HIPAA COW Spring 2012 HIPAA Provider 5010 Claim Experience. Quick Identification + Quick Notification = Quick Resolutions

Save this PDF as:
 WORD  PNG  TXT  JPG

Size: px
Start display at page:

Download "HIPAA COW Spring 2012 HIPAA 5010. Provider 5010 Claim Experience. Quick Identification + Quick Notification = Quick Resolutions"

Transcription

1 HIPAA COW Spring Highlights and Updates Christol Green Sr. EDI Business Consultant HIPAA 5010 Provider 5010 Claim Experience Anthem 5010 Experience Escalating 5010 Questions Anthem EDI 5010 Analysis and Resolutions For Your Information Slides 5010 Testing Notifications Important 5010 Changes EDI Claim Reports Billing Provider and Pay to Address Nine-digit ZIP Code Anesthesia Units vs. Minutes 2 Provider 5010 Claim Experience Rejected Claims Triage Issues -Software, Clearinghouse, Payer Escalation Accounts Receivable Quick Identification + Quick Notification = Quick Resolutions 3 1

2 Anthem 5010 Experience Industry is Adjusting to New Mandate 5010 is Complex Providers, Clearinghouse, Software Vendors, Payers Industry Experiencing 5010 Related Issues Reaction Time-Quick or Slow Providers, Clearinghouse, Software Vendors, Payers Anthem 5010 Approach Monitoring daily reject rates, submission volumes, support calls Work with Trading Partners directly Internal triage and escalation for all 5010 issues Identify and implement changes 4 Escalating 5010 Questions 1 st Point of Contact Clearinghouse Vendor In-House Technical Staff 2 nd Point of Contact EDI Solutions Helpdesk (option 2) Live Chat/ 5010 Questions 3 rd Point of Contact Provider Network Representative 5 Anthem EDI 5010 Research and Resolutions 6 2

3 Anthem EDI 5010 Research and Resolutions Required when different editing 32066, 60028, The Claim Filing Indicator (Loop 2000B, SBR09) must = BL. (Blue Cross/Blue Shield). Secondary Claim Rejections (837I) & (837P)- When Total Charge (2300 CLM02) does Not equal Paid Amount (Loop 2320 AMT02), CAS segments plus Total Paid must equal Total Charge Top EDI Rejects March Member ID Invalid One WI TP -about 1/3 of claim errors were due to a wrong claim filing indicator, they were sending CI instead of BL Anthem Fix 03/16/ Anthem Fix 04/20/ Anthem EDI 5010 Research and Resolutions 837P Claims being returned from our WGS system, stating submit to your home plan? Issue: mapping used Pay To Provider ( Payment/remit address) when Service Facility field (box 32) was blank to determine Provider location of Service. Correction: mapping changed to look first at Service Facility field (box 32) if blank then use Billing Provider field (box 33) to determine Provider location of Service. 8 Anthem EDI 5010 Research and Resolutions Phone number - hyphens/spaces Not allowed 277CA Report-Real-time Delivery Anthem Fix 03/16/2012 ********** 9 3

