PIE (PAYER INITIATED ELIGIBILITY/BENEFIT): Requirements of The Deficit Reduction Act Scope (Washington State Medicaid) PIE (Payer Initiated Eligibility/Benefit) transaction was developed to deliver membership and benefit information in one single, unsolicited transaction. The PIE (Payer Initiated Eligibility/Benefit) Transaction uses the same identifiers as the ASC X12 271 response transaction and therefore mirrors the format of the Read More →

Payer Initiated Eligibility/Benefit (PIE) Within The Requirements of The Deficit Reduction Act Scope (Washington State Medicaid) Payer Initiated Eligibility/Benefit (PIE) electronic transaction can be used by health plans to transmit eligibility and benefit information to Washington State Medicaid. basic guidelines given below are to assist State Medicaid agencies and payers in implementing the Payer Initiated Eligibility/Benefit (PIE) Transaction. Read More →

EDI Testing CAQH CORE 153 Trading Partner Guidelines EDI Testing CAQH CORE 153 Basics must be combined when determining the overall CAQH CORE Connectivity requirements. Find the fourth part of EDI Testing CAQH CORE FAQs for trading partners below. 1.For batch response pick-up, does CAQH CORE intend for this to be a programmatic interface or a human interface? Under Read More →

CAQH CORE 153 EDI Payload ID Basics (Connectivity Rule) CAQH CORE 153 EDI Payload ID Basics must be combined when determining the overall CAQH CORE Connectivity requirements. Find the first part of FAQs for trading partners below. 1.Is the payload ID outside the X12 interchange? Yes. 2. Is the payload ID generated and sent by the Read More →

CAQH CORE 153 Batch Processing (Integration and Testing Guidelines) CAQH CORE 153 Batch Processing rules provide special testing batch processing guidelines for CAQH CORE-authorized and new vendors. Part 2 FAQs are provided below. 1.Batch processing: Will a receiver be able to re-pickup a file if needed? CAQH CORE does not specify this, but recommends that information sources allow for re-pickup Read More →

CAQH CORE 153 Batch Processing FAQs CAQH CORE 153 Batch Processing basic rules provide integrity guidelines for CAQH CORE-authorized and new testing vendors. Part 1 FAQs are provided below. 1.Batch processing: Why not FTP or sFTP for batch transactions instead of HTTP/S? HHTTP/S is robust and has a proven track record with batch transactions. The benefits of a single Read More →

EDI CAQH CORE 153 EDI Connectivity And Testing Requirements EDI CAQH CORE 153 EDI Connectivity And Testing basics provide connectivity guidelines for CAQH CORE-authorized testing vendors. Part 2 FAQs are given below. 1. Will all CAQH CORE-authorized testing vendors use the same certification test scripts and the same detailed connectivity method to test the Phase I CAQH CORE Connectivity Read More →

CAQH CORE 153 EDI Connectivity Rule (Eligibility & Claim Status Operating Rules) CAQH CORE 153 EDI Connectivity Rule must be combined when determining the overall CAQH CORE Connectivity requirements. The Part 1 of CAQH CORE 153 EDI Connectivity Rule FAQs is given below. 1. How did CAQH CORE decide that HTTP/S is secure and reliable enough to protect the delivery of Read More →

EDI 837 Dental Healthcare Claim Technical Environment Guidelines (Washington State Medicaid) EDI 837 Dental Healthcare Claim technical guides are to be used by members/technical staff of trading partners who are responsible for electronic transaction/file exchanges. Completion of the testing process must occur prior to submitting electronic transactions in production to ProviderOne. EDI 837 Dental Healthcare Claim Read More →