Oklahoma Medicaid Management Information System Guides For The 837 Dental Transaction The ASC X12 837 Dental transaction is the electronic equivalent of the ADA 2012 paper claim form. Key Notes: No more than 50 service lines are allowed per claim. Providers must use the 10-digit NPI as the billing/pay- to, referral, and rendering provider ID. The … Read More →
HIPAA 837 Institutional Transaction Guides (OCHCA) The ASC X12N 837 Institutional transaction is the electronic equivalent of the UB-92 paper claim form. All hospitals and institutional facilities must use the 837 Institutional transaction to bill electronically for services covered under the SoonerCare program. The 837 Institutional transaction must be used for inpatient claims. Providers must … Read More →
HIPAA 837 Professional Claim Requirements (Oklahoma Health Care Authority) The ASC X12N 837 Professional transaction is the electronic equivalent for the 1500 paper claim form. Key Notes: No more than 50 service lines are allowed per claim. Typical Providers must use the 10-digit NPI as the billing/pay-to, referring and rendering provider ID. For atypical providers … Read More →
Oklahoma Medicaid Management Information System EDI Guidelines Electronic Data Interchange (EDI) is the most efficient method of submitting and receiving large amounts of information within the Oklahoma Medicaid Management Information System (OKMMIS). Some benefits of EDI include: Improved accuracy. Low operating costs. Increased cash flow. Shorter payment turnaround time. Ability to check claims status electronically. … Read More →
X12 has submitted the first in a series of recommendations related to advancing the version of already adopted and mandated transactions and proposing additional transactions for adoption Based on industry feedback, X12 is using a phased approach for the recommendations rather than presenting the entire catalog of adopted and mandated transactions at once. Each recommendation … Read More →
HCA-28B: Medicare-Medicaid Crossover Invoice Form Outpatient and HCFA 1500 Claims (Special Batch Processing ONLY) The Medicare-Medicaid Crossover Invoice form (HCA-28B) should be used when submitting Outpatient claims and HCFA 1500 claims for Special Processing only. Use this form as a supplement to the Medicare Explanation of Benefit (EOB) statement attachment previously required on paper crossover … Read More →
No Surprises Act Good Faith Estimate / Advanced EOB Standards-based Approach * Cooperative Exchange, The National Clearinghouse Association Explained On December 27, 2020, the No Surprises Act was signed into law as part of the Consolidated Appropriations Act of 20211, Public Law 116-260. The No Surprises Act (NSA) seeks to protect consumers from surprise medical … Read More →
HCA-28: Medicare-Medicaid Crossover Invoice Form – Inpatient Claims Special Batch Processing (OHCA) The Medicare-Medicaid Crossover Invoice form (HCA-28) should be used when submitting Inpatient crossover claims for Special Processing ONLY. Use this form as a supplement to the Medicare Explanation of Benefit (EOB) statement attachment previously required on paper crossover claims. The form was created … Read More →
Claim Submission Via Electronic Data Interchange (OHCA) EDI is a way for providers to check eligibility on a larger scale than the previously listed options. Providers purchase third-party, HIPAA compliant software used to send a 270 transaction with their search criteria and receive a 271 response, which provides eligibility information. A 271 will provide information … Read More →
HCA-28: Medicare-Medicaid Crossover Invoice Form – Inpatient Claims Special Batch Processing ONLY The Medicare-Medicaid Crossover Invoice form (HCA-28) should be used when submitting Inpatient crossover claims for Special Processing ONLY. Use this form as a supplement to the Medicare Explanation of Benefit (EOB) statement attachment previously required on paper crossover claims. The form was created … Read More →