4 EDI Claim File Reports 999 Interchange Acknowledgment (for Inbound Transactions) The Enterprise EDI Gateway generates a 999 Interchange Acknowledgment in response to an EDI file submission. This process applies Level 1 edits and reports the results. Recognize errors occurred and begin a correct/resubmit action, or Recognize that all transactions were accepted. 277CA Claims Acknowledgment (for Inbound 837 Transactions) The Enterprise EDI Gateway generates a 277CA in response to an EDI file submission. This process applies edits and reports the results. Recognize errors that occurred and begin a correct/resubmit action on specific claims, Recognize transactions were accepted and, use returned claim numbers for future status inquiries. EDI Response Report (Level 2) Anthem reports are delivered within 24hours after receipt of the electronic file. Reports are often re-formatted by the clearinghouse as a service to the provider. Review reports daily or as often as submissions occurs and reconcile claim totals and dollars submitted. Anthem s Level 2 Response reports can be used to support timely filing. Contact your clearinghouse or vendor for questions about reformatted reports. Correct errors and resubmit claims electronically 10 Billing Provider and Pay-to Address For 5010, the Billing Provider must contain a physical street address only and the Pay-to Address is available for the P.O. Box or Lock Box address, if needed. Additionally, the Pay-to Address, submitted only when different from the Billing Provider, may include a P.O. Box, Lock Box, and/or street address, as applicable. Actual claim payment is sent to the address established on system during the initial set-up and/or contracting, based on the provider's 1099 form. Therefore, ACTION IS REQUIRED by providers for the following situations: 1. Provider currently submits a P.O. Box or Lock Box address in the Billing Provider Determine a physical street address Determine if P.O. Box or Lock Box address needed, and submit in Pay-to Address Verify with software vendor, clearinghouse, or billing service that correct address is being submitted 2. Provider changes destination for claim payment; different from that contractually established. Notify Provider Relations representative (billing/contracting) Verify with software vendor, clearinghouse, or billing service that correct address is being submitted 11 Billing Provider and Pay-to Address - Example Currently, Dr. Provider submits his billing address as "P.O. Box 1234" and is in process of having his payments sent to a pay-to address different from what was set up contractually, "1111 Payto Street, P.O. Box 1111". He knows that for 5010, he must submit a physical street address in the Billing Provider loop. To ensure that his claims are processed and payments made to the correct address, he contacts his provider representative with his updated information. BILLING address N301 = P.O. Box 1234 BILLING address N302 = 123 Billing Street BILLING address N301 = 123 Billing Street Pay-to address N301 = P.O. Box 1234 BILLING address N301 = 123 Billing Street Pay-to address N301 = 1111 Pay-to Street Pay-to address N302 = P.O. Box 1111 FAIL: P.O. Box is not allowed PASS: payment made to address on system PASS: payment made to address on system 12 4

5 Nine-digit ZIP codes When reporting the ZIP code for U.S. addresses in the Billing Provider and Service Facility Location, the full nine digit ZIP code must be provided. Dental - Billing Provider (2010AA, N403), Service Facility Location (2310C & 2420D, N403) Institutional - Billing Provider (2010AA, N403), Service Facility Location (2310E, N403) Professional - Billing Provider (2010AA, N403), Service Facility Location (2310C & 2420C, N403) All valid codes are identified in Code Source 932: Universal Postal Codes, and also accessible from the internet look-up tool: Example: Currently, Dr. Bill Provider submits his ZIP code as '90212'. But he knows that for 5010, he must submit his full nine-digit ZIP code in the Billing Provider loop. He verifies the last four digits of his ZIP code as '2403'. Claim submission with N403 = FAIL: ZIP code is not valid Claim submission with N403 = FAIL: ZIP code is not valid, requires 9 digits Claim submission with N403 = FAIL: spaces are not allowed Claim submission with N403 = FAIL: hyphens are not allowed Claim submission with N403 = PASS: ZIP code is valid, format is correct 13 Anesthesia Services - Units vs Minutes Administration of anesthesia must be reported with the correct measurement per the 837 TR3. Institutional (837I) - Service Line (2400, SV204), Quantity measured using 'UN' (units) Professional (837P) - Service Line (2400, SV103), Quantity measured using 'MJ' (minutes) Providers no longer need to apply a conversion factor to calculate units when reporting on anesthesia services on 837P claim submissions. *If the conversion factor is a concern, please contact your Provider Representative or Relations area. Example: Today, Dr. Rendering A. Provider submits a claim for laser eye surgery; anesthesia reported in units. But he knows that for 5010, he must submit his anesthesia services in minutes. He verifies the use of the qualifier 'MJ' for future 5010 claim submissions for anesthesia services. Service = SV1*HC:00142:QK:QS:P1*2600*UN*7***1~ Service = SV1*HC:00142:QK:QS:P1*2600*MJ*104***1~ FAIL: Units are not accepted PASS: Minutes are accepted Example: Today, Dr. Rendering B. Provider submits a claim for laser eye surgery; anesthesia reported in minutes. And he knows that for 5010, anesthesia services are accepted in minutes only. He determines that no change is needed. Service = SV1*HC:00142:QK:QS:P1*2600*MJ*104 ***1~ PASS: Minutes are accepted Anthem BCBS WI EDI Contact Information EDI Solutions Help Desk Monday Friday, 8:00 a.m.- 4:30 p.m. Telephone: (option 2) Website: (select state) LIVE CHAT 15 5

