HCA-28: Medicare

HCA-28: Medicare-Medicaid Crossover Invoice Form – Inpatient Claims Special Batch Processing ONLY The Medicare-Medicaid Crossover Invoice form (HCA-28) should be used when submitting Inpatient crossover claims for Special Processing ONLY. Use this form as a supplement to the Medicare Explanation of Benefit (EOB) statement attachment previously required on paper crossover claims. The form was created Read More →

HIPAA claims

Oklahoma Health Care Authority Provider Portal Guides Oklahoma Health Care Authority uses the SoonerCare Provider Portal offering providers several services from submitting claims on the web to fast verification of claim status. The SoonerCare Provider Portal is available 24 hours a day, 7 days a week, except during scheduled maintenance. Find the types of Web Users Read More →

Health Care EDI

Health Care EDI Real World Practice: HIPAA Compliance And Deviations Health Care EDI is one of the branches where Electronic Data Interchange accelerates information exchange, reduces manual interruption and provides processing reliability and security. Health Care EDI operates under the rules of HIPAA – standard that states requirements to health care electronic transactions. HIPAA concerns health care Read More →

HIPAA Policy

HealthLink’s HIPAA Additional Requirements HealthLink strongly encourages Trading Partners to send HealthLink fully populated 997s for all received 837 transactions. The only naming convention requirement is the file should contain the text “997” within the file name. Acknowledgements will help ensure that the receiving party has accepted the claim files sent by HealthLink. For any Read More →

HIPAA Required Data

Non-Standard Electronic Claims Per CMS HIPAA guidance, HealthLink continues to accept non-standard electronic claims from providers. A number of the required data elements on the 837 are not required in the proprietary formats that HealthLink receives from providers. Therefore, HIPAA required data might be missing from some claims. Again, by populating default “UNKNOWN” data, these Read More →

HIPAA Claims

Non-Standard Claims Converted to Standard Claims (HealthLink) If the HealthLink Document Control Number (DCN) begins with an “E”, HealthLink received the claim electronically from a provider. If the HealthLink DCN starts with any other character, the claim was received on paper (or manually). Professional and institutional claims which can be scanned and via imaging made Read More →

HIPAA Institutional Claims

HealthLink Guidelines For HIPAA Institutional Claims Find below the HealthLink requirements for Institutional Claims. Institutional: Related Causes Code If an Accident Date is provided on the claim the assumption is that the condition being reported is Accident or Employment related. In these cases a Related-Causes Code is required in the 837. If this field is blank, HealthLink Read More →

HealthLink HIPAA

HealthLink HIPAA Guidelines For Institutional Claims The instructions conform to all the requirements of any associated ASC X12 Implementation Guides and are in conformance with ASC X12’s Fair Use and Copyright statements. HealthLink companion guides must be used in conjunction with an associated ASC X12. Institutional: Claims 837I (UB04s) Messages In the 837I, the File Read More →

EDI Instructor-led Webinars

EDI Instructor-led Webinars: All Industries and HIPAA Last chance to join interactive online webinars for All Industries and HIPAA professionals. Designed for Retail, Supply Chain, Manufacturing and Finance Transactions (e.g. 850,810,856,210,820 etc), HIPAA and Health Care EDI Transactions (e.g. 837,278,835) These are live webinars. You have the opportunity to consult with an expert that has implemented EDI for Read More →

Claims Mapping Guidelines

Professional Claims Mapping Guidelines (HealthLink) Correct claims mapping is the basis for the timely claims receiving and billing. All HealthLink business partners must comply with the guides given below. Related Causes Code If an Accident Date is provided on the claim the assumption is that the condition being reported is Accident or Employment related. In these cases Read More →