PRV Taxonomy Codes Segment

PRV Taxonomy Codes Segment Description The PRV Taxonomy Codes segment is used to the provider type by a 10-digit identification number known as a Taxonomy-Specialty code.  These codes are used by the health plan’s claim adjudication logic. The X12 standard says this segment is required only if the payer’s adjudication is known to be impacted Read More →

837 CLM Segment

837 CLM Segment Facility Code Values On the 837 claim in the CLM segment in position CLM05-1 you will find facility codes also known as Place of Treatment (POT) codes. Place of Treatment (POT) codes are alpha or numeric codes that indicate where a service was performed. The Centers for Medicare & Medicaid Services (CMS) Read More →

837 Receiver Names

837 Receiver Names Examples 837 Healthcare Claim Receiver Name segment is a common segment across all EDI Transactions. This segment is required and it is qualified with ‘40’ for Receiver. This segment is part of LOOP ID 1000B Receiver name. To learn more  about EDI loops visit our course schedule page to sign up for Read More →

EDI Notice testing

EDI Notice Stopping Temporary (LIBC-502) (BWC EDI testing procedures) We continue a series of posts regarding Commonwealth of Pennsylvania Department of Labor & Industry (BWC) EDI testing procedures. Find below guidelines for Generation of EDI Notice Stopping Temporary Compensation Payable (LIBC-502). The purpose of this process is to verify if the Claim Administrator has implemented the changes that would result in the generation Read More →

BWS EDI Claim

BWS EDI Claim Administrator-specific Match Data Elements BWS EDI Claim Administrator FEIN (DN0187) must be in a valid format & belong to a valid, PA-registered, Third Party Administrator or a PA-licensed Insurer. Insurers who are not registered to administrate on behalf of another Insurer should not have their FEIN in this field if their FEIN is not also Read More →

EDI Information

EDI Information and Data Reporting Guidelines (Commonwealth of Pennsylvania) For Date of Injury, if the employee or other relevant individual providing the data is uncertain about the exact date, use the earliest date about which there is some degree of certainty or the date that you received notice of the accident, whichever is earlier. For Read More →

EDI Reporting Rules

EDI Reporting Rules (BWC – Commonwealth of Pennsylvania) BWC uses IAIABC Claims Release 3.0 standards for all EDI submissions. Data format must be in compliance with the standard data format described in the Systems Rules. Required BWC requires the electronic submission of injury reports as part of its EDI Implementation. For all data and information Read More →

EDI Claims Implementation

Commonwealth of Pennsylvania EDI  Claims Implementation EDI Claims Release provides the electronic transfer of comprehensive injury data and gives significant benefits for Trading Partners and stakeholders. Data submitted through EDI transactions will be integrated with the Workers’ Compensation Automation and Integration System (WCAIS). The WCAIS system provides the Commonwealth of Pennsylvania with the technology to efficiently Read More →

Florida Health X12 834

Florida Health Care Plan X12 834 Transaction FHCP processes the ASC X12 834 transaction for Benefit Enrollment and Maintenance. These 834 brief mapping guidelines help FHCP trading partners to supplement the 834 TR3. It briefly describes the global data content, business rules, and characteristics of the 834 transaction. All Segments. Only loops, segments, and data elements valid for Read More →

EDI Transmission Security

  EDI Transmission Security Protocols Prevea360 Health Plan requires 834 files to be PGP encrypted with its public key. Prevea360 requires PGP encryption, in addition to transmission via the SSH security protocol, to achieve a defense-in-depth/layered security posture for the protection of member/customer confidentiality. SFTP (SSH file transfer protocol) provides protection of the data in transit from the Read More →