Medicare EDI

Medicare EDI Enrollment Information Required EDI Enrollment Information Required for Inclusion at a Minimum in Each A/B MAC, and CEDI EDI Enrollment Form. Medicaid state agencies are not required to complete an EDI Enrollment Form as a condition for receipt of COB claims. In accord with a particular MAC’s business processes, providers who have a signed EDI Read More →

EDI Enrollments

Maintenance of Existing EDI Enrollments The term Medicare beneficiary identifier (Mbi) is a general term describing a beneficiary’s Medicare identification number. For purposes of this manual, Medicare beneficiary identifier references both the Health Insurance Claim Number (HICN) and the Medicare Beneficiary Identifier (MBI) during the new Medicare card transition period and after for certain business Read More →

Electronic Remittance Advice

Electronic Remittance Advice (ERA) Enrollment Form The Medicare Electronic Remittance Advice (ERA) Enrollment process provides for collection of the information needed to successfully receive ERA transactions from Medicare and EDI trading partners. This agreement must be executed by each provider that receives ERA either directly to or from Medicare or through a third party. Each Read More →

Claims EDI Processing

HIPAA EDI Legislative Background In The Healthcare Business EDI is the process of using nationally established standards to exchange electronic information between business entities. These national standards are developed and maintained by a group of standards development organizations (SDOs), such as the Accredited Standards Committee (ASC) X12 and the National Council of Prescription Drug Programs Read More →

HIPAA EDI Acronyms

HIPAA EDI Acronyms and Definitions Learn basic HIPAA EDI acronyms and definitions to understand the terminology used in health care CMS guidelines. EDI – Electronic Data Interchange – the process of using nationally established standards to exchange electronic information between business entities. HIPAA – Health Insurance Portability and Accountability Act of 1996 – legislation that mandated that Read More →

Medicare EDI Enrollment

New Medicare EDI Enrollments The Medicare EDI Enrollment process provides for collection of the information needed to successfully exchange EDI transactions between Medicare and EDI trading partners and also establishes the expectations for both parties in the exchange. This agreement must be executed by each provider that submits/receives EDI either directly to or from Medicare Read More →

EDI Enrollment

EDI Enrollment Procedures (CMS) A/B MACs and CEDI are required to furnish new providers that request Medicare claim privileges information on EDI. A/B MACs and CEDI are required to assess the capability of entities to submit data electronically, establish their qualifications, and enroll and assign submitter EDI identification numbers to those approved to use EDI. Read More →

HIMSS-OMB-Blog_Updated

EDI Enrollment and Registration (AKA Trading Partner Agreements) Medicare FFS’ Trading Partner Agreement is comprised of two forms: 1) EDI Registration and 2) EDI Enrollment. The forms are identified under CMS form 10164 and can be accessed at: EDI Registration EDI Enrollment A/B MACs and CEDI must use these two forms, or their own organization Read More →

HIPAA EDI Standard

HIPAA EDI Standard History EDI is the process of using nationally established standards to exchange electronic information between business entities. These national standards are developed and maintained by a group of standards development organizations (SDOs), such as the Accredited Standards Committee (ASC) X12 and the National Council of Prescription Drug Programs (NCPDP). The Department of Health Read More →

EDI Forms Solution

EDI Forms Solution (Pennsylvania Bureau of Workers’ Compensation’s (BWC) strategy) This blog describes the strategy to implement EDI Forms Solution. Please note that the BWC claim forms referred to in the below sections refer to only the following four forms: EDI Form Description LIBC-495 NOTICE OF COMPENSATION PAYABLE LIBC-496 NOTICE OF WORKERS’ COMPENSATION DENIAL LIBC-501 NOTICE OF Read More →