Eligibility & Claim Status Operating Rules: Service Type Codes (STCs) Eligibility & Claim Status Operating Rules define some Service Type Codes (STCs) as “discretionary” in the CAQH CORE Eligibility & Benefits (270/271) Data Content Rules (CAQH CORE 154 & 260 Rules). For certain STCs, the patient financial data is not required to be returned for some benefits … Read More →
CAQH CORE 259: AAA Error Code Reporting Rule (Eligibility & Claim Status Operating Rules) CAQH CORE 259: AAA Error Code Reporting Rule requires a health plan/information source to return a AAA segment for each error condition that it detects in a X12 270 request, as described in sections 4.3-4.5 of the rule. CAQH CORE 259: AAA Error Code … Read More →
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 →