Electronic Claims Notes: Coordination of Benefits, Clean Claim, Claims Reimbursement Electronic Claims Notes given in the blog refer to Coordination of Benefits, Clean Claim, Claims Reimbursement guidelines for Health Plan of San Joaquin payers. Coordination of Benefits (COB) When HPSJ or the employer-sponsored plan of an SJHA client is the secondary payer, all claims must be submitted within 365 … Read More →
EDI Claims Procedures And Guidelines For Billing Parties EDI Claims procedures state that providers are encouraged to submit clean claims and encounter data electronically. Buckeye Health Plan Medicare Advantage can receive an ANSI X12N 837 professional, institution, or encounter transaction. In addition, Buckeye Health Plan can generate an ANSI X12N 835 electronic remittance advice known … Read More →
Clean Claims And Rejections (Upfront Rejections vs. Denials) Clean Claims are a type of a claim that does not require external investigation or development to obtain information not available on the claim form or on record in the health plan’s systems in order to adjudicate the claim. Clean claims must be filed within the timely filing period. … Read More →
Electronic Claim Verification Procedure For Buckeye Health Plan Partners Electronic Claim Verification follows the Center for Medicare and Medicaid Services (CMS) billing requirements for paper, electronic data interchange (EDI), and secure web-submitted claims. The provider must adhere to all billing requirements in order to ensure timely processing of claims and to avoid unnecessary upfront rejections or … Read More →