CAQH CORE Connectivity Safe Harbor Guidelines CAQH CORE Connectivity Safe Harbor requirements that a health plan must use if requested by a provider are described in CAQH CORE 270 Rule, Section 5, CORE Safe Harbor. The CAQH CORE Connectivity Safe Harbor specifies connectivity methods that application vendors, providers, and health plans can be assured will be supported Read More →

CAQH CORE 270: Connectivity Rule: Relationship Between Phase I and Phase II CAQH CORE 270: Connectivity Rule is not a reference to X12 270 eligibility transaction. The CAQH CORE 270: Connectivity Rule Version 2.2.0, is payload agnostic, and is designed to carry any X12 v4010 and v5010 administrative transaction payload as well as any other non-X12 payload. The CAQH CORE Read More →

Eligibility & Claim Status Operating Rules: Service Type Codes (STCs) Eligibility & Claim Status Operating Rules define some Service Type Codes (STCs) as “discretionary” in the CAQH CORE Eligibility & Benefits (270/271) Data Content Rules (CAQH CORE 154 & 260 Rules). For certain STCs, the patient financial data is not required to be returned for some benefits Read More →

Coordination of Benefits (COB) Assistance By BCRC (Benefits Coordination & Recovery Center) Coordination of Benefits (COB) issues can be consolidated by BCRC (Benefits Coordination & Recovery Center) that will correct any possible issues on their end, or report to the contractor any issues that require action on the part of the contractor. The Contractor can verify whether Medicare claims Read More →

Benefits Coordination & Recovery Center: Coordination of Benefits (COB) A Celerian Group Company Benefits Coordination & Recovery Center consolidates the activities that support the collection, management, and reporting of other insurance coverage for Medicare beneficiaries. The purposes of the Benefits Coordination & Recovery Center program are to identify the health benefits available to a Medicare beneficiary and Read More →

Health Care EDI Real World Practice: HIPAA Compliance And Deviations Health Care EDI is one of the branches where Electronic Data Interchange accelerates information exchange, reduces manual interruption and provides processing reliability and security. Health Care EDI operates under the rules of HIPAA – standard that states requirements to health care electronic transactions. HIPAA concerns health care Read More →