HL7 standard

HL7 Standard Description HL7 standard is an abbreviation of “Health Level Seven” where “Level Seven” refers to the Seventh OSI layer protocol for the healthcare environment. The 7 OSI levels or layers are: Level 7: Application Layer Level 6: Presentation Layer Level 5: Session Layer Level 4: Transport Layer Level 3: Network Layer Level 2: Read More →

CLEARING HOUSE EDI

Clearing house and it’s role in Healthcare EDI Communication Clearing house is a third party service provider. It takes non-EDI data and translates them to EDI data. Clearing house can also translate EDI to EDI. This is done by taking the received raw data, massaging and scrubbing it. Then data are sent to another document. Clearinghouse can also Read More →

edi considerations

BCBSM EDI Testing Requirements For The Specific Bill Type BCBSM EDI Testing (Blue Cross Blue Shield of Michigan) steps should be done before you will start sending and receiving information electronically. BCBSM EDI Testing files must follow the 837/835 TR3’s and companion document requirements for the specific bill type. BCBSM EDI Testing – Professional Claim files must Read More →

Blue Cross Blue Shield EDI

Blue Cross Blue Shield EDI: Getting Started Guidelines Blue Cross Blue Shield EDI Guidelines described below will be useful for providers, facilities, software vendors or clearinghouses and will help you learn how to reduce costs and save time by sending and receiving Blue Cross Blue Shield EDI information. Blue Cross Blue Shield EDI claims submission tool is: Easy Read More →

targetmarketing

278 EDI Transaction (Response) example – raw data and human readable In our previous posts we have already spoke about 278 EDI Transaction. We mentioned definition and purposes of the 278 EDI Transaction and reviewed 278 EDI Transaction (Request) example. The following is a turn-around from the previous 278 EDI Transaction request. The HRC segment authorizes Read More →

information

278 Health Care Services Review Information – definition and purpose The 278 Health Care Services Review Information transaction belongs to HIPAA EDI documents. A health organization can send 278 Health Care Services Review Information (patient data, diagnosis or treatment data) for the purposes of requesting a review. Typically the requestor (the sending party) is the Read More →

HIPAA EDI 835

HIPAA EDI 835 transaction and balancing formula description The HIPAA EDI 835 example given in the post is for two institutional claims. It is a remittance advice and it’s submitted by BCBS DISNEY (payer) to UCLA MEDICAL CENTER (payee). BPR-01 = “I” which means “Remittance Advice Only” The payment is for patient Mickey Mouse and Donald Read More →

820

820 Payment Order / Remittance Advice (RA) definition and important notes The 820 Payment Order / Remittance Advice can be used in three ways: (1) It can be used as a remittance advice to describe detailed information about a payment. (2) It can be used to authorize financial institutions to electronically transfer funds (EFT) from Read More →

835 billing

835 billing scenarios examples 835 billing scenarios  describe what meaning and purpose can 835 transaction bring to the receiver. The 835 (similar to the 820) can be transmitted from the payer just as a remittance advice (and EOB explanation of benefits) letting the provider know what is being paid. It can also be transmitted as an Read More →