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 →

837 Professional and Institutional Claims Notes (Washington State Medicaid processing for Washington State HCA) 837 Professional and Institutional Claims implementation guides are represented for each mandated transaction and modified by authorized Addenda. When accepting 837 Encounters transactions from trading partners, HCA follows HIPAA standards. These standards involve Interchange (ISA/IEA) and Functional Group (GS/GE) Segments or “outer Read More →

EDI 837 Dental Healthcare Claim Set-up, Directory and File Naming Notes EDI 837 Dental Healthcare Claim set-up requires establishing connections through the SFTP server with further instructions on SFTP usage. SFTP Directory Naming Convention There would be two categories of folders under Trading Partner’s SFPT folders: TEST – Trading Partners should submit and receive their test files Read More →

Announcing a Public Review Period for the 270/271 Health Care Eligibility/Benefit Inquiry and Information Response Announcing A Public Review Period for Health Care Eligibility/Benefit Inquiry and Information Response (270/271) Implementation Guide (007030X332) and the Code Value Usage in Eligibility Benefit Inquiry and Subsequent Response (007030X347) is planned for public review beginning July 16, 2018. The review period will Read More →

HIPAA 271 Premium Grace Period Notification: Determining Transaction Compliance with Industry Usage Requirements HIPAA 271 Premium Grace Period Notification transmitted transaction complies with the governing implementation guide when it satisfies the requirements as defined within the implementation guide. Specifically, the presence or absence of an item (loop, segment, or element) complies with the industry usage specified by this implementation Read More →