Health Care Payment and Remittance Advice Health Care Payment information is reported within ERA (Electronic Remit Advice) or SPR (Standard Paper Remit). After Medicare processes a claim, either an Electronic Remit Advice or a Standard Paper Remit is sent with final claim adjudication and payment information. One Electronic Remit Advice or Standard Paper Remit usually Read More →

ASCA Waiver Application Guidelines For Providers ASCA Waiver Application guidelines describe some situations when this electronic billing requirement could be waived for some or all claims, but a provider must obtain Medicare pre-approval to submit paper claims in these situations: Any situation where a provider can demonstrate that the applicable adopted HIPAA claim standard does not Read More →

Claim Status Request and Response CMS Guidelines Claim Status Request and Response: Providers have a number of options to obtain claim status Information from Medicare Administrative Contractors (MACs): Providers can enter data via the Interactive Voice Response (IVR) telephone systems operated by the MACs. Providers can submit claim status inquiries via the Medicare Administrative Contractors’ provider Read More →

Electronic Health Care Claims Submission Notes Electronic Health Care Claims: Claims may be electronically submitted to a Medicare Administrative Contractor (MAC) from a provider using a computer with software that meets electronic filing requirements as established by the HIPAA claim standard and by meeting CMS requirements contained in the provider enrollment & certification category area Read More →

ASCA Self Assessment Basic Requirements ASCA Self Assessment guidelines refer to the Administrative Simplification Compliance Act (ASCA) that prohibits payment of initial health care claims not sent electronically except in limited situations: Small Provider Claims: The word “provider” is being used generically here to refer to physicians, suppliers, and other providers of health care services. Providers Read More →

ASCA (Administrative Simplification Compliance Act) Enforcement Reviews ASCA (Administrative Simplification Compliance Act) prohibits payment of services or supplies that a provider did not bill to Medicare electronically. “Providers” is used in a generic sense here and refers equally to physicians, suppliers, and other health care providers. Providers are required to self-assess to determine whether they Read More →

Advanced EDI Online Trainings: New 2018 Courses Advanced EDI Online Trainings are offered by EDI Academy for specialists who have already passed basic online courses. Find below the description and available dates for Advanced EDI Online Trainings. EDI 201 & 301 (EDI All Industries) and HIPAA EDI 110, HIPAA EDI 210 HIPAA EDI (HIPAA EDI) courses Read More →

Medicare EDI Enrollment General Requirements Medicare EDI Enrollment should be started with the Enrollment Form. The Centers for Medicare & Medicaid Services (CMS) Standard Electronic Data Interchange (EDI) Enrollment Form (Medicare EDI Enrollment Form) must be completed prior to submitting electronic media claims (EMC) or other EDI transactions to Medicare. The agreement must be executed by each provider of Read More →

Medicare EDI Support Program Medicare EDI Support is released by A/B Medicare Administrative Contractors (MACs) and Durable Medical Equipment (DME) MACs as well as the DME MAC Common Electronic Data Interchange (CEDI) contractor. Medicare EDI Support is provided for physicians, suppliers and other providers that submit claims and conduct other Health Insurance Portability and Accountability Act Read More →

Medicare EDI  Basics For Providers, Clearinghouses And Agents Medicare EDI systems contain extensive Personally Identifiable Information (PII) on beneficiaries. As established by the Privacy Act and the Health Insurance Portability and Accountability Act (HIPAA), beneficiaries have a right to expect that their data will not be seen by individuals or entities that do not have Read More →