HIPAA 837 Institutional Claim

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

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

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 →

Clean Claims

Clean Claims, Unclean Claims, Rejected Claims And Claims Resubmission (Midwest Health Plan) Clean Claims are claims that have all information in them and nothing is missing. If any mandatory or conditional information is missing, the claim will be considered unclean. Examples of unclean claims include invalid member ID, provider data discrepancy NPI and atax ID does not Read More →

Midwest Health Plan EDI

Midwest Health Plan EDI Claims General Guidelines Midwest Health Plan EDI Claims Department endeavors to assure prompt and accurate claim and encounter review, processing, adjudication and payment. This is accomplished through the development of Midwest Health Plan EDI claims processing systems, pre-payment and post-payment audits, policies, and procedures that are consistently and appropriately applied. Midwest Read More →

Phoenix Health Plan EDI

Phoenix Health Plan EDI Claims Submission Guidelines Phoenix Health Plan EDI department encourages providers to consider electronic claims submission (EDI – 837) for your practice. There are many advantages to submitting Phoenix Health Plan EDI claims electronically (decreased submission costs, faster processing and reimbursement, allows for documentation of timely filing, etc). However, any claims requiring attachments, Read More →

EDI data integration

EDI Data Integration Methods And Guides EDI data integration is an essential part of any successful Electronic Data Interchange business implementation. EDI data integration is needed because most business applications will accept an EDI transaction in its raw format for processing. This means there has to be integration software in the middle that will map the EDI transaction into the Read More →

edi_education

EDI Business Solutions For Modern Industrial Effectiveness EDI Business Solutions are used in many industries and branches where parties need to exchange data – retail, insurance, healthcare, transport and logistics etc. Big retailers such as Wal-Mart, Barnes and Noble, Target, Walgreen’s, Harrods and others apply EDI Business Solutions for electronic documents exchange with their trading Read More →

University Of Utah Health Plan Claims

University Of Utah Health Plan Claims Submitting Guidelines University Of Utah Health Plan Claims Submitting supposes several different options through UHIN. These include the following: Direct link – Provider is creating a HIPPA compliant file from their billing system and is sending the file to the UHIN HIPPA server (UHINet). ProClaim – A Regence dial-up product, Read More →