Alaska Medicaid HIPAA EDI

Alaska Medicaid HIPAA EDI Requirements And Transactions Guidelines Alaska Medicaid HIPAA EDI Companion Guide is authored by the health plan. The purpose of a companion guide is to supplement the Technical Reports Type 3 (TR3s) which are also known as the HIPAA EDI Implementation Guides. These TR3s can be purchased at the X12 Store. Companion guides are Read More →

CMS Finale Rule

CMS Final Rule to Protect Medicaid Provider Payments CMS Final Rule ensures Medicaid providers receive complete payments as required by law. The Centers for Medicare & Medicaid Services (CMS) released the Medicaid Provider Reassignment Regulation final rule removing a state’s ability to divert portions of Medicaid provider payments to third parties outside of the scope Read More →

Aetna SSI 270 271

Aetna SSI 270 271 Companion Guide Information Aetna SSI (Senior Supplemental Insurance) is a division of Aetna that providers medical insurance to seniors. The Eligibility Enquiry 270 and the 271-eligibility response are a key component of their business process. These transactions allow members to receive co-pay, deductible and other important information about their plan when Read More →

Claims Submission Changes

Claims Submission Changes (EmblemHealth Provider Updates) Claims submission changes listed in the blog refer to some new demands for providers sending HIPAA claims to EmblemHealth. Starting October 1, 2018, eviCore began to process claims for radiology services performed by radiologists for ACPNY members. Claims sent to EmblemHealth after October 1, 2018 will be denied, indicating that the claim Read More →

HIPAA Billing

HIPAA Billing Internal Dispute Process At Highmark HIPAA billing dispute regarding claims payment decisions made by Highmark can be requested by any provider that treats a Highmark member. Any claim dispute between a provider and Highmark arising from a provider’s request for payment is solely a contract dispute between the provider and Highmark, and does not involve Read More →

HIPAA claim investigation

HIPAA Claim Investigation (Highmark) HIPAA claim investigation is the ordinary means providers use to communicate their questions regarding pending, paid, or denied claims. An investigation should be submitted if the provider has a question about the status of a claim. Complete research should be completed by the provider prior to submitting the investigation. A claim investigation Read More →

Emblem Health HIPAA Claims

Emblem Health HIPAA Claims Electronic Submission Emblem Health HIPAA Claims are received from thousands of health care practitioners that eliminated paper claims and are submitting electronic claims in HIPAA-compliant professional provider (837P), institutional provider (837I) and dental provider (837D) EDI claims transaction formats. When billing electronically, please allow a reasonable amount of time to complete your account Read More →

Remittance Advice

Remittance Advice Guidelines (Palmetto GBA Providers) Remittance Advice is sent to nonparticipating physicians, suppliers, and non-physician practitioners billing non-assigned claims, unless the beneficiary or the provider requests that the remittance advice be suppressed. An informational Remittance Advice is identical to other RAs, but must carry a standard message to notify providers that they do not have Read More →

EDI Claims Electronic Submission

EDI Claims Electronic Submission (Palmetto GBA Guidelines) EDI Claims Electronic Submission is released via telephone lines, via a modem, to Palmetto GBA. EDI Claims Electronic Submission gives the provider control over the timeliness and accuracy of the claims entry by eliminating the need for mailroom processing and manual data entry by Palmetto GBA. Payment for ‘clean Read More →

HIPAA Claims Filing

HIPAA Claims Filing Requirements For Palmetto GBA Providers HIPAA Claims Filing requirements by Palmetto GBA require providers to submit claims for all Medicare patients for services rendered. HIPAA Claims Filing requirements apply to all physicians and suppliers who provide covered services to Medicare beneficiaries. You may not charge your patients for preparing or filing a Medicare claim. The requirement Read More →