HIPAA 837 Institutional Claim

HIPAA 837 Institutional Claim Mapping Guides For HAP Midwest Health Plan Partners HIPAA 837 Institutional Claim EDI transaction set is used to exchange institutional health care claim information from providers of health care services. HIPAA 837 Institutional Claim transaction can be submitted either directly or via intermediary billing services and/or claims clearinghouses. HIPAA 837 Institutional Claim Read More →

HIPAA 837 Professional Claim

HIPAA 837 Professional Claim Mapping Guides For HAP Midwest Health Plan Partners HIPAA 837 Professional Claim transaction set is used to exchange institutional health care claim information from providers of health care services. HIPAA 837 Professional Claim can be submitted either directly or via intermediary billing services and/or claims clearinghouses. Please note that Professional and Institutional 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. Coordination of benefits 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 Read More →

EDI Claims

EDI Claims Post Payment Review (HAP Midwest Health Plan) EDI Claims post payment: HAP Midwest Health Plan conducts ongoing internal review of EDI Claims to determine completeness of claim, eligibility of member, benefit level for service, prior authorization as indicated, duplication of service and appropriate billing codes.  In cases where the services rendered appear to Read More →

EDI Claims Statusing

EDI Claims Statusing On The HAP Midwest Health Plan Website EDI Claims Statusing is provided for all HAP Midwest Health Plan providers.  EDI Claims Statusing can be tracked 24/7 on website at www.midwesthealthplan.com. Midwest Health Plan EDI Claims Statusing gives you the possibility to status up to three years of claims data. EDI Claims Statusing procedure Click on Read More →

Clean Claims

Clean Claims, Unclean Claims, Rejected Claims And Claims Resubmission (Midwest Health Plan) Clean Claims are claims that have all information in them and nothing is missing. If any mandatory or conditional information is missing, the claim will be considered unclean. Examples of unclean claims include invalid member ID, provider data discrepancy NPI and atax ID does not Read More →

Midwest Health Plan EDI

Midwest Health Plan EDI Claims General Guidelines Midwest Health Plan EDI Claims Department endeavors to assure prompt and accurate claim and encounter review, processing, adjudication and payment. This is accomplished through the development of Midwest Health Plan EDI claims processing systems, pre-payment and post-payment audits, policies, and procedures that are consistently and appropriately applied. Midwest Read More →

Phoenix Health Plan EDI

Phoenix Health Plan EDI Claims Submission Guidelines Phoenix Health Plan EDI department encourages providers to consider electronic claims submission (EDI – 837) for your practice. There are many advantages to submitting Phoenix Health Plan EDI claims electronically (decreased submission costs, faster processing and reimbursement, allows for documentation of timely filing, etc). However, any claims requiring attachments, Read More →