HIPAA Transaction Standards

HIPAA Transaction Standards as Designated by CMS HIPAA transaction standards shall be supported by the A/B MACs, DME MACs, CEDI or other contractors if designated by CMS for the electronic data with Medicare providers/submitters/receivers/COB trading partners. ASC X12 Technical Report 3s (TR3s) for mandated HIPAA transactions may be purchased from the official Washington Publishing Company Read More →

Electronic Remittance Advice

Electronic Remittance Advice (ERA) Enrollment Form The Medicare Electronic Remittance Advice (ERA) Enrollment process provides for collection of the information needed to successfully receive ERA transactions from Medicare and EDI trading partners. This agreement must be executed by each provider that receives ERA either directly to or from Medicare or through a third party. Each Read More →

HIMSS-OMB-Blog_Updated

EDI Enrollment and Registration (AKA Trading Partner Agreements) Medicare FFS’ Trading Partner Agreement is comprised of two forms: 1) EDI Registration and 2) EDI Enrollment. The forms are identified under CMS form 10164 and can be accessed at: EDI Registration EDI Enrollment A/B MACs and CEDI must use these two forms, or their own organization Read More →

EDI Claims Codes

EDI LIBC-495 (Notice of Compensation Payable – BWC) EDI LIBC-495 verifies if the Claim Administrator has implemented the changes that would result in the generation of the Notice of Compensation Payable (LIBC-495) based on the following EDI transaction/maintenance type codes: SROI IP SROI PY SROI AP SROI RB SROI 02 SROI CA SROI PD SROI IP 1. Read More →

EDI LIBC-501

EDI LIBC-501 (Notice of Temporary Compensation Payable) The purpose of EDI LIBC-501 is to verify if the Claim Administrator has implemented the changes that would result in the generation of the Notice of Temporary Compensation Payable (LIBC-501) based on the following EDI transaction/maintenance type codes: SROI IP SROI PY SROI AP SROI RB SROI RE SROI 02 SROI PD SROI Read More →

PRV Taxonomy Codes Segment

PRV Taxonomy Codes Segment Description The PRV Taxonomy Codes segment is used to the provider type by a 10-digit identification number known as a Taxonomy-Specialty code.  These codes are used by the health plan’s claim adjudication logic. The X12 standard says this segment is required only if the payer’s adjudication is known to be impacted Read More →

837 CLM Segment

837 CLM Segment Facility Code Values On the 837 claim in the CLM segment in position CLM05-1 you will find facility codes also known as Place of Treatment (POT) codes. Place of Treatment (POT) codes are alpha or numeric codes that indicate where a service was performed. The Centers for Medicare & Medicaid Services (CMS) Read More →

837 Receiver Names

837 Receiver Names Examples 837 Healthcare Claim Receiver Name segment is a common segment across all EDI Transactions. This segment is required and it is qualified with ‘40’ for Receiver. This segment is part of LOOP ID 1000B Receiver name. To learn more  about EDI loops visit our course schedule page to sign up for Read More →

EDI Notice testing

EDI Notice Stopping Temporary (LIBC-502) (BWC EDI testing procedures) We continue a series of posts regarding Commonwealth of Pennsylvania Department of Labor & Industry (BWC) EDI testing procedures. Find below guidelines for Generation of EDI Notice Stopping Temporary Compensation Payable (LIBC-502). The purpose of this process is to verify if the Claim Administrator has implemented the changes that would result in the generation Read More →

BWS EDI Claim

BWS EDI Claim Administrator-specific Match Data Elements BWS EDI Claim Administrator FEIN (DN0187) must be in a valid format & belong to a valid, PA-registered, Third Party Administrator or a PA-licensed Insurer. Insurers who are not registered to administrate on behalf of another Insurer should not have their FEIN in this field if their FEIN is not also Read More →