837P Claim

837P Claim Form CMS-1500: Implementation Guides 837P Claim (Professional) is the standard format used by health care professionals and suppliers to transmit health care claims electronically. The Form CMS-1500 is the standard paper claim form health care professionals and suppliers use to bill Medicare Administrative Contractors (MACs) when a paper claim is allowed. Centers for Read More →

837 Institutional Healthcare Claim

837 Institutional Healthcare Claim Testing: Set-up, Directory and File Naming 837 Institutional Healthcare Claim Testing should be followed by requesting information on establishing connections through the SFTP server. Upon completion of 837 Institutional Healthcare Claim set-up, providers will receive additional instructions on SFTP usage. SFTP Directory Naming Convention There would be two categories of folders under Trading Read More →

837 Institutional Healthcare Claim Testing

837 Institutional Healthcare Claim Testing (Washington State Health Care Authority (HCA)) Procedure 837 Institutional Healthcare Claim Testing completion  must occur prior to submitting electronic transactions in production to Washington State Health Care Authority ProviderOne. 837 Institutional Healthcare Claim Testing is conducted to ensure the following levels of HIPAA compliance: Level 1 – Syntactical integrity: Testing of Read More →

HIPAA Dental COB Claim

 HIPAA Dental COB Claim Mapping Exercise Example HIPAA Dental COB Claim example and exercise represent how to generate HIPAA Dental COB Claim file for processing by the destination payer. HIPAA Dental COB Claim Scenario Patient PUFFY DOG is seen a dentist DONALD D, DUCK in the office INFINITE ENDODONTICS. The payer of the HIPAA Dental COB Claim is Read More →

837 Dental Transaction Mapping

837 Dental Transaction Mapping Exercise Example 837 Dental Transaction Mapping exercise gives a scenario of working with a 837 Dental Transaction file to complete the claim and send it to processing. 837 Dental Transaction Mapping exercise will be useful for insurance companies, providers and HIPAA specialists. Scenario: Patient MINI DUCK dependent son of DONALD DUCK goes to the Read More →

Compliance Checking

EDI Compliance Checking For X12, EDIFACT And HIPAA Standard Requirements EDI Compliance Checking is the process of incoming and outgoing X12/EDIFACT/HIPAA documents validation. The documents are being checked for compliance with the established and agreed formats. There exist EDI Compliance Checking packs – frameworks that check incoming documents for compliance before they are transformed. After Read More →

MIME

MIME Definition MIME (Multipart Internet Message Extensions) defines a message format (a set of documents) represents a mechanism of sending different file types as one part or together with common mail messages. Multipart Internet Message Extensions has headers that are defined by RFC 822 and extensions to those header definitions. Multipart Internet Message Extensions follows Read More →

Passport Health Plan EDI

Passport Health Plan Electronic Submission Advanatages (for Medical and Hospital Claims) Passport Health Plan Electronic Submission is the initiative for all providers. Passport Health Plan Electronic Submission 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. The benefits Read More →

HIPAA EDI training

HIPAA EDI Support Service Operation Process Common Description HIPAA EDI Support Service serves for parties involved in EDI documents exchange process to make the operation easy and effective. Before any operation providers should obtain an account at the chosen service and make the enrollment. Usually creating a profile in EDI support service the party is Read More →

EDI Solution

EDI Solution For OOCL Partners (Marine Shipments) EDI Solution for system-to-system integration is implemented by many companies in a variety of industries to transmit business information electronically. Organizations that handle large volumes of data often use EDI Solution to minimize data entry and share information with other systems within their organization. In the shipping industry, customers Read More →