834 Test File Validation

834 Test File Validation Prevea360 will review and test all trading partner files with Optum Transaction Testing Service to perform SNIP level validations to ensure that transactions are valid using the following testing categories. Integrity Testing Requirement Testing Balancing Testing Situation Testing Code Set Testing Product Types/Types of Service Testing. The EDI team will work Read More →

834 Transaction Scenarios

834 HIPAA Transaction Scenarios (Prevea360 Health Plan) In today’s post we offer four 834 Transaction Scenarios. Find below the description and mapping. Adding a Subscriber Scenario John Doe is enrolling into the plan as a new-hire. His coverage is effective 4/1/17. His employment begin date is 4/1/17. Changes include transactions such as address, name, phone Read More →

835 5010 Mapping

EDI 835 5010 Mapping Excersise Try your HIPAA EDI skills in EDI 835 5010 Mapping Excersise. Find the scenario below. The Outbound 837P, completed in Exercise 1, was sent on to Blue Cross the payer. The Claim was adjudicated and Blue Cross has transmitted the 835 5010A1 transaction directly to the receiving billing provider, Abuncha Physicians. Within Read More →

EDI HIPAA education

EDI Testing and Approval Requirements (Prevea360 Health Plan) EDI testing and approval require a minimum of two test cycles and test files. The first test file must be a full population file. This means it must contain all subscribers and dependents currently enrolled in the group for which the test file is being submitted. It Read More →

834 Full File Submission

834 Full File Submission Information (Prevea360 Health Plan) 834 Full File Submission is not allowed if the number of enrolled members is greater than 500. Change Only file submission will need to be utilized. This excludes the initial full eligibility file for production go-live and quarterly audit files. A full file is defined as BGN08 = Read More →

834 HIPAA File

Change Only File Submission Information (Prevea360) Change Only File Submission Information method is required to be used when the enrolled number of members is greater than 500. A Change Only file is defined as BGN08 = 2 and Member Level Detail Loop 2000 INS01 <> 030. Loop 2300, Health Coverage Dates, DTP01 = 348 should Read More →

834 File

834 File Requirements (Prevea360 Health Plan) 834 File will be used as an audit file to make sure the records for both parties are in sync prior to moving to production. While Prevea360 can accept both full enrollment files and change only files, it prefers to receive change only/event only files on an ongoing basis for groups Read More →

834 EDI

Prevea360 Health Plan EDI 834 Implementation Guides EDI 834 Transactions must be submitted in the proper order to ensure correct processing. For example, an add transactions must be submitted on a file and processed prior to a termination transaction being submitted for a given member. It is recommended that the full population is submitted in Read More →

EDI 834

EDI 834 challenges and pitfalls (Caliber Health) EDI 834 includes vital information that can become a major impact on the sponsor, the payer, and especially the member. Ensuring the EDI 834 file processing goes smoothly is very critical. Here are some EDI 834 challenges and pitfalls Caliber Health have seen over the years. Common Issues in Processing EDI Read More →

EDI 834 Enrollment

EDI 834 Enrollment And Maintenance File (Caliber Health) EDI 834 is the Benefit Enrollment transaction type found in the X12 transaction set directory. It is used by government agencies, employers, and health plans to enroll and maintain membership in a healthcare benefit plan and can be processed utilizing Healthcare EDI software. The EDI 834 spec is Read More →