CAQH CORE 154 X12

CAQH CORE 154 X12 271 Response Back Guides CAQH CORE 154 X12 271 response with the health plan name (assuming it is available within the system[s]) in EB05 element of all EB segments sent back in the response has some notes. Since the CAQH CORE 154 Rule does not explicitly identify which EB segments are to carry Read More →

CAQH CORE 154 Eligibility & Benefits

CAQH CORE 154 Eligibility & Benefits 270/271 Data Content Rule CAQH CORE 154 Eligibility & Benefits 270/271 eligibility data content rule subjects to the general CAQH CORE 260 Rule X12 270/271 requirements. CAQH CORE 154 Eligibility & Benefits 270/271 Guidelines Code 52 is specific to hospital emergency services; Code 86 is general. CAQH CORE selected Code 86 so that Read More →

CAQH CORE

CAQH CORE 154 Eligibility & Benefits 270/271 Data Content Rule CAQH CORE 154 Eligibility & Benefits 270/271 eligibility data content subjects to the Phase I and general CAQH CORE 260 Rule rule requirements for the X12 270/271. CAQH CORE 154 Eligibility & Benefits 270/271 Notes The CAQH CORE 154 Eligibility & Benefits (270/271) Data Content Rule Version 1.1.0 does not Read More →

Payer Initiated Eligibility/Benefit

EDI Payer Initiated Eligibility/Benefit Transaction (Washington State Medicaid) Additional Guides EDI Payer Initiated Eligibility/Benefit Transaction transmission must be secure in accordance with 45 CFR Parts 160, 162, and 164 Health Insurance Reform: Security Standards. Control segments/envelopes EDI Payer Initiated Eligibility/Benefit Transaction conforms to ASC X12 Control Segments / Envelopes (ISA-IEA, GS-GE, and ST-SE) for Version Read More →

PIE Transaction

PIE Transaction (Payer Initiated Eligibility/Benefit) Washington State Medicaid Testing Requirements PIE Transaction should be submitted by the trading partner through the Washington State Medicaid ProviderOne Secure File Transfer Protocol (SFTP). The trading partner downloads acknowledgements for the test file from the ProviderOne SFTP HIPAA ACK folder. If the ProviderOne system generates a positive TA1 and Read More →

PIE

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

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

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

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 →