EDI Verification

EDI for Eligibility & Benefits Verification (HIPAA Standard 270/271 Eligibility Transactions) Requests for eligibility status for a single commercial, Medicare or state health programs member transaction may be submitted by registered participating providers on the Health Net provider website. To request eligibility and obtain eligibility information for multiple members at one time, providers can use Read More →

Encounter Submission

Using EDI for Capitated Encounter Submission (Health Net) Capitated participating physician groups (PPGs), hospitals and ancillary providers are required to provide complete encounter data about professional services rendered to Health Net members. To comply with the requirements of the U.S. Department of Health and Human Services (HHS), the Centers for Medicare & Medicaid Services (CMS), Read More →

LWC EDI Production Claim

LWC EDI Production Claim JCN Assignment LWC EDI Production Claim JCN assignments will be used for the EDI Production Process that will be applicable in the daily business in the production environment use of JCN within LWC. Data Population Format: 4 digit year (based on calendar year) followed by a unique 6 digit number using Read More →

LWC EDI Submission

LWC EDI Submission Options For Trading Partners LWC EDI Submission for reporting IAIABC Claims Release 3 FROI to LWC and receiving the acknowledgments includes three options. Direct Reporting SFTP. The Trading Partner has the ability and experience to create (using the IAIABC Standards and LWC Requirement Tables), edit and send via SFTP to LWC a clean edited IAIABC Read More →

LWC EDI Partner Guides

LWC (Louisiana Workforce Commission) EDI Partner Guides LWC EDI Partner Registration provides each trading partner the ability to create and submit a New Profile or Updated Trading Partner Profile. This form will uniquely identify a trading partner as the sender of the data and how the data will be sent, the business and technical contacts, Read More →

Health Net EDI

Health Net EDI (Frequently Asked Questions) EDI claims submission has many options. Depending on the needs of your organization, there may be costs associated. Clearinghouses should be contacted directly so needs and options can be discussed. CAN CLAIMS BE PAID FASTER IF I SUBMIT THEM ELECTRONICALLY? Yes. Electronic claims are generally received in less time than those Read More →

Health Net EDI

Health Net EDI Provider Claims Submission And EDI Exchange Health Net EDI technology is used to communicate claims, electronic remittance, claims payment, eligibility, and other information, providing a paperless and efficient process. Quicker claims payment, confirmation reports, and elimination of paper and associated expenses are just a few of the reasons why nearly 80 percent of Read More →

AHCCCS EDI FAQs

AHCCCS EDI FAQs (Frequently Asked Questions regarding EDI communication) Following the series of posts for AHCCCS EDI partners, find below Part 2 Frequently Asked Questions regarding EDI communication. Q: Our clearinghouse sent a request to be setup for 835, 270/271, 276/277. Why was the ticket closed without being setup? A: A request for setup must Read More →

EDI Acknowledgements

EDI Acknowledgements and Reports (AHCCCS) AHCCCS will respond to all transactions with the creation of the standard Acknowledgement response files as defined in the HIPAA Implementation Guides. EDI system will not reject the whole file but will be split to good/bad records. An acknowledgement is produced accordingly and the good documents will continue for further processing. Read More →

EDI Transmission Guides

EDI Transmission Guides (AHCCCS Provider Electronic Communication) EDI Transmission Guides refer to all users who have access to the computer network and EDI data, and are bound by applicable laws, HIPAA rules and AHCCCS requirements. ISA13 Interchange Control Number The trading partner assigns the Interchange Control Number in the rightmost six characters of this 9 character Read More →