HIPAA: Electronic Data Interchange (EDI) Rule (ASHA) The EDI rule is very technical and based on the X12N EDI data transmission protocol standard. Although rare allowances are made, the rule requires that any covered entity who electronically transmits data must use this, and only this format in doing so. The EDI rule is a set Read More →

Administrative Simplification Compliance Act

Administrative Simplification Compliance Act Basics Section 3 of the Administrative Simplification Compliance Act (ASCA), Pub. L. 107-105 and the implementing regulation at 42 CFR 424.32, require that all initial claims for reimbursement from Medicare be submitted electronically, with limited exceptions. The ASCA amendment to section 1862(a) of the Social Security Act prescribes that “no payment Read More →


CGS EDI: Benefits For Partners There are advantages to providers who conduct business with Medicare electronically. Some of those benefits include: No more paper claims. EDI (submitting claims to CGS electronically eliminates paperwork, so your staff can accomplish more in less time). You will also save money on postage and claim forms. Earlier payment floor. Electronic Read More →

Correct Billing Procedures

Health Partners Plans Correct Billing Procedures Health Partners Plans has identified the most common electronic errors that occur and compiled a list of helpful hints. All Health Partners Plans (Medicaid) claims must be submitted with the Member’s 9 digit Health Partners Plans ID number. All Kidz Partners (CHIP) claims must be submitted with the 10 digit Read More →

Incorrect EDI Billing Procedures

The most common electronic errors Health Partners Plans has identified the most common electronic errors that occur. Find below the incorrect billing procedures: DO NOT submit claims with the Member’s 10 digit access number or their Social Security number. DO NOT submit Kidz Partners (CHIP) claims with the member’s Social Security number only. DO NOT Read More →


All Industries EDI Training Bundle: The detailed content Let’s get closer to EDI Academy training. Learn the detailed content of All Industries EDI Training Bundle. Register at the best price (early-bird). EDI 101 – Introduction To EDI History and Origin of EDI  Major EDI Advances How EDI is applied in different industries The Business Need for Read More →


HIPAA X12 EDI Training Bundle: The detailed course agenda Learn about Health Care EDI Environment and dive into deep mapping. Register for a training bundle. HIPAA EDI 101 – Introduction To The Health Care EDI Environment  Introduction to the Health Care EDI Environment  Health Care EDI Defined Benefits of Health Care EDI X12 Standards X12N Workgroups Read More →

HIPAA EDI Acronyms

HIPAA EDI Acronyms and Definitions Learn basic HIPAA EDI acronyms and definitions to understand the terminology used in health care CMS guidelines. EDI – Electronic Data Interchange – the process of using nationally established standards to exchange electronic information between business entities. HIPAA – Health Insurance Portability and Accountability Act of 1996 – legislation that mandated that Read More →

EDI Claims

Health Partners General Requirements for the Electronic Claims Submission Process (837 Professional Claims) Find below Health Partners Plans general guidelines for 837 Professional Claims Submission. Only loops, segments, and data elements valid for the HIPAA 837 Professional (005010X222A1) Technical Report Type 3 will be translated. Deviating from the Technical Report Type 3 and submitting invalid data will Read More →

837 Institutional

General Business Requirements for the 837 Institutional 5010A2 Claims Submission Process (Health Partners Claims) These mapping guidelines will address a variety of issues that will facilitate the Electronic Media Claims Processing for the 837 Institutional (005010X223A2). Coding Guidelines Use most recent ICD-9, CPT, HCPC, and Revenue codes. Always check for 4th and 5th digit code Read More →