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 →

HIPAA EDI Webinars

HIPAA EDI Webinars Schedule HIPAA EDI 101 – Introduction To The Health Care EDI Environment Webinar Times: Mondays at 03:00 PM – 04:30 PM EST – 2020 Dates: October 26th or December 7th Register a la carte: https://attendee.gototraining.com/rt/151393259285733634 Introduction to the Health Care EDI Environment Health Care EDI Defined Benefits of Health Care EDI X12 Read More →

BWC Testing

Testing Procedures Completion BWC Testing Completion is the final step of testing between direct-filing Trading Partners and/or EDI Transaction Partners and BWC. During this step direct-filing Trading Partners and/or EDI Transaction Partners will be given formal approval by BWC to proceed with its system updates to their respective production environments. Additional test cycles will need to be conducted if direct-filing Read More →

EDI Claims Codes

EDI LIBC-495 (Notice of Compensation Payable – BWC) EDI LIBC-495 verifies if the Claim Administrator has implemented the changes that would result in the generation of the Notice of Compensation Payable (LIBC-495) based on the following EDI transaction/maintenance type codes: SROI IP SROI PY SROI AP SROI RB SROI 02 SROI CA SROI PD SROI IP 1. Read More →

EDI LIBC-501

EDI LIBC-501 (Notice of Temporary Compensation Payable) The purpose of EDI LIBC-501 is to verify if the Claim Administrator has implemented the changes that would result in the generation of the Notice of Temporary Compensation Payable (LIBC-501) based on the following EDI transaction/maintenance type codes: SROI IP SROI PY SROI AP SROI RB SROI RE SROI 02 SROI PD SROI Read More →

PRV Taxonomy Codes Segment

PRV Taxonomy Codes Segment Description The PRV Taxonomy Codes segment is used to the provider type by a 10-digit identification number known as a Taxonomy-Specialty code.  These codes are used by the health plan’s claim adjudication logic. The X12 standard says this segment is required only if the payer’s adjudication is known to be impacted Read More →

837 CLM Segment

837 CLM Segment Facility Code Values On the 837 claim in the CLM segment in position CLM05-1 you will find facility codes also known as Place of Treatment (POT) codes. Place of Treatment (POT) codes are alpha or numeric codes that indicate where a service was performed. The Centers for Medicare & Medicaid Services (CMS) Read More →

837 Receiver Names

837 Receiver Names Examples 837 Healthcare Claim Receiver Name segment is a common segment across all EDI Transactions. This segment is required and it is qualified with ‘40’ for Receiver. This segment is part of LOOP ID 1000B Receiver name. To learn more  about EDI loops visit our course schedule page to sign up for Read More →

EDI Notice testing

EDI Notice Stopping Temporary (LIBC-502) (BWC EDI testing procedures) We continue a series of posts regarding Commonwealth of Pennsylvania Department of Labor & Industry (BWC) EDI testing procedures. Find below guidelines for Generation of EDI Notice Stopping Temporary Compensation Payable (LIBC-502). The purpose of this process is to verify if the Claim Administrator has implemented the changes that would result in the generation Read More →

LIBC-496

Generation of Notice of Compensation Denial (LIBC-496) In this blog we continue a series of posts regarding Commonwealth of Pennsylvania Department of Labor & Industry (BWC) EDI testing procedures. Generation of Notice of Compensation Denial (LIBC-496) purpose is to verify if the Claim Administrator has implemented the necessary changes to their system that would trigger the generation of the Notice of Compensation Denial (LIBC-496) based Read More →