EDI Claims Electronic Submission

EDI Claims Electronic Submission (Palmetto GBA Guidelines) EDI Claims Electronic Submission is released via telephone lines, via a modem, to Palmetto GBA. EDI Claims Electronic Submission gives the provider control over the timeliness and accuracy of the claims entry by eliminating the need for mailroom processing and manual data entry by Palmetto GBA. Payment for ‘clean Read More →

HIPAA Claims Filing

HIPAA Claims Filing Requirements For Palmetto GBA Providers HIPAA Claims Filing requirements by Palmetto GBA require providers to submit claims for all Medicare patients for services rendered. HIPAA Claims Filing requirements apply to all physicians and suppliers who provide covered services to Medicare beneficiaries. You may not charge your patients for preparing or filing a Medicare claim. The requirement Read More →

Passport Health Plan EDI Guidelines And Recommendations Passport Health Plan EDI Program stimulates providers to submit claims electronically using Electronic Data Interchange instruments. Passport Health Plan EDI claims submitting allows faster, more efficient, and cost-effective claim submission for providers. EDI, performed in accordance with nationally recognized standards, supports the health care industry’s efforts to reduce administrative costs. Read More →

Clean Claims

Clean Claims EDI Processing and Other Health Coverage Cases Clean Claims will be processed by San Francisco Health Plan as submitted in a timely manner for medically necessary and covered services by a participating provider group in accordance with the agreement between SFHP and the provider group for the applicable benefit program. Clean Claims are Read More →

San Francisco Health Plan EDI Claims: Common Requirements San Francisco Health Plan EDI Claims are processed for the following medical groups: San Francisco Community Clinic Consortium, San Francisco Health Network (previously known as the Community Health Network) and UCSF Medical Group. Any delegated medical group must submit encounter EDI data to San Francisco Health Plan Read More →

medical codes

Medical Codes Overview San Francisco Health Plan uses medical codes according to Medi-Cal billing guidelines in addition to Optum coding books application for claim activities. The following procedure medical codes must be used for a claim to be processed: Professional charges – HIPAA compliant HCPCS Level 1 (CPT) & level 2 Inpatient hospital/facility/institutional charges – Read More →

edi clearinghouse

HealthSmart EDI provider and vendor solutions HealthSmart EDI program offers a Full Service Healthcare EDI Clearinghouse. It is open to all providers in the healthcare community. The goal at HealthSmart is to give network providers the highest level of customer service possible. HealthSmart is engineered with the latest technology and is committed to meeting all HIPAA requirements Read More →