Medicare EDI Enrollement

Medicare EDI Enrollment Basic Guidelines Medicare EDI Enrollment process for the Medicare beneficiary inquiry system (HETS 270/271) is currently a separate process. A/B MACs and CEDI are required to furnish new providers that request Medicare claim privileges information on EDI. A/B MACs and CEDI are required to assess the capability of entities to submit data Read More →

Health Care Information

The America Reinvestment and Recovery Act Purposes The America Reinvestment and Recovery Act purpose is to provide guidance with the development of nationwide health information technology infrastructure that allows for the electronic use and exchange of information that: (1) ensures that each patient’s health information is secure and protected, in accordance with applicable law; (2) Read More →

EDI Enrollment and Registration

EDI Enrollment and Registration (Trading Partner Agreements Basics) EDI Enrollment and Registration basics state that Medicare FFS’ Trading Partner Agreement is comprised of two forms: 1) EDI Registration and 2) EDI Enrollment. A/B MACs and CEDI must use these two forms, or their own organization specific forms given they are comparable in terms of content, Read More →

Health Care Information Security, Privacy And Compliance Health Care Information acts described are HIPAA, The America Reinvestment and Recovery Act and Administrative Simplification and Compliance Act (ASCA). Two aspects of the Health Care Information legislation are pertinent to this post: Ensuring the security of electronic data transmitted between covered entities, and Ensuring the privacy of individuals Read More →

HIPAA EDI

HIPAA EDI Legislative Basics And Requirements HIPAA EDI is the process of using nationally established standards to exchange electronic information between business entities in health care. EDI national standards are developed and maintained by a group of standards development organizations (SDOs), such as the Accredited Standards Committee (ASC) X12 and the National Council of Prescription Drug Read More →

Medicare EDI Acronyms and Definitions Medicare EDI terms given below are represented by acronyms and definitions as assistance to understand the Medicare EDI terminology used in health care and insurance. EDI – Electronic Data Interchange – the process of using nationally established standards to exchange electronic information between business entities. HIPAA – Health Insurance Portability and Read More →

EDI For Medicare

EDI For Medicare Fee For Services (FFS) Introduction And Requirements EDI For Medicare FFS is not limited to the submission and processing of claim related transactions, but includes processes such as provider EDI enrollment, beneficiary eligibility, coordination of benefits, as well as security and privacy concerns. So as not to be duplicative, where EDI is a relevant part Read More →

Coordination of Benefits

Coordination of Benefits HIPAA Basics Coordination of Benefits requirements and basic procedure descriptions subject to the rules of the X12 837 HIPAA Technical Reports Type 3 (TR3s) as the national standard for provider electronic submission of health care claims to payers such as Medicare. It also contains the requirements for electronic transfer of claims from Medicare to Read More →

Health Care Payment

Health Care Payment: Electronic Remit Advice and Standard Paper Remit Health Care Payment with Electronic Remit Advice (ERA) has a number of advantages over Standard Paper Remit (SPR). The amount payable for each line and/or claim as well as each adjustment applied to a line or claim can be automatically posted to accounting or billing applications from an Read More →

Health Care Payment

Health Care Payment and Remittance Advice Health Care Payment information is reported within ERA (Electronic Remit Advice) or SPR (Standard Paper Remit). After Medicare processes a claim, either an Electronic Remit Advice or a Standard Paper Remit is sent with final claim adjudication and payment information. One Electronic Remit Advice or Standard Paper Remit usually Read More →