Health Care EDI Real World Practice: HIPAA Compliance And Deviations Health Care EDI is one of the branches where Electronic Data Interchange accelerates information exchange, reduces manual interruption and provides processing reliability and security. Health Care EDI operates under the rules of HIPAA – standard that states requirements to health care electronic transactions. HIPAA concerns health care Read More →

NCPDP SCRIPT Standard In The Health Care Industry NCPDP SCRIPT Standard was first published in 1997 and has been updated at least annually based on the business needs identified by the industry. SCRIPT is a standard created to facilitate the transfer of prescription data between pharmacies, prescribers, intermediaries, facilities, and payers. Within SCRIPT, basic business operations Read More →

Medicare Dual Eligible Members (EmblemHealth Billing Guides) Medicare Dual Eligible Members are individuals with both Medicare and Medicaid coverage. Depending on their category of Medicaid coverage, a dual eligible may receive state Medicaid plan assistance to cover their Medicare Part B premium, Medicare Parts A and B cost-share and certain benefits not covered by Medicare. Read More →

EDI Worldwide Standards List And Description (Part 2) EDI worldwide standards appeared as business requirements were quite different and diverse, and organizations tried to optimize messaging formats. There are formats used across industries to facilitate business communication. We continue to describe international EDI standard formats. HIPAA (The Health Insurance Portability and Accountability Act). HIPAA EDI is a set of Read More →

Electronic Medical Claims Program Requirements (Manitoba Health, Healthy Living and Seniors) Electronic Medical Claims Program requires automation integrated with the current office tasks and procedures to maximize the benefits. An electronic medical billing system should provide your office with more rapid input, improved accuracy, faster processing and the ability to report and analyze practice statistics. Read More →

Benefits of Electronic Data Interchange For CGS (A Celerian Group Company) Providers Benefits of Electronic Data Interchange to providers who conduct business with Medicare electronically are vivid. Some of those benefits include: No more paper claims: EDI (submitting claims to CGS electronically eliminates paperwork so your staff can accomplish more in less time. You will also Read More →

Jurisdiction 15 A/B MAC EDI Enrollment: CGS Provider EDI Enrollement Jurisdiction 15 A/B MAC EDI Enrollment goes under CMS instructions and CGS EDI providers must  follow the listed requirements. CGS will obtain an EDI Enrollment form for each provider prior to electronic transfer of data and issuance of system passwords/billing numbers to protect the security of transferred data. CGS Read More →

Celerian Group Company EDI Enrollment: The Internet EDI Enrollment Packet Celerian Group Company EDI Enrollment Packet should be completed to request an Internet EDI ID necessary to transmit Claim Status Request transactions (ANSI 276) and receive Claim Status Response transactions (ANSI 277), and/or retrieve Electronic Remittances (ANSI 835), via CGS’s public Internet. If retrieving Electronic Remittances (ANSI Read More →

Medicare Electronic Options: Transactions Increasing Business Productivity Medicare Electronic Options which will increase your business’ productivity include Claim Status Inquiry (CSI), payable Certificate of Medical Necessity (CMN) status, Beneficiary Eligibility (BE), 270/271, 276/277, and Electronic Remittance Advice (ERAs). Claim Status Inquiry (CSI) Claim Status Inquiry (CSI) allows you to electronically check the status of production claims after they have Read More →

Common Electronic Date Interchange (CEDI): Handling Medicare Transactions Common Electronic Date Interchange provides a single front end solution for the submission and retrieval of DME MAC electronic transactions. The Common Electronic Data Interchange contract for EDI services for all DME MAC suppliers. The acceptable HIPAA compliant format is the American National Standards Institute (ANSI) X12N Version 4010A1 837 transaction Read More →