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 →

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 →