UHA Claim Submission

UHA Claim Submission (Trading Partner Guidelines) UHA Claim Submission specific instructions are required for electronic transfer of the claims data via Electronic Data Interchange processing systems. 997 Functional Acknowledgement UHA is required to create a 997 Functional Acknowledgement to report the results of the standard X12 syntax editing. The 997 will normally be available by the next business Read More →

UHA Claim Submission

UHA Claim Submission Requirements For Trading Partners UHA Claim Submission must be processed using the codes required in the National Implementation Guides and the HIPAA rules. Each transmission to UHA should have a unique Interchange Control Number (ISA13). UHA will use this number to determine if it is a duplicate file. b. Submitters are required to submit Read More →

Claims Processing

Claims Processing Cycle (UHA Providers) Claims Processing Cycle via EDI provides a quicker turnaround time on provider claims since it will eliminate the need for UHA to manually process the majority of the claims. However, the length of time required to process a claim depends on many variables in addition to the medium on which they are Read More →

Pre-Auditing

Pre-Auditing And Tracking Claims Operation Guides (The American Medical Association (AMA)) Pre-Auditing Claims is available for practice management software systems, clearinghouses, billing services or other claims transmission vendors for missing or incorrect information (such as an invalid patient identification number, a diagnosis code that is no longer valid or gender misidentification) prior to their submission Read More →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 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 →

Institutional Paper Claim Form

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

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 Health Care Insurance

Ohana Health Plan EDI Claims Submission Guidelines Ohana Health Plan EDI Claims are sent electronically via EDI. Ohana Health Plan EDI Claims Submission is less costly than billing with paper and, in most instances, the Plan can process your electronic claim in half the time of a paper claim. For EDI submissions, providers should follow the HIPAA transaction Read More →