Medical EDI

Medical EDI Implementation Guide (Electronic Medical Report Submission) Medical EDI is the electronic submission of medical bills by all healthcare providers. The Medical EDI Team assists electronic medical submitters with the management of electronic medical filings. To allow comparison benchmarking among the insurance industry, the team generates monthly report cards that denote the primary reasons for Read More →

837 Healthcare Claim

837 Healthcare Claim Implementation Guides 837 healthcare claim can be compared to an invoice in the merchandising world. However, it is much more complicated than that and some consider it to be the most complicated EDI transaction set. The purpose of this transaction is to submit healthcare billing information from providers of healthcare services to payers, either directly or Read More →

HIPAA EDI Online Webinars

HIPAA EDI Online Webinars And Courses Description HIPAA EDI Online Webinars are suitable for novice and experienced specialists involved in health care electronic operations. Training goes in a format of online instructor-led webinar. Attendees have the possibility to work on real-world examples and to ask the instructor HIPAA-related questions. Below we give the description of Read More →

HIPAA Claim Form

HIPAA Claim Form Requirements: Provider Signature on Claims HIPAA Claim Form CMS-1500, American Dental Association (ADA) Dental Claim Form, and 2017 Claim Form must be submitted with the provider’s or an authorized representative’s handwritten signature (or signature stamp) in the appropriate block of the claim form. Signatory supervision of the authorized representative is required. Providers delegating Read More →

Procedure Coding

HIPAA Claim: Procedure Coding (Texas Medicaid) Texas Medicaid uses the Healthcare Common Procedure Coding System (HCPCS) for HIPAA Claim submission. HCPCS provides health-care providers and third-party payers a common coding structure that uses codes designed around a five-character numeric or alphanumeric base. The procedure codes are updated annually and quarterly. HCPCS consists of two levels Read More →

Health Care Claim

Health Care Claim: Diagnosis Coding (Texas Medicaid) Health Care Claim must be coded by electronic billers. Health Care Claim is processed fast and accurately if providers furnish appropriate information. By coding EDI Health Care Claim, providers ensure precise and concise representation of the services provided and are assured reimbursement based on the correct code. If providers Read More →


TMHP HIPAA EDI Claim Guides TMHP HIPAA EDI transactions are assigned an eight-character Batch ID immediately upon receipt by the TMHP EDI Gateway. The batch ID format allows electronic submitters to determine the exact day and year that a batch was received. The batch ID format is JJJYSSSS, where each character is defined as follows: Read More →

TMHP Electronic Claims Submission

TMHP Electronic Claims Submission: Acceptance And Rejection TMHP Electronic Claims submission requires the HIPAA-compliant American National Standards Institute (ANSI) ASC X12 5010 file format through secure socket layer (SSL) and virtual private networking (VPN) connections for maximum security. Providers must retain all claim and file transmission records. They may be required to submit them for pending Read More →


HIPAA for Professionals: Federal Privacy Protection Rules To improve the efficiency and effectiveness of the health care system, the Health Insurance Portability and Accountability Act of 1996 (HIPAA), Public Law 104-191, included Administrative Simplification provisions that required HHS to adopt national standards for electronic health care transactions and code sets, unique health identifiers, and security. At the Read More →

Provider Claim Guidelines

CMS HIPAA Standards Approved CMS HIPAA Standards shall be supported by the A/B MACs, DME MACs, CEDI or other contractors if designated by CMS for the electronic data with Medicare providers/submitters/receivers/COB trading partners. ASC X12 Technical Report 3s (TR3s) for mandated HIPAA transactions may be purchased from Washington Publishing Company. The HIPAA-standard implementation specifications for Read More →