Transport Instruction EDI

Transport Instruction EDI Message – GS1 Standard Guidelines The main objective of the Transport Instruction is to communicate the arrangements (through the agreed conditions) of the movement of the goods (including collection and delivery) between all parties involved and providing the information necessary to perform the handling of the goods. The Transport Instruction will be Read More →

Interoperability Testing

Interoperability Testing In Electronic Data Interchange Interoperability Testing is a kind of software checking that confirms whether the definite software can interoperate with partner software or its components. The successful results of interoperability testing proves the required functionality between communicating systems as required by specifications. There are different levels of EDI interoperability testing: Physical Interoperability Read More →

HIPAA EDI Acronyms

HIPAA EDI Acronyms and Definitions Learn basic HIPAA EDI acronyms and definitions to understand the terminology used in health care CMS guidelines. EDI – Electronic Data Interchange – the process of using nationally established standards to exchange electronic information between business entities. HIPAA – Health Insurance Portability and Accountability Act of 1996 – legislation that mandated that Read More →

B2B

B2B (Business-to-Business) Relationships B2B model means a type of business relationships where two companies sell products or services to each other. This model does not refer to companies and end consumers’ relationships (business-to-consumer or consumer-to-business models). B2B may be treated as supportive enterprise relationships between two business to reach the benefits goal, e.g. between manufacturer Read More →

EDI Claims

Health Partners General Requirements for the Electronic Claims Submission Process (837 Professional Claims) Find below Health Partners Plans general guidelines for 837 Professional Claims Submission. Only loops, segments, and data elements valid for the HIPAA 837 Professional (005010X222A1) Technical Report Type 3 will be translated. Deviating from the Technical Report Type 3 and submitting invalid data will Read More →

837 Institutional

General Business Requirements for the 837 Institutional 5010A2 Claims Submission Process (Health Partners Claims) These mapping guidelines will address a variety of issues that will facilitate the Electronic Media Claims Processing for the 837 Institutional (005010X223A2). Coding Guidelines Use most recent ICD-9, CPT, HCPC, and Revenue codes. Always check for 4th and 5th digit code Read More →

837 Institutional Claims

General Requirements for the Electronic Claims Submission Process (837 Institutional Claims) EDI Claims guidelines facilitate the Institutional Claims Submission Process. Only loops, segments, and data elements valid for the HIPAA 837 Institutional (005010X223A2) Technical Report Type 3 will be translated. Deviating from the Technical Report Type 3 Guidelines and submitting invalid data will cause files to Read More →

276/277 Health Care

276/277 Health Care Claim Status Request and Response The purpose of generating a 276 Claim Status Request is to obtain the current status of the claim(s) within the adjudication process. A claim is located by supplying Health Partners Plans the following information: Member ID Provider ID Member Name and Date of Birth Member Gender. A service start Read More →

Eligibility Inquiry & Response

270/271 Eligibility Inquiry & Response Companion Guidelines (Health Partners) The companion guidelines explain the procedures and requirements necessary for Trading Partners of Health Partners Plans, Inc. to transmit the following HIPAA standard transaction: 270/271 Eligibility Inquiry & Response. The information is conveyed within the framework of the ASC X12N Implementation Guides adopted for use under HIPAA. Read More →

HIPAA Transactions

HIPAA Transactions and Code Sets Frequently Asked Questions (Health Partners Plans) HIPAA FAQs is one of the resources for information regarding Health Partners Plans Health Insurance Portability and Accountability Act of 1996 (HIPAA) Administrative Simplification implementation. Q: Does Health Partners Plans require certification/testing with providers? A: Health Partners Plans does not require providers to certify with Read More →