EDI Order-to-Cash Transactions

EDI Order-to-Cash Transactions in U.S. Healthcare Using GTINs and GLNs in EDI business messaging instead of proprietary identifiers can help improve transaction accuracy and efficiency, and more fully support traceability from the manufacturer to the patient / end user. GS1 guidelines describe key aspects of Order-to-Cash transactions in U.S. healthcare. 850 Purchase Order Used by the Read More →

Implementing GLNs

Implementing GLNs and GTINs in Order-to-Cash Transactions (GS1 Healthcare US) When identification standards are not widely used across an industry, trading partners often use nonstandard and proprietary identifiers. This practice can result in multiple identifiers for the same product (e.g., buyer’s part number; supplier’s catalog number; vendor’s item number; etc.) or party/location (e.g., DUNS Number; Read More →

EDI Transmission Security

  EDI Transmission Security Protocols Prevea360 Health Plan requires 834 files to be PGP encrypted with its public key. Prevea360 requires PGP encryption, in addition to transmission via the SSH security protocol, to achieve a defense-in-depth/layered security posture for the protection of member/customer confidentiality. SFTP (SSH file transfer protocol) provides protection of the data in transit from the Read More →

834 Test File Validation

834 Test File Validation Prevea360 will review and test all trading partner files with Optum Transaction Testing Service to perform SNIP level validations to ensure that transactions are valid using the following testing categories. Integrity Testing Requirement Testing Balancing Testing Situation Testing Code Set Testing Product Types/Types of Service Testing. The EDI team will work Read More →

834 Transaction Scenarios

834 HIPAA Transaction Scenarios (Prevea360 Health Plan) In today’s post we offer four 834 Transaction Scenarios. Find below the description and mapping. Adding a Subscriber Scenario John Doe is enrolling into the plan as a new-hire. His coverage is effective 4/1/17. His employment begin date is 4/1/17. Changes include transactions such as address, name, phone Read More →

835 5010 Mapping

EDI 835 5010 Mapping Excersise Try your HIPAA EDI skills in EDI 835 5010 Mapping Excersise. Find the scenario below. The Outbound 837P, completed in Exercise 1, was sent on to Blue Cross the payer. The Claim was adjudicated and Blue Cross has transmitted the 835 5010A1 transaction directly to the receiving billing provider, Abuncha Physicians. Within Read More →

EDI HIPAA education

EDI Testing and Approval Requirements (Prevea360 Health Plan) EDI testing and approval require a minimum of two test cycles and test files. The first test file must be a full population file. This means it must contain all subscribers and dependents currently enrolled in the group for which the test file is being submitted. It Read More →

834 Full File Submission

834 Full File Submission Information (Prevea360 Health Plan) 834 Full File Submission is not allowed if the number of enrolled members is greater than 500. Change Only file submission will need to be utilized. This excludes the initial full eligibility file for production go-live and quarterly audit files. A full file is defined as BGN08 = Read More →

834 HIPAA File

Change Only File Submission Information (Prevea360) Change Only File Submission Information method is required to be used when the enrolled number of members is greater than 500. A Change Only file is defined as BGN08 = 2 and Member Level Detail Loop 2000 INS01 <> 030. Loop 2300, Health Coverage Dates, DTP01 = 348 should Read More →

834 File

834 File Requirements (Prevea360 Health Plan) 834 File will be used as an audit file to make sure the records for both parties are in sync prior to moving to production. While Prevea360 can accept both full enrollment files and change only files, it prefers to receive change only/event only files on an ongoing basis for groups Read More →