HIPAA Compliance

HIPAA Compliance At Emdeon: Overview of HIPAA Legislation HIPAA Compliance (The Health Insurance Portability and Accountability Act) of 1996 carries provisions for administrative simplification. HIPAA Compliance requires the Secretary of the Department of Health and Human Services (HHS) to adopt standards to support the electronic exchange of administrative and financial health care transactions primarily between Read More →

EDI Acknowledgment – Emdeon  Receiver Guidance This blog post represents EDI Acknowledgment Emdeon implementation guidance for supporting claim acknowledgment transactions in response to a received 837 5010 claim file. Emdeon strongly recommends that payers return EDI Acknowledgment, claim status, and ERA transaction responses. 837 5010 Claim EDI Acknowledgment file received from Emdeon Payer generated claim acknowledgement Read More →

EDI Control Segments (Envelopes)

EDI Control Segments (Envelopes) – Emdeon 837 Claims Notes EDI Control Segments (Envelopes) notes are given in today’s post to provide the information necessary to facilitate electronic interchange of healthcare transactions with Emdeon. Emdeon partners with hundreds of practice management system vendors to bring the connectivity to the network. EDI Control Segments (Envelopes) Necessary Points Read More →

EDI Acknowledgment Emdeon

EDI Acknowledgment – Emdeon Submitter Guidance EDI Acknowledgment Emdeon implementation guidance is given below in today’s post for supporting claim acknowledgment transactions in response to a submitted 837 5010 claim file. Emdeon strongly recommends that submitters accept EDI Acknowledgment transaction responses. 837 5010 EDI Acknowledgment File received from Submitters Emdeon generated EDI acknowledgment transactions in response Read More →

EDI communication protocols

EDI Communication Protocols and File Formats Accepted Emdeon allows connections using multiple EDI communication protocols. Each of the agreed EDI communication protocols is described below. Sterling Gentran® IBM® Sterling Gentran® is a third party product providing an EDI and data translation solution that supports multiple protocols. Emdeon supports connectivity with this product through one of Read More →

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Test EDI files  Submission and Validation Guides The process of submitting test EDI files  varies based on the selected platform and the implementation method. During EDI implementation, you will log a ticket to the ON24/7 application that includes the following information: Tracking/Reference number Number of claims submitted Time and date of submission Submitter ID Line of Business Read More →

Emdeon EDI Testing

Emdeon EDI Testing and Certification Overview Emdeon EDI Testing consists of submitting EDI claims, validating the EDI data, and certifying multiple electronic transmissions. Emdeon EDI Certification for a new implementation requires the successful submission of 100 test EDI claims with a validation percentage that meets or exceeds 95%. Emdeon EDI Certification for a conversion project begins Read More →

Affinity Health Plan 837 Claims:  Electronic Claims Submission Find out the third part of Affinity Health Plan 837 Claims FAQs regarding to Affinity Health Plan Electronic Data Interchange program. Affinity Health Plan 837 Claims FAQs present additional information useful for all parties taking part in claims submission. Affinity Health Plan 837 Claims FAQs Why is Read More →

EDI Claim Status Codes

Affinity Health Plan EDI Claim Status Codes and Emdeon Clearinghouse Claim Status Codes Affinity Health Plan EDI Claim information, unique to Affinity Health Plan claims, must be provided and properly formatted in the EDI file. Affinity Health Plan EDI Claim sent to Emdeon is checked at the clearinghouse for format and syntax errors. If Emdeon identifies an Read More →

CLEARING HOUSE EDI

Clearing house and it’s role in Healthcare EDI Communication Clearing house is a third party service provider. It takes non-EDI data and translates them to EDI data. Clearing house can also translate EDI to EDI. This is done by taking the received raw data, massaging and scrubbing it. Then data are sent to another document. Clearinghouse can also Read More →