CERT Program Processing CERT program ensures a statistically valid random sample; therefore, the improper payment rate calculated from this sample is considered to reflect all claims processed by the Medicare FFS program during the report period. The sample of Medicare FFS claims is reviewed by an independent medical review contractor to determine if they were Read More →

Comprehensive Error Rate Testing Program (Celerian Group Company): Acceptable electronic signature notations Comprehensive Error Rate Testing Program was implemented by the Centers for Medicare & Medicaid Services (CMS) to measure improper payments in the Medicare Fee-for-Service (FFS) program. CERT is designed to comply with the Improper Payments Information Act (IPIA) of 2002, as amended by the Read More →

Electronic Claim Submission To Celerian Group Company (CGS) Electronic Claim Submission is a part of EDI program for providers who conduct business with Celerian Group Company and Medicare electronically. Find some FAQS and answers regarding Electronic Claim Submission below. How can I tell if my claims have been received by CGS? – If claims are electronically submitted from Read More →

EDI Enrollment (Celerian Group Company) A/B MACs and DME MACs EDI Enrollment means that Celerian Group Company (CGS) will obtain an EDI Enrollment form for each provider prior to electronic transfer of data and issuance of system passwords/billing numbers to protect the security of transferred data. CGS will obtain a new EDI Enrollment package or a Read More →

CAQH CORE 259: AAA Error Code Reporting Rule CAQH CORE 259: Operating Rule states that the receiver of the X12 271 response, i.e., the system that originated the X12 270 inquiry, is required to detect all combinations of error conditions from the AAA segments in the X12 271 responses, and to display to the receiving Read More →

CAQH CORE 258: Normalizing Patient Last Name Rule CAQH CORE 258 Operating Rule requires the removal of both the apostrophe and the hyphen in the O’Donnell-Griswold example cited. The normalized name would be ODONNELLGRISWOLD. CAQH CORE 258: Last Name Normalization Rule Version 2.1.0 does not address this specific scenario. Since the characters “De” are not included in Read More →

CGS EDI Application Errors During Trading Partner Registration CGS EDI Application Errors may occure due to mistakes made during trading partner registration in CSG EDI program. CGS EDI Enrollment form (commonly referred to as the EDI Agreement) should be submitted when enrolling for electronic billing. It should be reviewed and signed only by the providers to Read More →

CGS EDI Enrollment Packet Instructions CGS EDI Enrollment Packet should be completed to request an Internet EDI ID necessary to transmit Claim Status Request transactions (ANSI 276) and receive Claim Status Response transactions (ANSI 277), and/or retrieve Electronic Remittances (ANSI 835), via CGS’s public Internet. If retrieving Electronic Remittances (ANSI 835) via an Internet EDI ID Read More →

Web-based EDI Application: Solution That Moves Your Business Web-based EDI Application enables business partners to exchange EDI transactions (files) using simple web-forms. Today EDI technology stimulates companies to switch from obsolete EDI application to web-based EDI application. In general, many businesses have alternated to web-based format of files exchange because it offers several vivid advantages Read More →

HIPAA X12 EDI Training Online Schedule December 2018 HIPAA X12 EDI training is conducted through a session of webinars for staff involved in electronic business processes in health care (clearing houses, providers, Medicare institutions etc.). The cost is $250 per session per person. A 20% discount is available if you select all sessions (email us info@ediacademy.com for Read More →