CAQH CORE 258

CAQH CORE 258: Normalizing Patient Last Name Rule CAQH CORE 258 Operating Rule requires the removal of both the apostrophe and the hyphen in the O’Donnell-Griswold example cited. The normalized name would be ODONNELLGRISWOLD. CAQH CORE 258: Last Name Normalization Rule Version 2.1.0 does not address this specific scenario. Since the characters “De” are not included in Read More →

X12 276/277 Transactions

X12 276/277 Transactions In CAQH CORE 250: Claim Status Rule X12 276/277 Transactions can be tracked throughout a system/application to demonstrate conformance with the response time requirements specified in the CAQH CORE 250 Rule. CAQH CORE 250: Claim Status Rule requires HIPAA covered entities to capture, log, audit, match, and report the date, time, and control Read More →

CAQH CORE HTTP/S

CAQH CORE HTTP/S Vendor Parties Guidelines CAQH CORE HTTP/S vendor rules do not require that an entity (provider or health plan) implement the technology directly into their own data center. The Phase I CAQH CORE Rules implicitly acknowledge that both providers and health plans will use technology solutions provided by vendors to accomplish all that must Read More →

CAQH CORE Batch Processing

CAQH CORE Batch Processing Vendor Requirements CAQH CORE Batch Processing: Why not FTP or sFTP for batch transactions instead of HTTP/S?HTTP/S is robust and has a proven track record with batch transactions. The benefits of a single communication standard were a compelling reason to mandate its availability. Information sources that allow FTP and/or sFTP for Read More →

EDI HTTP

EDI HTTP Guidelines For CAQH CORE 250: Claim Status Infrastructure Rule EDI HTTP guidelines refer to parties contracting with Medicare and CAQH CORE-authorized testing vendors. One of the typical questions from vendors – “Is there a required format in Phase I CAQH CORE Connectivity for the authorization, date/time, and payload ID to be sent in the Read More →

CAQH CORE 250

CAQH CORE 250: Claim Status Infrastructure Rule Guides CAQH CORE 250 Rule for operating rules for the eligibility and claim status transactions adopts all the Phase I and II CAQH CORE Eligibility and Claim Status Operating Rules except those requirements pertaining to the use of Acknowledgements. Entities seeking CORE Certification must implement all of the CAQH CORE Eligibility and Claim Read More →

EDI 837 Institutional Quiz

CGS EDI Enrollment Provider Guidelines CGS EDI Enrollment form (commonly referred to as the EDI Agreement) should be submitted when enrolling for electronic billing. It should be reviewed and signed only by the providers to ensure each provider is knowledgeable of the enrollment request and the associated requirements. Providers that have contracted with a third Read More →

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CGS EDI Program: Advantages and myCGS Portal CGS EDI Program offers advantages to providers who conduct business with Medicare electronically. 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 save money on postage and claim forms. Earlier payment Read More →

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Rejected HIPAA Claims Basic Guides (CGS Administrators, LLC) Rejected HIPAA Claims are claims that are in a rejected status and has failed one of the set validations. Find below some ANSI Claim Rejections. More ANSI Claim Rejections examples can be found in the previous posts. X222.262. 2310B. NM109.030 This Claim is rejected for Invalid Information for a Rendering Provider’s National Read More →

EDI quiz

Top 10 ANSI Claim Rejections Examples Top 10 ANSI Claim Rejections occur at multiple locations within the electronic EDI claim. Suppliers are strongly encouraged to review all aspects of a claim denial. Find below Top 10 ANSI Claim Rejections. X222.087. 2010AA. NM109.050 This Claim is rejected for relational field due to Billing Provider’s submitter not approved for electronic claim Read More →