Eligibility & Claim Status Operating Rules: Service Type Codes (STCs) Eligibility & Claim Status Operating Rules define some Service Type Codes (STCs) as “discretionary” in the CAQH CORE Eligibility & Benefits (270/271) Data Content Rules (CAQH CORE 154 & 260 Rules). For certain STCs, the patient financial data is not required to be returned for some benefits … Read More →
Coordination of Benefits (COB) Assistance By BCRC (Benefits Coordination & Recovery Center) Coordination of Benefits (COB) issues can be consolidated by BCRC (Benefits Coordination & Recovery Center) that will correct any possible issues on their end, or report to the contractor any issues that require action on the part of the contractor. The Contractor can verify whether Medicare claims … Read More →
Benefits Coordination & Recovery Center: Coordination of Benefits (COB) A Celerian Group Company Benefits Coordination & Recovery Center consolidates the activities that support the collection, management, and reporting of other insurance coverage for Medicare beneficiaries. The purposes of the Benefits Coordination & Recovery Center program are to identify the health benefits available to a Medicare beneficiary and … Read More →
CAQH CORE 259: AAA Error Code Reporting Rule (Eligibility & Claim Status Operating Rules) CAQH CORE 259: AAA Error Code Reporting Rule requires a health plan/information source to return a AAA segment for each error condition that it detects in a X12 270 request, as described in sections 4.3-4.5 of the rule. CAQH CORE 259: AAA Error Code … Read More →
CAQH CORE 258: Normalizing Patient Last Name Rule (Eligibility & Claim Status Operating Rules) CAQH CORE 258: Normalizing Patient Last Name Rule does not require that a health plan use the patient’s last name in its search and matching logic for locating an individual within its systems. Further, the rule does not specify the search … Read More →
EDI Training Schedule 2019: San Diego Workshops And Webinars EDI Academy is proud to announce the EDI Training Schedule for the summer of 2019. Let us know if you are interested in registering for these classes (email info@ediacademy.com). All Industries – EDI Fundamentals & Best Practices – San Diego Workshops 2019: September 17-18 Health Care (HIPAA) EDI Fundamentals & Best Practices – San Diego … Read More →
Alaska Medicaid HIPAA EDI Requirements And Transactions Guidelines Alaska Medicaid HIPAA EDI Companion Guide is authored by the health plan. The purpose of a companion guide is to supplement the Technical Reports Type 3 (TR3s) which are also known as the HIPAA EDI Implementation Guides. These TR3s can be purchased at the X12 Store. Companion guides are … Read More →
CMS Final Rule to Protect Medicaid Provider Payments CMS Final Rule ensures Medicaid providers receive complete payments as required by law. The Centers for Medicare & Medicaid Services (CMS) released the Medicaid Provider Reassignment Regulation final rule removing a state’s ability to divert portions of Medicaid provider payments to third parties outside of the scope … Read More →
Getting Started With Alabama Medicaid HIPAA EDI Transactions Seventy-Five Million Americans (23%) have Medicaid Insurance. Medicaid is a government insurance program for low-income and disabled individuals. Medicaid Agencies use Electronic Data interchange (EDI) technology for these transactions. Alabama is one of the Medicaid agencies using EDI. Alabama uses standard HIPAA EDI Transactions which are listed … Read More →
Aetna SSI 270 271 Companion Guide Information Aetna SSI (Senior Supplemental Insurance) is a division of Aetna that providers medical insurance to seniors. The Eligibility Enquiry 270 and the 271-eligibility response are a key component of their business process. These transactions allow members to receive co-pay, deductible and other important information about their plan when … Read More →