WPS Health Insurance

WPS Health Insurance EDI Overview and Advantages WPS Health Insurance EDI program encourages health care providers to file their claims electronically. The WPS Health Insurance EDI Corporate Services – EDI department – has a dedicated team whose primary function is to consult and serve providers regarding Electronic Data Interchange (EDI) issues. WPS Health Insurance EDI team is Read More →

270/271 Eligibility and Benefit Inquiry and Response

270/271 Eligibility and Benefit Inquiry and Response Transaction Guidelines 270/271 Eligibility and Benefit Inquiry and Response guidelines describe recommendations for HMSA partners involved in electronic documents transmission. The main requirements include the following: If multiple payers or multiple HMSA contracts cover a patient, the 271 response will contain multiple EB segments (where EB01 = “R” Read More →

Washington State Medicaid 270/271 HIPAA

Washington State Medicaid 270/271 HIPAA Transaction Notes Washington State Medicaid 270/271 HIPAA Transaction guidelines adopted under HIPAA clarify and specifiy the data content when exchanging electronically with Washington State Medicaid. When the trading partner submits the 270 request by any one of the specified methods the 270 request will be validated using EDI validator (up to Read More →

Washington State Health Care Authority

Washington State Health Care Authority EDI And Enrollment Requirements Washington State Health Care Authority EDI program works under general HIPAA standard requirements. Health Insurance Portability and Accountability Act (HIPAA) Electronic Data Interchange (EDI) is an electronic method of communicating standard transactions between covered entities (providers, clearinghouses and health plans). HIPAA EDI allows covered entities to submit Read More →

832 Price/Sales Catalog Mapping

832 Price/Sales Catalog Mapping Notes (Town Shoes EDI Program) 832 Price/Sales Catalog Mapping user notes will help all Town Shoes EDI vendors to create EDI maps according to the set requirements (X12/V4010/832). EDI General Information: VAN: HP MFT AS2: Available FTP: Preferred Portal: https://www.connectspice.com/portal/ ISA Qualifier: ZZ ISA ID: TOWNSHOESLTD GS ID: TOWNSHOESLTD ISA Test / Read More →

Matching 27x Request and Responses

Matching 27x Request and Responses In Electronic Data Interchange Between HMSA And Its Partners Matching 27x Request and Responses recommendations are given to facilitate electronic documents transmission. The matching of a 27x request transaction with its response, it is recommended that a unique trace number be submitted in TRN02 at the patient level (Subscriber or Dependent loop) and, Read More →

batch and real-time transactions

Batch And Real-Time Transactions Guidelines for HMSA EDI Partners Batch And Real-Time Transactions should adhere to the guidelines given in the today’s post. HMSA will respond to a batch request within eight hours. If the request is for non-HMSA requests (ie, BlueCard or FEP) the transaction must be routed to another entity outside of HMSA and may Read More →

hmsa edi mapping

HMSA EDI Mapping Guidelines (File, Functional Group, Transaction Set, and Claim Rejection) HMSA EDI Mapping Guidelines are given for business partners transmitting electronic transactions to HMSA. HMSA EDI Mapping Guidelines cover the following points – File, Functional Group, Transaction Set, and Claim Rejection. A file level reject occurs when an error is detected in the interchange control header Read More →

Submitting Electronic Transactions

Submitting Electronic Transactions to HMSA (General requirements) Submitting Electronic Transactions to HMSA partners should remember that  each transmission to HMSA should have a unique Interchange Control Number (ISA13). HMSA will use this number to determine if it is a duplicate file. HMSA will only accept one interchange (ISA/IEA) per input file from a submitter. There Read More →

HMSA EDI Center

HMSA EDI Center File Name Standard Descriptions HMSA EDI Center File Name Standard Descriptions are given in the blog for providers that submit claims electriically via EDI to HMSA EDI Center. It is strongly recommended that any provider submitting claims electronically, make the appropriate arrangements to ensure the security of the claims data being submitted to Read More →