EDI Process Flow At Veterans Health Administration (VHA) EDI Process Flow above flowchart represents the path that electronic claims follow at Veterans Health Administration (VHA). The objective of electronic billing is to submit completely correct claims. Claims sent electronically reach the payer faster, are processed faster, and are paid faster than claims submitted to the … Read More →
GS1 Healthcare Case Study: Improving patient safety through traceability initiative Sanatorio Güemes is a 522-bed private hospital in Buenos Aires, Argentina, that has established best practices regarding patient safety and quality of care. The hospital has implemented processes and policies to enable electronic medical records and improve inventory management, and are meeting many requirements of the National … Read More →
Transformation with GS1 Standards: Franciscan Missionaries Case Study The Franciscan Missionaries of Our Lady Health System (FMOLHS) is a non-profit healthcare system serving more than half of Louisiana’s population. Challenged by the rising costs and growing complexity of delivering quality healthcare, FMOLHS needed to improve its operational efficiencies, control costs, and remain focused on what mattered most—the … Read More →
Clean Claim Requirements (Cigna vendors) Clean Claim Requirements were developed with the goal to process all claims at initial submission. Before Cigna can process a claim, it must be a “clean” or complete claim submission, which includes the following information, when applicable: primary carrier explanation of benefits (EOB) when Cigna is the secondary payer prescription for physical … Read More →
Prevea360 ASC X12 Acknowledgments And Additional Reporting Prevea360 will produce a Response Acknowledgement TA1 and Implementation Acknowledgement 999 for every 834 file received. Both of these are placed within the sponsor/trading partners /999 FTP folder for transaction acceptance review. The TA1 Response Acknowledgement will indicate that the file was successfully received as well as indicate what … Read More →
Functional Grouping and Transaction Set File Structure Options (Prevea360 Partner Guidelines) Prevea360 is able to process different variations of transaction sets. Option 1 is the most commonly received structure and is acceptable for files with up to 8000 members. Option 1 (All INS in one ST/SE) Due to system limitations, Prevea360 is unable to process files … Read More →
HIPAA Transaction Standards as Designated by CMS HIPAA transaction standards shall be supported by the A/B MACs, DME MACs, CEDI or other contractors if designated by CMS for the electronic data with Medicare providers/submitters/receivers/COB trading partners. ASC X12 Technical Report 3s (TR3s) for mandated HIPAA transactions may be purchased from the official Washington Publishing Company … Read More →
Electronic Remittance Advice (ERA) Enrollment Form The Medicare Electronic Remittance Advice (ERA) Enrollment process provides for collection of the information needed to successfully receive ERA transactions from Medicare and EDI trading partners. This agreement must be executed by each provider that receives ERA either directly to or from Medicare or through a third party. Each … Read More →
EDI Enrollment and Registration (AKA Trading Partner Agreements) Medicare FFS’ Trading Partner Agreement is comprised of two forms: 1) EDI Registration and 2) EDI Enrollment. The forms are identified under CMS form 10164 and can be accessed at: EDI Registration EDI Enrollment A/B MACs and CEDI must use these two forms, or their own organization … Read More →
EDI LIBC-495 (Notice of Compensation Payable – BWC) EDI LIBC-495 verifies if the Claim Administrator has implemented the changes that would result in the generation of the Notice of Compensation Payable (LIBC-495) based on the following EDI transaction/maintenance type codes: SROI IP SROI PY SROI AP SROI RB SROI 02 SROI CA SROI PD SROI IP 1. … Read More →