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 →

837 Institutional Claims

General Requirements for the Electronic Claims Submission Process (837 Institutional Claims) EDI Claims guidelines facilitate the Institutional Claims Submission Process. Only loops, segments, and data elements valid for the HIPAA 837 Institutional (005010X223A2) Technical Report Type 3 will be translated. Deviating from the Technical Report Type 3 Guidelines and submitting invalid data will cause files to Read More →

276/277 Health Care

276/277 Health Care Claim Status Request and Response The purpose of generating a 276 Claim Status Request is to obtain the current status of the claim(s) within the adjudication process. A claim is located by supplying Health Partners Plans the following information: Member ID Provider ID Member Name and Date of Birth Member Gender. A service start Read More →

Eligibility Inquiry & Response

270/271 Eligibility Inquiry & Response Companion Guidelines (Health Partners) The companion guidelines explain the procedures and requirements necessary for Trading Partners of Health Partners Plans, Inc. to transmit the following HIPAA standard transaction: 270/271 Eligibility Inquiry & Response. The information is conveyed within the framework of the ASC X12N Implementation Guides adopted for use under HIPAA. Read More →

HIPAA Transactions

HIPAA Transactions and Code Sets Frequently Asked Questions (Health Partners Plans) HIPAA FAQs is one of the resources for information regarding Health Partners Plans Health Insurance Portability and Accountability Act of 1996 (HIPAA) Administrative Simplification implementation. Q: Does Health Partners Plans require certification/testing with providers? A: Health Partners Plans does not require providers to certify with Read More →

HIPAA Privacy

HIPAA’s Privacy and Security Rules Key Enforcement Provisions The Office of Civil Rights (OCR), a division of HHS, is responsible for the enforcement of HIPAA’s Privacy and Security Rules. Key enforcement provisions are as follows: Civil enforcement The OCR may assess civil penalties for HIPAA violations. These penalties may not apply if the violation is Read More →

EDI Rule

HIPAA EDI Rule: Clarke & Company Benefits, LLC Clarifications The EDI Rule is intended to streamline electronic health care transactions by requiring that covered entities keep and exchange information in a uniform format. Key aspects of the EDI Rule are as follows: Standardized transactions The EDI Rule provides that, if a covered entity (or a business Read More →

Security Rule

Security Rule Guidelines (Clarke & Company Benefits) The HIPAA Security Rule imposes requirements on covered entities with respect to the protection of electronic PHI (ePHI). Key aspects of the Security Rule are as follows: Safeguarding ePHI The main purpose of the Security Rule is to ensure the confidentiality, availability and integrity of ePHI. Covered entities Read More →

HIPAA Rule

Clarke & Company Benefits HIPAA Rules Description The HIPAA Privacy Rule governs the use and disclosure of personally identifiable health information. Clarke & Company Benefits  key provisions of the Privacy Rule are listed in the previous post and below. Permitted uses and disclosures The Privacy Rule provides that PHI may not be used or disclosed other Read More →