Healthcare EDI Transactions Real World Difference HIPAA The Health Insurance Portability and Accountability Act (HIPAA) was enacted by the U.S. Congress in 1996 as President Clinton responded to the need for more efficient healthcare services at lower costs. The solution was signing into law the Kennedy-Kassebaum Act. This act is also known as Health Insurance Read More →

HIPAA 837 Transaction related documents and indutry guides HIPAA 837 Transaction has some more directly and indirectly related transactions like the Healthcare Claim Status Request (276) and Response (277) & the Healthcare Claim Remittance Advice (835). The 837 transaction is the submission of the claim. The 276 Claim Status transaction allows the Provider of Service to check Read More →

HIPAA Implementation General Guides and Notes HIPAA (Health Insurance Portability and Accountability Act) was enacted in 1996. The “Administrative Simplification” provisions of HIPAA require that certain types of transactions among health care entities be conducted in a standard format when they are conducted electronically. These transactions include: Submitting claims Receiving remittance advice statements Querying patient Read More →

Empire EDI Program Guidelines For Partners Empire EDI Program offers a range of electronic connectivity services to suit the various technology needs of its providers. While Empire tries to keep the information of Empire EDI Program as accurate as possible, the company disclaims any implied warranty or representation about the accuracy, completeness, or appropriateness of the information for Read More →

HIPAA 837 Institutional Claim Mapping Guides For HAP Midwest Health Plan Partners HIPAA 837 Institutional Claim EDI transaction set is used to exchange institutional health care claim information from providers of health care services. HIPAA 837 Institutional Claim transaction can be submitted either directly or via intermediary billing services and/or claims clearinghouses. HIPAA 837 Institutional Claim Read More →

HIPAA 837 Professional Claim Mapping Guides For HAP Midwest Health Plan Partners HIPAA 837 Professional Claim transaction set is used to exchange institutional health care claim information from providers of health care services. HIPAA 837 Professional Claim can be submitted either directly or via intermediary billing services and/or claims clearinghouses. Please note that Professional and Institutional Read More →

HAP Midwest Health Plan Billing And Reimbursment Requirements HAP Midwest Health Plan Billing and Reimbursment process will be discribed below in this blog. Coordination of benefits MDCH contracts with HAP Midwest Health Plan to administer the Medicaid HMO benefits to its enrolled members. Medicaid is considered as payment source of last resort. Some Medicaid members have Read More →

EDI Claims Post Payment Review (HAP Midwest Health Plan) EDI Claims post payment: HAP Midwest Health Plan conducts ongoing internal review of EDI Claims to determine completeness of claim, eligibility of member, benefit level for service, prior authorization as indicated, duplication of service and appropriate billing codes.  In cases where the services rendered appear to Read More →