837 Professional and Institutional

837 Professional and Institutional Claims Notes (Washington State Medicaid processing for Washington State HCA) 837 Professional and Institutional Claims implementation guides are represented for each mandated transaction and modified by authorized Addenda. When accepting 837 Encounters transactions from trading partners, HCA follows HIPAA standards. These standards involve Interchange (ISA/IEA) and Functional Group (GS/GE) Segments or “outer Read More →

EDI 837 Dental Healthcare Claim

EDI 837 Dental Healthcare Claim Set-up, Directory and File Naming Notes EDI 837 Dental Healthcare Claim set-up requires establishing connections through the SFTP server with further instructions on SFTP usage. SFTP Directory Naming Convention There would be two categories of folders under Trading Partner’s SFPT folders: TEST – Trading Partners should submit and receive their test files Read More →

Public Review Period

Announcing a Public Review Period for the 270/271 Health Care Eligibility/Benefit Inquiry and Information Response Announcing A Public Review Period for Health Care Eligibility/Benefit Inquiry and Information Response (270/271) Implementation Guide (007030X332) and the Code Value Usage in Eligibility Benefit Inquiry and Subsequent Response (007030X347) is planned for public review beginning July 16, 2018. The review period will Read More →

837 Institutional Healthcare Claim Testing

837 Institutional Healthcare Claim Testing (Washington State Health Care Authority (HCA)) Procedure 837 Institutional Healthcare Claim Testing completion  must occur prior to submitting electronic transactions in production to Washington State Health Care Authority ProviderOne. 837 Institutional Healthcare Claim Testing is conducted to ensure the following levels of HIPAA compliance: Level 1 – Syntactical integrity: Testing of Read More →

чсчсчс

HIPAA 271 Premium Grace Period Notification: Determining Transaction Compliance with Industry Usage Requirements HIPAA 271 Premium Grace Period Notification transmitted transaction complies with the governing implementation guide when it satisfies the requirements as defined within the implementation guide. Specifically, the presence or absence of an item (loop, segment, or element) complies with the industry usage specified by this implementation Read More →

271 Premium Grace Period Notification

271 Premium Grace Period Notification: Industry Usage Instructions 271 Premium Grace Period Notification (HIPAA 007030X344) industry usage instructions describe when loops, segments, and elements are to be sent when complying with the transaction implementation guides. The three choices for usage are required, not used, and situational. To avoid confusion, these are named differently than the X12 standard Read More →

HIPAA 007030X344 271

HIPAA 007030X344 271 Premium Grace Period Notification: Presentation Examples HIPAA 007030X344 271 Premium Grace Period Notification implementation guides use a format that depicts both the generalized standard and the insurance industry-specific implementation. The ASC X12 standards are generic. For example, multiple trading communities use the same PER segment to specify administrative communication contacts. Each community decides which elements to Read More →

Без названия

837 Professional Healthcare Claim (Washington State Medicaid Trading Partners Requirements) 837 Professional Healthcare Claim guidelines can be used by members/technical staff of trading partners who are responsible for electronic transaction/file exchanges. Completion of the testing process must occur prior to submitting electronic transactions in production to ProviderOne. Testing is conducted to ensure the following levels Read More →

Healthcare-Billing-Outsourcing-Services

HIPAA 7030 271 Transaction: Detail Levels 3-4 HIPAA 7030 271 transaction is intended to meet the particular needs of the health care industry for the reporting of premium payment grace period information from a health plan to a provider. Find info about Header and Detail Levels 1-2 in the previous blog post. Detail Level 3 – Enrollee (2000C) Read More →

HIPAA 7030 271 Transaction

HIPAA 7030 271 Transaction Data Overview: Header, Detail Levels 1-2 HIPAA 7030 271 transaction is divided into five major areas – one header, and four detail hierarchical levels. Header The header area identifies the transaction type and implementation, as well as the transaction date and the business purpose of the specific transaction. ST03 identifies the Technical Report version Read More →