HIPAA Testing and Certification

HIPAA Testing and Certification (New Jersey Medicaid 5010 Guides) HIPAA Testing and Certification requires each prospective electronic data interchange (EDI) submitter to be certified and approved before HIPAA transactions will be processed in production. The Workgroup for Electronic Data Interchange (WEDI), through a collaborative healthcare industry effort called the Strategic National Implementation Process (SNIP), has Read More →

HIPAA companion guide

New Jersey Medicaid HIPAA 5010 Version Updates New Jersey Medicaid signifies its ongoing effort to adhere to the HIPAA transaction set requirements. HIPAA provides all healthcare entities a tremendous opportunity to realize many administrative and systemic benefits because it provides a national standard of transaction and code sets for the electronic exchange of healthcare information. New Read More →

HIPAA seminar

HIPAA Claims Submission: Intermediary Service Providers can submit claims directly to third party insurers if their software systems have been upgraded to comply with the EDI standards. This approach helps the provider to maintain the maximum amount of control over the claims submission and payment review process, but also necessitates the maintenance of a more Read More →

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HIPAA Electronic Data Interchange (EDI) Rule (The American Speech-Language-Hearing Association) HIPAA Electronic Data Interchange Rule is very technical and based on the X12N EDI data transmission protocol standard. Although rare allowances are made, the rule requires that any covered entity who electronically transmits data must use this, and only this format in doing so. The Read More →

HAP Midwest Health Plan Billing

HAP Midwest Health Plan Billing And Reimbursment Requirements HAP Midwest Health Plan Billing and Reimbursment process will be discribed below in this blog. MDCH contracts with HAP Midwest Health Plan to administer the Medicaid HMO benefits to its enrolled members. Medicaid is considered as payment source of last resort. Some Medicaid members have dual insurance coverage. Read More →

Pharmaceutical EDI Data Integration

Pharmaceutical EDI Data Integration capabilities at McKesson Pharmaceutical EDI Data integration enables configurable pharmaceutical product and data sharing between pharmacy management systems, provider information systems and enterprise resource planning (ERP) systems. McKesson provides data interface solutions for pharmacy customers who are unable to support direct, automated electronic data interchange (EDI) through McKesson Data Exchange module. Solutions allow Read More →

EDI Report Types

EDI Report Types (Claims Status Awaiting Resolution Option) There are a number of EDI Report Types available to monitor and manage electronic claims. TR reports provide the end-user with information to monitor and manage EDI claims still within the VA, that is, between the VAMC and the FSC in Austin, TX. The MM reports provide the Read More →

EDI Billing Updates

EDI Billing Updates (Veterans Health Administration) EDI Billing Updates as for ASC X12N 5010 Health Care Claim (837) Transactions in the Veterans Health Administration EDI billing system include the following changes: An inpatient institutional 837 transaction no longer requires a POA for each diagnosis An inpatient admission date can no longer be transmitted on outpatient claims All Read More →

EDI Billing Set-Up

EDI Billing Set-Up Veterans Health Administration (VHA). Associated Insurance Companies and Copying Physician/Provider Secondary IDs and Additional Billing Provider Secondary IDs Patch IB*2.0*320 provides the ability for users to associate multiple Insurance Company entries with each other. Example: If there are 45 Blue Cross/Blue Shield entries in the Insurance Company file, users can make one of Read More →

Pay-to Provider IDs

Defining Pay-to Provider IDs  On Billing Forms The Pay-to Provider NPI is not entered or maintained by Billing personnel. The Pay-to Provider NPI is retrieved from the Institution file (#4). Beginning with Patch IB*2*432, the Pay-to Provider Primary ID is the NPI number of the site defined as the Pay-to Provider. The Federal Tax Number is Read More →