Clean Claims

Clean Claims EDI Processing and Other Health Coverage Cases Clean Claims will be processed by San Francisco Health Plan as submitted in a timely manner for medically necessary and covered services by a participating provider group in accordance with the agreement between SFHP and the provider group for the applicable benefit program. Clean Claims are Read More →

San Francisco Health Plan EDI Claims: Common Requirements San Francisco Health Plan EDI Claims are processed for the following medical groups: San Francisco Community Clinic Consortium, San Francisco Health Network (previously known as the Community Health Network) and UCSF Medical Group. Any delegated medical group must submit encounter EDI data to San Francisco Health Plan Read More →

medical codes

Medical Codes Overview San Francisco Health Plan uses medical codes according to Medi-Cal billing guidelines in addition to Optum coding books application for claim activities. The following procedure medical codes must be used for a claim to be processed: Professional charges – HIPAA compliant HCPCS Level 1 (CPT) & level 2 Inpatient hospital/facility/institutional charges – Read More →

healthcare claims

HealthSmart Claims EDI Clearinghouse services HealthSmart Claims solution for payors and those with self-administered health plans, offers complete Electronic Data Interchange (EDI) Clearinghouse services. HealthSmart Claims Information Systems offers significant operating efficiencies to the healthcare industry through a range of solutions that streamline electronic claims processing. HealthSmart Claims services facilitate “clean claims,” resulting in reduced Read More →

edi clearinghouse

HealthSmart EDI provider and vendor solutions HealthSmart EDI program offers a Full Service Healthcare EDI Clearinghouse. It is open to all providers in the healthcare community. The goal at HealthSmart is to give network providers the highest level of customer service possible. HealthSmart is engineered with the latest technology and is committed to meeting all HIPAA requirements Read More →

EDI 5010

EDI 5010 Version Changes EDI 5010 recent updates can influence correspondence in healthcare claims exchange and flow between partners. It is recommended that both parties take part in EDI 5010 updates testing procedures in order to prevent delays or issues in processing your claims cycle. EDI 4010 to EDI 5010 basis The centers for Medicare and Read More →

837 institutional claim

837 Institutional Claim scenario and mapping guidelines 837 Institutional Claim example presented in today’s post shows a standard 837 Institutional claim. As we spoke in our previous post, the 837 Healthcare Claim transaction has three different implementation guides specifically developed for Professional, Institutional and Dental claims. The specifications are geared to meet the individual requirements Read More →