EDI Coordination of Benefits

EDI Coordination of Benefits Basics For Celerian Group Company Medicare Contractors EDI Coordination of Benefits program purposes are to identify the health benefits available to a Medicare beneficiary and to coordinate the payment process to prevent mistaken payment of Medicare benefits. The BCRC (Benefits Coordination & Recovery Center) consolidates the activities that support the collection, management, and reporting Read More →

CAQH CORE 259

CAQH CORE 259: AAA Error Code Reporting Rule CAQH CORE 259: Operating Rule states that the receiver of the X12 271 response, i.e., the system that originated the X12 270 inquiry, is required to detect all combinations of error conditions from the AAA segments in the X12 271 responses, and to display to the receiving Read More →

CAQH CORE 258

CAQH CORE 258: Normalizing Patient Last Name Rule CAQH CORE 258 Operating Rule requires the removal of both the apostrophe and the hyphen in the O’Donnell-Griswold example cited. The normalized name would be ODONNELLGRISWOLD. CAQH CORE 258: Last Name Normalization Rule Version 2.1.0 does not address this specific scenario. Since the characters “De” are not included in Read More →

X12 276/277 Transactions

X12 276/277 Transactions In CAQH CORE 250: Claim Status Rule X12 276/277 Transactions can be tracked throughout a system/application to demonstrate conformance with the response time requirements specified in the CAQH CORE 250 Rule. CAQH CORE 250: Claim Status Rule requires HIPAA covered entities to capture, log, audit, match, and report the date, time, and control Read More →

CAQH CORE HTTP/S

CAQH CORE HTTP/S Vendor Parties Guidelines CAQH CORE HTTP/S vendor rules do not require that an entity (provider or health plan) implement the technology directly into their own data center. The Phase I CAQH CORE Rules implicitly acknowledge that both providers and health plans will use technology solutions provided by vendors to accomplish all that must Read More →

CAQH CORE Batch Processing

CAQH CORE Batch Processing Vendor Requirements CAQH CORE Batch Processing: Why not FTP or sFTP for batch transactions instead of HTTP/S?HTTP/S is robust and has a proven track record with batch transactions. The benefits of a single communication standard were a compelling reason to mandate its availability. Information sources that allow FTP and/or sFTP for Read More →

EDI HTTP

EDI HTTP Guidelines For CAQH CORE 250: Claim Status Infrastructure Rule EDI HTTP guidelines refer to parties contracting with Medicare and CAQH CORE-authorized testing vendors. One of the typical questions from vendors – “Is there a required format in Phase I CAQH CORE Connectivity for the authorization, date/time, and payload ID to be sent in the Read More →

CAQH CORE 250

CAQH CORE 250: Claim Status Infrastructure Rule Guides CAQH CORE 250 Rule for operating rules for the eligibility and claim status transactions adopts all the Phase I and II CAQH CORE Eligibility and Claim Status Operating Rules except those requirements pertaining to the use of Acknowledgements. Entities seeking CORE Certification must implement all of the CAQH CORE Eligibility and Claim Read More →

healthcare-technology

EDI 837 Common Ground Healthcare Cooperative Highlights EDI 837 Common Ground Healthcare Cooperative transaction requires efficient and accurate electronic transaction processing. To promote this EDI partners should note: Each user is assigned a 6-digit EDI Direct Trading Partner ID. Logon User Name is 8 characters. Logon User ID (password) is 9 characters. All dates are in the CCYYMMDD format. Read More →

Healthcare-Billing-Outsourcing-Services

HIPAA 7030 271 Transaction: Detail Levels 3-4 HIPAA 7030 271 transaction is intended to meet the particular needs of the health care industry for the reporting of premium payment grace period information from a health plan to a provider. Find info about Header and Detail Levels 1-2 in the previous blog post. Detail Level 3 – Enrollee (2000C) Read More →