security and Confidentiality. Correction Adjustment Request
Security Health Plan EDI Data security is maintained by reasonable security procedures to prevent unauthorized access to data, data transmissions, security access codes, envelope, backup files, source documents or the covered entity’s operating system. Security Health Plan and the affiliated provider will immediately notify each other of any unauthorized attempt to obtain access to or otherwise tamper with data, data transmissions, security access codes, envelope, backup files, source documents or the other party’s operating system which attempt may have an impact on the other party.
- Protected health information. Security Health Plan and the affiliated provider will comply with all applicable privacy statutes and regulations, guidelines and health care industry customs concerning treatment of protected health information.
- Notice of unauthorized disclosures and uses. Security Health Plan and the affiliated provider will promptly notify each other of any unlawful or unauthorized use or disclosure of confidential or protected health information in which the disclosure may have an impact on the other party, and will cooperate with each other in the event that any litigation arises concerning the unlawful or unauthorized disclosure or use of confidential or protected health information.
Security Health Plan EDI Data Security: Operating systems
Security Health Plan and the affiliated provider will develop, implement and maintain appropriate security measures for the operating system. Security Health Plan and the affiliated provider will document and keep current its security measures. Security Health Plan and the affiliated provider’s security measures will include, at a minimum, the requirements and implementation features set forth in all applicable DHHS security regulations.
Correction Adjustment Request
Correction adjustment requests are required when facilities have found a charge or charges that need to be added, corrected, adjusted or deleted, and must be received within 60 days from date of payment/ denial/rejection of original claim (365 days from the date of service for Medicare Advantage plans).
Here are some examples:
- Duplicate payment
- Incorrect patient
- Incorrect date of service
- Incorrect provider
- Amount billed correction/adjustment
- Payment amount is questionable
- Credits are missing or incorrect
- Refunds
- CPT/modifier changes
- Other insurance payments/corrections (include a copy of the primary EOB)
- Specify date(s) of service involved
CMS 1500: Corrections need to be submitted electronically/paper on a CMS 1500 claim form with “correction/resubmission” identified in box 19.
UB-04: Corrections need to be submitted electronically/paper on a UB-04 claim form with the appropriate type of bill in box 4.