Eligibility And Claim Status CAQH CORE Companion Guides For Trading Partners and Providers Eligibility And Claim Status companion guides can be independently created by health plans so they can often vary in format and structure. Such variance can be confusing to trading partners and providers. CAQH CORE adapted its CAQH CORE Master Companion Guide Template based on the CAQH/WEDI Read More →

 Eligibility & Claim Status Real Time Acknowledgements (CAQH CORE Operating Rules) Eligibility & Claim Status Real Time Acknowledgements guidelines define that for real time inquiries, your organization’s system must return the X12 271 response or an ASC X12 Implementation Acknowledgement (999) when the functional group is rejected, to be conformant with this rule. Thus, your organization’s Read More →

CAQH CORE Eligibility & Claim Status Batch Acknowledgements Guidelines CAQH CORE Eligibility & Claim Status Batch Acknowledgements guidelines require that the health plan or information receiver must always return an ASC X12 Implementation Acknowledgement (999) for all functional groups, whether or not the group is rejected. This requirement allows the provider to know within a Read More →

CAQH CORE HIPAA Operating Rules (Eligibility & Claim Status) CAQH CORE HIPAA Operating Rules are mandated for all HIPAA-covered entities by the ACA (with the exception of requirements pertaining to acknowledgments). Find CAQH CORE HIPAA Operating Rules (Eligibility & Claim Status) in the form of FAQs below. What do the Phase I and Phase II CAQH CORE Eligibility & Read More →

270/271 HIPAA Transaction Validation (Pre-Query and Post-Query) (Washington State Health Care Authority) 270/271 HIPAA Transaction validation (Washington State Medicaid’s 270/271 transaction) will perform a pre-query validation to make sure the required Subscribe data elements are preset prior to routing the information to Eligibility and Benefit system. For Subscriber request below data elements can be submitted: Read More →

EDI 5010 Version Changes EDI 5010 recent updates can influence correspondence in healthcare claims exchange and flow between partners. It is recommended that both parties take part in EDI 5010 updates testing procedures in order to prevent delays or issues in processing your claims cycle. EDI 4010 to EDI 5010 basis The centers for Medicare and Read More →

271 ASC X12 Premium Payment Grace Period Notification: public review of Implementation Guide (007030X344) 271 ASC X12 Premium Payment Grace Period Notification Implementation Guide (007030X344) was developed by Insurance Subcommittee of ASC X12. Now this guide is available for public view. During this period the committee will provide an informational forum where the audience can discuss the document, review comments and Read More →

Healthcare Eligibility, Coverage and Benefit Request (270) and Response (271) additional notes concerning batch and timing Healthcare Eligibility, Coverage and Benefit Request (270) and Response (271) EDI transactions were already discussed earlier in the blog. You can find general information about these healthcare EDI transactions as well as the description of the relationship during the Read More →

270, 271 EDI relationship: senders and receivers, subscribers and dependents 270, 271 EDI transactions basic information was described in our previous blog post. Today we speak about the relationship between the participants of the 270, 271 EDI transactions process. During 270, 271 EDI exchange provider of service can request more detailed eligibility information other than a patient’s standard eligibility. Read More →