Detailed Course Content - Advanced HIPAA EDI Training All Industries

Section One: Enrollment, Eligibility and Prior/Referral Authorizations


834 Benefit Enrollment Advanced EDI Mapping Exercises and Implementation Concepts.We will include a discussion of Benefit Enrollment implementations with commercial sponsors and health care exchanges. We will cover the CMS Companion guide and other state exchange companion guides. We’ll also explain how the820 005010X306 Health Insurance Exchangeis used alongside the 834.

270/271 Eligibility Inquiry and Response - Advanced EDI Mapping Exercises and Implementation Concepts.We’ll cover advanced Grace-Period and Paid-Through-Date details. Instructor will cover a lot of interesting things that are happening to this transaction at the ANSI X12N Workgroup for the 270/271. We’ll discuss advanced concepts such as tiered benefits and tiered networks. The instructor will also cover CAQH Core operating rules and show you how this transaction be exchanged in real time.

278 Prior Authorization and Referral Authorization - Advanced EDI Mapping Exercises.
All payers, plan sponsors, providers, utilization management and other entities involved in health care services review benefit from this training session. In addition to conducting an EDI mapping exercise, we will have more time to discuss best practices of implementation. This transaction is also getting a lot of CAQH Core operating rules attention and buzz and changes are happening to the 278 at the X12 conference. A case study will be provided on how a 278 was used to help with clinical decision support and prior authorizations.


Section Two: Payments, Encounters and Billing


837 - Health Care Claim - Advanced EDI Mapping Exercises and Implementation Concepts.
Several 837 mapping exercise (Professional, Institutional and Dental upon request) scenarios will be covered for in this section.
We will also cover advanced concepts such as Coordination of Benefits (COB) and outbound MRA (Medicare Risk Adjustment) claims.

835 - ERA/EOB - Advanced EDI Mapping Exercises and Implementation Concepts.
You’ll have an opportunity to do a mapping exercise and we will cover some interesting initiatives currently in the 835 Health Care Payment world.

277 RFAI/275 Attachments This combined section will cover the 277 Request for Additional Information along with the 275 Health Care attachments. Real-world implementation examples and scenarios will be covered.

Section Three: Open Forum For Your Needs


This section is designed and customized for the attendee. For all registered attendees the instructor will survey the attendees to find out what their challenges or interests ar
This time is blocked off to discuss your EDI challenges and brainstorm possible solutions.