837 Health Care Claim

837 Health Care Claim Technical Procedures And Infrastructure (IEHP Provider Network) 837 Health Care Claim: Professional Transaction must be transmitted by business partners to IEHP by connecting to the IEHP Network. They go from the Internet through a Virtual Private Network (VPN) tunnel to the IEHP Secure File Transfer Protocol (SFTP) Server. In standard software-to-hardware VPN connections, VPN client Read More →

HIPAA 837 Transaction

HIPAA 837 Transaction IEHP Business Scenarios (Examples) and Frequently Asked Questions HIPAA 837 Transaction IEHP Business Scenarios described will be useful for partners Submitting HIPAA 837 Transaction to IEHP. Example 1- IPA Submitting Institutional Encounter Data Encounter data must be submitted by IPAs for all covered services provided to assigned Capitated members. Covered services include PCP visits Read More →

837 Health Care Claim

837 Health Care Claim: Professional Transaction based on ASC X12 Technical Report Type 3 (TR3) 837 Health Care Claim: Professional Transaction may be transmitted any day of the week to IEHP from a customer’s business partner. The transaction provides data on Medicare Advantage / Part D data. Technical Infrastructure and Procedures Business partners transmitting 837 Health Care Read More →

837 Institutional Healthcare Claim

837 Institutional Healthcare Claim Testing: Set-up, Directory and File Naming 837 Institutional Healthcare Claim Testing should be followed by requesting information on establishing connections through the SFTP server. Upon completion of 837 Institutional Healthcare Claim set-up, providers will receive additional instructions on SFTP usage. SFTP Directory Naming Convention There would be two categories of folders under Trading Read More →

837 Institutional Healthcare Claim Testing

837 Institutional Healthcare Claim Testing (Washington State Health Care Authority (HCA)) Procedure 837 Institutional Healthcare Claim Testing completion  must occur prior to submitting electronic transactions in production to Washington State Health Care Authority ProviderOne. 837 Institutional Healthcare Claim Testing is conducted to ensure the following levels of HIPAA compliance: Level 1 – Syntactical integrity: Testing of Read More →

837 Dental Transaction Mapping

837 Dental Transaction Mapping Exercise Example 837 Dental Transaction Mapping exercise gives a scenario of working with a 837 Dental Transaction file to complete the claim and send it to processing. 837 Dental Transaction Mapping exercise will be useful for insurance companies, providers and HIPAA specialists. Scenario: Patient MINI DUCK dependent son of DONALD DUCK goes to the Read More →

Compliance Checking

EDI Compliance Checking For X12, EDIFACT And HIPAA Standard Requirements EDI Compliance Checking is the process of incoming and outgoing X12/EDIFACT/HIPAA documents validation. The documents are being checked for compliance with the established and agreed formats. There exist EDI Compliance Checking packs – frameworks that check incoming documents for compliance before they are transformed. After Read More →

MIME

MIME Definition MIME (Multipart Internet Message Extensions) defines a message format (a set of documents) represents a mechanism of sending different file types as one part or together with common mail messages. Multipart Internet Message Extensions has headers that are defined by RFC 822 and extensions to those header definitions. Multipart Internet Message Extensions follows Read More →

Passport Health Plan EDI

Passport Health Plan Electronic Submission Advanatages (for Medical and Hospital Claims) Passport Health Plan Electronic Submission is the initiative for all providers. Passport Health Plan Electronic Submission allows faster, more efficient, and cost-effective claim submission for providers. EDI, performed in accordance with nationally recognized standards, supports the health care industry’s efforts to reduce administrative costs. The benefits Read More →

HIPAA EDI training

HIPAA EDI Support Service Operation Process Common Description HIPAA EDI Support Service serves for parties involved in EDI documents exchange process to make the operation easy and effective. Before any operation providers should obtain an account at the chosen service and make the enrollment. Usually creating a profile in EDI support service the party is Read More →