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 →

San Francisco Health Plan EDI Requirements

San Francisco Health Plan EDI Requirements: 270/271 Transactions Payer Specific Rules and Limitations San Francisco Health Plan EDI Requirements described below regard to all parties taking part in EDI process with San Francisco Health Plan. San Francisco Health Plan uses real time processing for its EDI transactions to provide immediate responses to its submitters. San Read More →

San Francisco Health Plan EDI

San Francisco Health Plan EDI Testing Process Overview San Francisco Health Plan EDI submitter setup must be completed before the submitter can send eligibility status transactions to the test San Francisco Health Plan EDI environment. San Francisco Health Plan notifies the provider after the successful completion of testing and prepares the provider for production status. During the Read More →

San Francisco Health Plan HIPAA

San Francisco Health Plan HIPAA Compliance General Overview San Francisco Health Plan HIPAA Compliance is viewed as a part of Health Insurance Portability and Accountability Act compliance program for all parties involved in electronic data interchange process in health care industry. Under the Administrative Simplification provisions of the Health Insurance Portability and Accountability Act (HIPAA) of 1996, Read More →

San Francisco Health Plan edi

San Francisco Health Plan EDI Eligibility and Benefits Request and Response (270/271) General Guides San Francisco Health Plan EDI 270/271 transactions are given in this post as a general overview on these EDI transactions. San Francisco Health Plan EDI 270/271 transactions are used in tandem: the 270 transaction is used to inquire about the eligibility benefit Read More →

X12 1

ANSI X12 Manual Overview and Usage Guidelines ANSI X12 Manual is the ultimate source for the EDI standards. It is a large thick book with over 1500 pages of EDI transaction-set, segment and data element references. ANSI X12 is also available on a CD-ROM in PDF format. ANSI X12 reference manual can be purchased on Read More →