CAQH CORE 258: Normalizing Patient Last Name Rule (Eligibility & Claim Status Operating Rules) CAQH CORE 258: Normalizing Patient Last Name Rule does not require that a health plan use the patient’s last name in its search and matching logic for locating an individual within its systems. Further, the rule does not specify the search … Read More →
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 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 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 →