EDI Submission Verification

EDI Submission Verification (NJ Medicaid EDI Guides) EDI Submission Verification (TA1 Interchange Acknowledgements) will be available to the EDI Submitter upon completion of uploading (dropping-off) their interchanges on the Website as long as the submitter stays connected. If the submitter disconnects immediately after dropping-off their interchange and does not receive their TA1, then the EDI Read More →

Interchange Naming Convention

Interchange Naming Convention (New Jersey Medicaid EDI Specifications) Interchange Naming Convention for submission of HIPAA transactions supports the DOS file-naming convention of 8- characters followed by a 3-character extension. The file name format MUST be one alphabetic character (A – Z) or one numeric character (0 – 9) or one of eight special characters (~, Read More →

EDI Telecommunications Specifications

EDI Telecommunications Specifications (New Jersey Medicaid HIPAA Transactions) EDI Submitters using the website will drop-off 837 transactions and pick-up TA1 and 999 transactions through a secure area of the New Jersey Medicaid Website. HIPAA interchanges can be sent seven days a week, Sunday thru Saturday, with the following exceptions, which have been scheduled as maintenance Read More →

EDI Translator Reports

EDI Translator Reports and Edits (New Jersey Medicaid Transaction Submission) New Jersey Medicaid validation of HIPAA interchanges will be done at four different levels of processing. The type of notification to the submitter will depend on where in the process the editing is completed. The first level of editing will be at the point of Read More →

HIPAA Testing and Certification

HIPAA Testing and Certification (New Jersey Medicaid 5010 Guides) HIPAA Testing and Certification requires each prospective electronic data interchange (EDI) submitter to be certified and approved before HIPAA transactions will be processed in production. The Workgroup for Electronic Data Interchange (WEDI), through a collaborative healthcare industry effort called the Strategic National Implementation Process (SNIP), has Read More →

HIPAA companion guide

New Jersey Medicaid HIPAA 5010 Version Updates New Jersey Medicaid signifies its ongoing effort to adhere to the HIPAA transaction set requirements. HIPAA provides all healthcare entities a tremendous opportunity to realize many administrative and systemic benefits because it provides a national standard of transaction and code sets for the electronic exchange of healthcare information. New Read More →

HIPAA seminar

HIPAA Claims Submission: Intermediary Service Providers can submit claims directly to third party insurers if their software systems have been upgraded to comply with the EDI standards. This approach helps the provider to maintain the maximum amount of control over the claims submission and payment review process, but also necessitates the maintenance of a more Read More →


HIPAA Electronic Data Interchange (EDI) Rule (The American Speech-Language-Hearing Association) HIPAA Electronic Data Interchange Rule is very technical and based on the X12N EDI data transmission protocol standard. Although rare allowances are made, the rule requires that any covered entity who electronically transmits data must use this, and only this format in doing so. The Read More →

EDI X12 envelope

EDI X12 Structure: Interchange Control Header (ISA) EDI X12 Structure will be analyzed on the the EDI 850 example document (Purchase Order). This particular EDI file contains two purchase orders from a retailer to a supplier, sent on 11/01/2005. Now you see why EDI transactions are primarily handled by computers. But with a little practice after our webinars you’ll Read More →

HAP Midwest Health Plan Billing

HAP Midwest Health Plan Billing And Reimbursment Requirements HAP Midwest Health Plan Billing and Reimbursment process will be discribed below in this blog. MDCH contracts with HAP Midwest Health Plan to administer the Medicaid HMO benefits to its enrolled members. Medicaid is considered as payment source of last resort. Some Medicaid members have dual insurance coverage. Read More →