Health Insurance Portability and Accountability Act (HIPAA) Basics The Health Insurance Portability and Accountability Act was released in 1996 by the U.S. Congress. It was a kind of response for raising efficiency of the health care service and reducing their cost. HIPAA solution unifies standards for healthcare EDI under the rules of the Department of Health. … 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 →
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 →