EmblemHealth Electronic Claims Submission Requirements EmblemHealth Electronic Claims should not be duplicated. When duplicate claims are submitted, vendor potentially delays claims processing and create confusion for the member. Attachments cannot be submitted electronically at this time. However, most claims should be submitted electronically. If supporting documentation is required for the settlement of a vendor claim, EmblemHealth will request it. … Read More →
EDI Overview and Enrollment Procedures For Optima Health Providers EDI overview and requirements are to be used with the HIPAA-AS Implementation Guide. Each EDI vendor will have to sign a Trading Partner Agreement, which includes the Network Access Agreement and the Business Associate Agreement. EDI overview: Business Use Each transaction set will be used to expedite the execution of electronic … Read More →
How To Choose A Medical Billing Software Vendor For Submitting HIPAA Claims To Manitoba Health? Prior to selecting a medical billing software vendor the list of questions should be considered including requirements for the MHHLS billing applications. Installation: What is the waiting period for delivery and installation? Training: Is the training included in the purchase price? How … 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 →