HIPAA Electronic Data Interchange (EDI) Rule (The American Speech-Language-Hearing Association) HIPAA Electronic Data Interchange Rule is very technical and based on the X12N EDI data transmission protocol standard. Although rare allowances are made, the rule requires that any covered entity who electronically transmits data must use this, and only this format in doing so. The Read More →

Filing A Healthcare Claim

Filing A Healthcare Claim Requirements For Cigna Vendors Filing A Healthcare Claim should be done as soon as possible. If you’re unable to file a claim right away, please make sure the claim is submitted accordingly. If you are a participating health care provider, submit by 90 days after the date of service If you are Read More →

EDI Report Types

EDI Report Types (Claims Status Awaiting Resolution Option) There are a number of EDI Report Types available to monitor and manage electronic claims. TR reports provide the end-user with information to monitor and manage EDI claims still within the VA, that is, between the VAMC and the FSC in Austin, TX. The MM reports provide the Read More →

EDI Billing Updates

EDI Billing Updates (Veterans Health Administration) EDI Billing Updates as for ASC X12N 5010 Health Care Claim (837) Transactions in the Veterans Health Administration EDI billing system include the following changes: An inpatient institutional 837 transaction no longer requires a POA for each diagnosis An inpatient admission date can no longer be transmitted on outpatient claims All Read More →

EDI Billing Set-Up

EDI Billing Set-Up Veterans Health Administration (VHA). Associated Insurance Companies and Copying Physician/Provider Secondary IDs and Additional Billing Provider Secondary IDs Patch IB*2.0*320 provides the ability for users to associate multiple Insurance Company entries with each other. Example: If there are 45 Blue Cross/Blue Shield entries in the Insurance Company file, users can make one of Read More →

Pay-to Provider IDs

Defining Pay-to Provider IDs  On Billing Forms The Pay-to Provider NPI is not entered or maintained by Billing personnel. The Pay-to Provider NPI is retrieved from the Institution file (#4). Beginning with Patch IB*2*432, the Pay-to Provider Primary ID is the NPI number of the site defined as the Pay-to Provider. The Federal Tax Number is Read More →

Provider ID Set-up

Provider ID Set-up (VA Guidelines) During Provider ID Set-up payers require the use of a variety of provider identifiers on claims submitted for adjudication. Printed claim forms have boxes where these IDs can be printed. The general term, Provider ID, can refer to an ID that belongs to a human being such as an Attending Read More →

Pay-to Provider Set-up

Pay-to Provider Set-up At Veterans Health Administration Pay-to Provider in the VA database is the entity which is seeking payment for a claim (who will receive the payment). Each VA database can have one or more Pay-to Providers. Each VA database must have at least one Payto Provider. The Pay-to Provider does not need to have a physical location. Read More →

Insurance Company EDI Set-up

Insurance Company EDI Set-up At Veterans Health Administration Improper insurance company EDI Set-up and/or provider IDs within VistA can cause claims rejection. With EDI Billing, there are fields in an 837 claim transmission that are autopopulated with the data defined in VistA. This information must be accurate to generate a clean electronic claim. Activate New Payer to Read More →

Medical Billing Reporting

  Medical Billing Reporting Via Electronic Data Interchange The North Carolina Industrial Commission has contracted with Insurance Services Office, Inc. (ISO) to manage Medical Billing Reporting Via Electronic Data Interchange. ISO will be administering registration of carriers, self-insurers, medical bill review companies and third party administrators as trading partners, EDI testing, and data collection and Read More →