EDI For Medicare

EDI For Medicare Fee For Services (FFS) Introduction And Requirements EDI For Medicare FFS is not limited to the submission and processing of claim related transactions, but includes processes such as provider EDI enrollment, beneficiary eligibility, coordination of benefits, as well as security and privacy concerns. So as not to be duplicative, where EDI is a relevant part Read More →

Coordination of Benefits

Coordination of Benefits HIPAA Basics Coordination of Benefits requirements and basic procedure descriptions subject to the rules of the X12 837 HIPAA Technical Reports Type 3 (TR3s) as the national standard for provider electronic submission of health care claims to payers such as Medicare. It also contains the requirements for electronic transfer of claims from Medicare to Read More →

Health Care Payment

Health Care Payment: Electronic Remit Advice and Standard Paper Remit Health Care Payment with Electronic Remit Advice (ERA) has a number of advantages over Standard Paper Remit (SPR). The amount payable for each line and/or claim as well as each adjustment applied to a line or claim can be automatically posted to accounting or billing applications from an Read More →

Health Care Payment

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

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 →

Medicare EDI

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

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 →

EDI Training Online

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 →