Electronic Medical Claims Program Requirements (Manitoba Health, Healthy Living and Seniors) Electronic Medical Claims Program requires automation integrated with the current office tasks and procedures to maximize the benefits. An electronic medical billing system should provide your office with more rapid input, improved accuracy, faster processing and the ability to report and analyze practice statistics. Read More →

Benefits of Electronic Data Interchange For CGS (A Celerian Group Company) Providers Benefits of Electronic Data Interchange to providers who conduct business with Medicare electronically are vivid. Some of those benefits include: No more paper claims: EDI (submitting claims to CGS electronically eliminates paperwork so your staff can accomplish more in less time. You will also Read More →

Jurisdiction 15 A/B MAC EDI Enrollment: CGS Provider EDI Enrollement Jurisdiction 15 A/B MAC EDI Enrollment goes under CMS instructions and CGS EDI providers must  follow the listed requirements. CGS will obtain an EDI Enrollment form for each provider prior to electronic transfer of data and issuance of system passwords/billing numbers to protect the security of transferred data. CGS Read More →

Celerian Group Company EDI Enrollment: The Internet EDI Enrollment Packet Celerian Group Company EDI Enrollment Packet should be completed to request an Internet EDI ID necessary to transmit Claim Status Request transactions (ANSI 276) and receive Claim Status Response transactions (ANSI 277), and/or retrieve Electronic Remittances (ANSI 835), via CGS’s public Internet. If retrieving Electronic Remittances (ANSI Read More →

Authorization EDI Data Submission Requirements (IEHP Providers) Authorization EDI Data policy applies to IPAs and other Entities that have been delegated medical management where IEHP retains financial risk or administrative processing for those services. IEHP contractually requires Independent Provider Associations (IPAs) to submit all authorization data to IEHP at a minimum frequency of once per business day and Read More →

IEHP 5010 837I Institutional Claim Transaction Basics IEHP 5010 837I Institutional Claim requirements are given below for providers submitting health care claims to IEHP via EDI Network and for those who are intended to start EDI exchange with IEHP. Clearinghouse/IEHP Direct Providers Submitting Claim Data Clearinghouses are largely used as an intermediary for fee-for-service Providers, hospitals, and other Providers submitting Read More →

Encounter Identification (IEHP Provider EDI Requirements) To aid in Encounter Identification, plans must use the HCP number of the plan that the beneficiary was enrolled in at the time of the encounter as the first three characters of CLM01. In accordance with X12 837 Professional data specification rules, unless the encounter is a void or replacement, CLM01 must Read More →

IEHP EDI Network Testing Basics And DHCS Duplicate Logic IEHP EDI Network Providers will be required to submit test files to ensure the submitter’s systems are properly configured for data submission. Before exchanging production transactions, each plan must complete testing to become certified. This process allows IEHP EDI Network to confirm that the DHCS operational guidance has been properly programmed Read More →

837 Health Care Claim Technical Procedures And Infrastructure (IEHP Provider Network) 837 Health Care Claim: Professional Transaction must be transmitted by business partners to IEHP by connecting to the IEHP Network. They go from the Internet through a Virtual Private Network (VPN) tunnel to the IEHP Secure File Transfer Protocol (SFTP) Server. In standard software-to-hardware VPN connections, VPN client Read More →

EDI Files Timeframe And Schedules For IEHP EDI Providers EDI Files processing schedules and timelines must be adhered to for IEHP COB plans. These schedules include: Eligibility Data File Transmission Schedule, Encounter Data File Due Date Schedule, Capitation Data File Transmission Schedule. Eligibility data files are placed on the Secure File Transfer Protocol (SFTP) server. A full monthly file is Read More →