HIPAA 837 Professional Claim

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 →

EDI Claims

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 →

Clean Claims

Clean Claims, Unclean Claims, Rejected Claims And Claims Resubmission (Midwest Health Plan) Clean Claims are claims that have all information in them and nothing is missing. If any mandatory or conditional information is missing, the claim will be considered unclean. Examples of unclean claims include invalid member ID, provider data discrepancy NPI and atax ID does not Read More →

Midwest Health Plan EDI

Midwest Health Plan EDI Claims General Guidelines Midwest Health Plan EDI Claims Department endeavors to assure prompt and accurate claim and encounter review, processing, adjudication and payment. This is accomplished through the development of Midwest Health Plan EDI claims processing systems, pre-payment and post-payment audits, policies, and procedures that are consistently and appropriately applied. Midwest Read More →

Phoenix Health Plan EDI

Phoenix Health Plan EDI Claims Submission Guidelines Phoenix Health Plan EDI department encourages providers to consider electronic claims submission (EDI – 837) for your practice. There are many advantages to submitting Phoenix Health Plan EDI claims electronically (decreased submission costs, faster processing and reimbursement, allows for documentation of timely filing, etc). However, any claims requiring attachments, Read More →

University Of Utah Health Plan Claims

University Of Utah Health Plan Claims Submitting Guidelines University Of Utah Health Plan Claims Submitting supposes several different options through UHIN. These include the following: Direct link – Provider is creating a HIPPA compliant file from their billing system and is sending the file to the UHIN HIPPA server (UHINet). ProClaim – A Regence dial-up product, Read More →

EDI Enrollment

EDI Enrollment For University Of Utah Health Plan Partners EDI Enrollment supposes that all HIPAA-compliant transactions with University of Utah Health Plans must be submitted through the Utah Health Information Network (UHIN). Before University of Utah Health Plans can process transactions, the submitting trading partner must obtain a trading partner ID and complete EDI Enrollment for Read More →

cigna 270 and 271

Cigna 270 and 271 Eligibility and Benefits HIPAA Transactions: Questions And Answers Cigna 270 and 271 Eligibility and Benefits Transactions provide access to Medicare Beneficiary eligibility data in a real-time environment. Providers, clearinghouses, and/or third party vendors may initiate a real-time 270 eligibility request to query coverage information from medicare on patients for whom services Read More →

University Of Utah Health Plan EDI

University Of Utah Health Plan EDI General Data And Guides University Of Utah Health Plan EDI program offers significant benefits for both providers and payers. Electronic claims can help improve efficiency, productivity and cash flow for providers, while payers can see benefits in reduction of data entry errors and faster turnaround times. Of the claims Read More →

Cigna 835

Cigna 835 Electronic Remittance Advice: Questions And Answers Cigna 835 Electronic Remittance Advice is the electronic transaction which provides claim payment information in the HIPAA mandated ACSX12 005010X221A1 format. Cigna 835 Electronic Remittance Advice files are used by practices, facilities, and billing companies to autopost claim payments into their systems. Find below some typical questions Read More →