Pay-to Provider IDs

Defining Pay-to Provider IDs  On Billing Forms The Pay-to Provider NPI is not entered or maintained by Billing personnel. The Pay-to Provider NPI is retrieved from the Institution file (#4). Beginning with Patch IB*2*432, the Pay-to Provider Primary ID is the NPI number of the site defined as the Pay-to Provider. The Federal Tax Number is Read More →

Provider ID Set-up

Provider ID Set-up (VA Guidelines) During Provider ID Set-up payers require the use of a variety of provider identifiers on claims submitted for adjudication. Printed claim forms have boxes where these IDs can be printed. The general term, Provider ID, can refer to an ID that belongs to a human being such as an Attending Read More →

Pay-to Provider Set-up

Pay-to Provider Set-up At Veterans Health Administration Pay-to Provider in the VA database is the entity which is seeking payment for a claim (who will receive the payment). Each VA database can have one or more Pay-to Providers. Each VA database must have at least one Payto Provider. The Pay-to Provider does not need to have a physical location. Read More →

Insurance Company EDI Set-up

Insurance Company EDI Set-up At Veterans Health Administration Improper insurance company EDI Set-up and/or provider IDs within VistA can cause claims rejection. With EDI Billing, there are fields in an 837 claim transmission that are autopopulated with the data defined in VistA. This information must be accurate to generate a clean electronic claim. Activate New Payer to Read More →

EDI Process Flow

EDI Process Flow At Veterans Health Administration (VHA) EDI Process Flow above flowchart represents the path that electronic claims follow at Veterans Health Administration (VHA). The objective of electronic billing is to submit completely correct claims. Claims sent electronically reach the payer faster, are processed faster, and are paid faster than claims submitted to the Read More →

Medical Billing Reporting

  Medical Billing Reporting Via Electronic Data Interchange The North Carolina Industrial Commission has contracted with Insurance Services Office, Inc. (ISO) to manage Medical Billing Reporting Via Electronic Data Interchange. ISO will be administering registration of carriers, self-insurers, medical bill review companies and third party administrators as trading partners, EDI testing, and data collection and Read More →

Acceptance Of Claims

Acceptance Of Claims For SROI (Subsequent Report of Injury) Reports Acceptance Of Claims EDI transactions for SROI (Subsequent Report of Injury) reports are suspended by the North Carolina Industrial Commission. The Commission will continue to accept and process Claims EDI transactions for FROI (First Report of Injury) reports with the exception of the FROI 04 Denial.  In order to maintain Read More →

Critical EDI Process

Critical EDI Process Terms For EDI Operations With Veterans Health Administration (VHA) Critical EDI process terms will be useful for medical providers that are on the stage of establishing EDI partnership with VHA. 835 Health Care Claim Payment/Advice – The HIPAA adopted standard for electronic remittance advice to report the processing of all claim types (including retail Read More →

Veterans Health Administration EDI

Veterans Health Administration EDI (HIPAA) Requirements Veterans Health Administration EDI Billing provides the VHA with the capability to submit Institutional and Professional claims electronically as 837 Health Care Claim transmissions, rather than printing and mailing claims from each facility. In 1996, Congress passed into law the Health Insurance Portability and Accountability Act (HIPAA). This Act directs the Read More →

Medical billing

Medical EDI Vendors Guidelines Medical EDI Vendors are subjected to successful completion of required testing before live data transmissions begin. Any vendor that does not successfully complete the required testing will not be permitted to submit EDI transactions on behalf of clients. Vendors that successfully complete the required testing will not be required to complete Read More →