Celerian Group Company EDI Enrollment

Celerian Group Company EDI Enrollment: The Internet EDI Enrollment Packet Celerian Group Company EDI Enrollment Packet should be completed to request an Internet EDI ID necessary to transmit Claim Status Request transactions (ANSI 276) and receive Claim Status Response transactions (ANSI 277), and/or retrieve Electronic Remittances (ANSI 835), via CGS’s public Internet. If retrieving Electronic Remittances (ANSI Read More →

Medicare Electronic Options

Medicare Electronic Options: Transactions Increasing Business Productivity Medicare Electronic Options which will increase your business’ productivity include Claim Status Inquiry (CSI), payable Certificate of Medical Necessity (CMN) status, Beneficiary Eligibility (BE), 270/271, 276/277, and Electronic Remittance Advice (ERAs). Claim Status Inquiry (CSI) Claim Status Inquiry (CSI) allows you to electronically check the status of production claims after they have Read More →

Common Electronic Date Interchange

Common Electronic Date Interchange (CEDI): Handling Medicare Transactions Common Electronic Date Interchange provides a single front end solution for the submission and retrieval of DME MAC electronic transactions. The Common Electronic Data Interchange contract for EDI services for all DME MAC suppliers. The acceptable HIPAA compliant format is the American National Standards Institute (ANSI) X12N Version 4010A1 837 transaction Read More →

Medicare Electronic Data Interchange

Medicare Electronic Data Interchange: Benefits And Advantages Medicare Electronic Data Interchange (EDI) is the computer-to-computer electronic exchange of Medicare files using standard format. Medicare Electronic Data Interchange gives the ability to transmit Electronic Media Claims (EMC) to Medicare in a Health Insurance Portability and Accountability Act (HIPAA) compliant format. National Government Services administers The Common Electronic Data Interchange (CEDI) contract Read More →

Authorization EDI Data

Authorization EDI Data Submission Requirements (IEHP Providers) Authorization EDI Data policy applies to IPAs and other Entities that have been delegated medical management where IEHP retains financial risk or administrative processing for those services. IEHP contractually requires Independent Provider Associations (IPAs) to submit all authorization data to IEHP at a minimum frequency of once per business day and Read More →

IEHP 5010 837I Institutional Claim

IEHP 5010 837I Institutional Claim Transaction Basics IEHP 5010 837I Institutional Claim requirements are given below for providers submitting health care claims to IEHP via EDI Network and for those who are intended to start EDI exchange with IEHP. Clearinghouse/IEHP Direct Providers Submitting Claim Data Clearinghouses are largely used as an intermediary for fee-for-service Providers, hospitals, and other Providers submitting Read More →

Encounter Identification

Encounter Identification (IEHP Provider EDI Requirements) To aid in Encounter Identification, plans must use the HCP number of the plan that the beneficiary was enrolled in at the time of the encounter as the first three characters of CLM01. In accordance with X12 837 Professional data specification rules, unless the encounter is a void or replacement, CLM01 must Read More →

IEHP EDI Network

IEHP EDI Network Testing Basics And DHCS Duplicate Logic IEHP EDI Network Providers will be required to submit test files to ensure the submitter’s systems are properly configured for data submission. Before exchanging production transactions, each plan must complete testing to become certified. This process allows IEHP EDI Network to confirm that the DHCS operational guidance has been properly programmed Read More →

837 Health Care Claim

837 Health Care Claim Technical Procedures And Infrastructure (IEHP Provider Network) 837 Health Care Claim: Professional Transaction must be transmitted by business partners to IEHP by connecting to the IEHP Network. They go from the Internet through a Virtual Private Network (VPN) tunnel to the IEHP Secure File Transfer Protocol (SFTP) Server. In standard software-to-hardware VPN connections, VPN client Read More →

EDI Files

EDI Files Timeframe And Schedules For IEHP EDI Providers EDI Files processing schedules and timelines must be adhered to for IEHP COB plans. These schedules include: Eligibility Data File Transmission Schedule, Encounter Data File Due Date Schedule, Capitation Data File Transmission Schedule. Eligibility data files are placed on the Secure File Transfer Protocol (SFTP) server. A full monthly file is Read More →