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 →
Filing A Healthcare Claim Requirements For Cigna Vendors Filing A Healthcare Claim should be done as soon as possible. If you’re unable to file a claim right away, please make sure the claim is submitted accordingly. If you are a participating health care provider, submit by 90 days after the date of service If you are … Read More →
Cigna Electronic Data Interchange Claims Process Cigna Electronic Data Interchange vendors securely transmit data electronically to Cigna and gain many benefits of this process. Filing paper claims can be time consuming. When you submit claims to Cigna electronically, including coordination of benefits (COB) claims, your practice can gain many benefits such as: Quicker claims submission, including Dental Health … Read More →
Operating Rules CAQH CORE 270: Connectivity Rule Guidelines Operating Rules CAQH CORE 270: Connectivity Rule requirements must be implemented by all entities seeking CORE Certification, including all other the CAQH CORE Eligibility and Claim Status Operating Rules. Operating Rules CAQH CORE 270: Connectivity Rule state that the CAQH CORE 270 Rule is applicable only to the public Internet, which is a TCP/IP … Read More →
CAQH CORE 270: Connectivity Rule Authentication Standards CAQH CORE 270: Connectivity Rule (Connectivity & Security Subgroup) evaluated the connectivity implementations used by its members, including what types of submitter authentication methods were being used. The results showed widespread use of both username/password and X.509 client certificate authentication. Though username/password is the base requirement with Phase … Read More →
CAQH CORE Connectivity Safe Harbor Guidelines CAQH CORE Connectivity Safe Harbor requirements that a health plan must use if requested by a provider are described in CAQH CORE 270 Rule, Section 5, CORE Safe Harbor. The CAQH CORE Connectivity Safe Harbor specifies connectivity methods that application vendors, providers, and health plans can be assured will be supported … Read More →
CAQH CORE 270: Connectivity Rule: Relationship Between Phase I and Phase II CAQH CORE 270: Connectivity Rule is not a reference to X12 270 eligibility transaction. The CAQH CORE 270: Connectivity Rule Version 2.2.0, is payload agnostic, and is designed to carry any X12 v4010 and v5010 administrative transaction payload as well as any other non-X12 payload. The CAQH CORE … Read More →
CAQH CORE Eligibility & Claim Status Operating Rules: CAQH CORE 260: Eligibility & Benefits Data Content (270/271) Rule As the CAQH CORE Eligibility & Claim Status Operating Rules (CAQH CORE 154 and 260 Rules) do not require that the X12 271 Response to an X12 270 inquiry include a specified grouping of service type codes (STCs), … Read More →