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for missing or incorrect information (such as an invalid patient identification number, a diagnosis code that is no longer valid or gender misidentification) prior to their submission Read More →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 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 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 (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 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 →

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 →

Passport Health Plan EDI Guidelines And Recommendations Passport Health Plan EDI Program stimulates providers to submit claims electronically using Electronic Data Interchange instruments. Passport Health Plan EDI claims submitting 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. Read More →

837P and 837I Health Care Claims Notes For Beacon Health Options Partnering Parties 837P and 837I Health Care Claims are accepted by Beacon Health Options (Beacon) as mandated by the administrative simplification provisions of HIPAA. 837P and 837I Health Care Claims guidelines provided below areused in conjunction with the X12 implementation guide. The implementation guides for all HIPAA Read More →

EDI Health Care Electronic Transaction Options EDI Health Care helps to minimize providers’ administrative time and effort, and to reduce paper waste in health care communities. EDI Health Care by Beacon Health Options company significantly enhanced eServices portal and electronic data interchange (EDI) capabilities for completing transactions efficiently and cost-effectively. The intended audience for the information below is Read More →