IEHP 5010 837I Institutional Claim Transaction Basics IEHP 5010 837I Institutional Claim requirements are given below for providers submitting health care claims to IEHP via EDI Network and for those who are intended to start EDI exchange with IEHP. Clearinghouse/IEHP Direct Providers Submitting Claim Data Clearinghouses are largely used as an intermediary for fee-for-service Providers, hospitals, and other Providers submitting Read More →

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 →

EDI 837 Common Ground Healthcare Cooperative Highlights EDI 837 Common Ground Healthcare Cooperative transaction requires efficient and accurate electronic transaction processing. To promote this EDI partners should note: Each user is assigned a 6-digit EDI Direct Trading Partner ID. Logon User Name is 8 characters. Logon User ID (password) is 9 characters. All dates are in the CCYYMMDD format. Read More →

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 →

Professional Claim Form Basics Professional Claim Form may be electronically submitted to a Medicare carrier, Durable Medical Equipment Medicare Administrative Contractor (DMEMAC), or A/B MAC from a provider’s office using a computer with software that meets electronic filing requirements as established by the HIPAA claim standard and by meeting CMS requirements contained in the provider enrollment & certification Read More →

Institutional Paper Claim Form Guidelines Institutional Paper Claim Form (CMS-1450 form), aka UB-04 at present, can be used by an institutional provider to bill a Medicare fiscal intermediary (FI) when a provider qualifies for a waiver from the Administrative Simplification Compliance Act (ASCA) requirement for electronic submission of claims. It is also used for billing Read More →

Electronic Claims Attachments: Supplemental Medical Documents Electronic Claims Attachments are supplemental documents providing additional medical information to the claims processor that cannot be accommodated within the claim format. Common attachments are Certificates of Medical Necessity (CMNs), discharge summaries and operative reports. They are sent to the Durable Medical Equipment Medicare Administrative Contractor (DME MAC) and/or A/B MAC with Read More →

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 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 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 →