Medical Associates Health Plans and Health Choices (835 EDI Transaction) The payer ID for Electronic Remittance Advice transactions is MAHC1. Below are the plans either owned or administered by MAHP/HC/Live360. These plans will be referred as MAHP/HC/Live360 in the document hereinafter: Medical Associates Health Plan Medical Associates Health Plan Community Health Plan Medical Associates Health … Read More →
EDI Online Webinars (Instructor-led) EDI Online Webinars are suitable for novice and experienced specialists involved in supply chain, inventory and sales, logistics, data analytics, finance, e-commerce etc. Training goes in a format of online instructor-led webinar. Attendees have the possibility to work on real-world examples and to ask the instructor EDI-related questions. Below we give … Read More →
270/271 HIPAA Transaction (MAHP/HC Guidelines) MAHP/HC’s Trading Partners must adhere to the following business rules and limitations for submitting transactions in real time: Only one patient per transaction. Only one transaction per functional group. Only one functional group per interchange. Interchange acknowledgements for successful deliveries will be honored for submitters using the dual-port method. If … Read More →
Medical Associates Health Plans and Health Choices 270/271 HIPAA Transaction Requirements 270/271 HIPAA transmissions are used in tandem with the v5010 ASC X12N Implementation Guides, are compliant with both ASC X12 syntax and those guides. MAHP/HC currently uses Change HealthCare as the exclusive clearinghouse for managing 270/271 connections. Learn the instructions needed to get connected and … Read More →
276/277 Acknowledgements and Reports (Medical Associates Health Plan) Medical Associates Health Plan HIPAA 276/277 transmissions are used in tandem with the v5010 ASC X12N Implementation Guides, are compliant with both ASC X12 syntax and those guides. As the 276 transaction is designed to be exchanged for a 277 response containing the claim status information sought in … Read More →
Medical Associates Health Plan Payer Specific Business Rules Submitters may send a 276 claim status request on claims filed electronically (via an 837 Health Care Claim) or on paper. MAHP/HC does not distinguish between paper and electronic claims when issuing a 277 response. Date ranges returned on the 277 response (DTP03) are those submitted on … Read More →
Medical Associates Health Plan 276-277 EDI Transaction Guides Before submitting or receiving a 276 or 277 transaction, registration as a Trading Partner with Change HealthCare and testing is required. Before testing with Change HealthCare can begin: Connectivity with Change HealthCare’s Real-Time Exchange Services must be established. The Implementation Coordinator will work to facilitate the setup … Read More →
EDI Communication With Trading Partners EDI is the electronic transfer of information, such as claims, remittance advice, eligibility inquiry and claim status inquiry, in a standard format between trading partners. EDI allows entities within the healthcare system to exchange medical, billing and other information and to process transactions in a fast and cost-effective manner. With … Read More →
Claim Requests for Reconsideration, Provider Disputes and Corrected Claims (Sunshine Health Guidelines) Provider billing department will need to submit to the appropriate payer to prevent payment delays. The provider should use the same date of service guidance on the first page to determine the correct payer. Corrected claims must be submitted within 90 days from the date … Read More →
Sunshine Health Electronic Claims Filing Deadlines Original claims (first time claims) and corrected claims must be submitted to Sunshine Health within 180 calendar days from the date services were rendered or compensable items were provided. When Sunshine Health is the secondary payer, claims must be received within 90 calendar days of the final determination of … Read More →