6 Questions Anthem Blue Cross and Blue Shield is the trade name of Blue Cross Blue Shield of Wisconsin ("BCBSWi") which underwrites or administers the PPO and indemnity policies; Compcare Health Services Insurance Corporation ("Compcare") which underwrites or administers the HMO policies; and Compcare and BCBSWi collectively which underwrite or administer the POS policies. Independent licensees of the Blue Cross and Blue Shield Association. ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association

Provider Information Exchanges April 16 th through 24 th 2012

Provider Information Exchanges April 16 th through 24 th 2012 Provider Information Exchanges April 16 th through 24 th 2012 Electronic Data Interchange (EDI) Presenter: Christol Green, Sr. EDI Business Consultant christol.green@anthem.com This presentation contains

More information

EDI Solutions Your guide to getting started -- and ensuring smooth transactions anthem.com/edi

EDI Solutions Your guide to getting started -- and ensuring smooth transactions anthem.com/edi EDI Solutions Your guide to getting started -- and ensuring smooth transactions anthem.com/edi 00175CEPEN (04/12) This brochure is a helpful EDI reference for both new and experienced electronic submitters.

More information

Anthem BlueCross BlueShield BCBSA Initiative Helps Insure Timely and Accurate Payment for Secondary Payer Medicare Claims

Anthem BlueCross BlueShield BCBSA Initiative Helps Insure Timely and Accurate Payment for Secondary Payer Medicare Claims Anthem BlueCross BlueShield BCBSA Initiative Helps Insure Timely and Accurate Payment for Secondary Payer Medicare Claims We implemented new guidelines to help reduce the administrative burden of getting

More information

Make the most of your electronic submissions. A how-to guide for health care providers

Make the most of your electronic submissions. A how-to guide for health care providers Make the most of your electronic submissions A how-to guide for health care providers Enjoy efficient, accurate claims processing and payment Reduce your paperwork burden and paper waste Ease office administration

More information

HIPAA 5010 Issues & Challenges: 837 Claims

HIPAA 5010 Issues & Challenges: 837 Claims HIPAA 5010 Issues & Challenges: 837 Claims Physicians Hospitals Dentists Payers Last update: March 22, 2012 Table of Contents Physicians... 4 Billing Provider Address... 4 Pay-to Provider Name Information...

More information

ICD-10 Updates. Working with Anthem Subject Specific Webinar Series. Special Session

ICD-10 Updates. Working with Anthem Subject Specific Webinar Series. Special Session Working with Anthem Subject Specific Webinar Series Special Session ICD-10 Updates Access to Audio Portion of Conference: Dial-In Number: 877-497-8913 Conference Code: 1322819809# Please Mute Your Phone

More information

ICD-10 Frequently Asked Questions for Providers

ICD-10 Frequently Asked Questions for Providers FAQ Sections: ICD-10 Claims Billing and Coding ICD-10 Testing ICD-10 Issues Resolution Processes ICD-10 Training and Resources ICD-10 Claims Billing and Coding Will you be ready to accept ICD-10 codes

More information

Electronic Data Interchange Companion Document

Electronic Data Interchange Companion Document Electronic Data Interchange Companion Document HIPAA...3 Getting Started with EDI...4 When You Are Set Up for EDI...4 When You Are Ready to Go Live...5 Specifications for 837P Transactions...6 Transaction

More information

Provider Additions and Maintenance

Provider Additions and Maintenance Working with Anthem Subject Specific Webinar Series Provider Additions and Maintenance Access to Audio Portion of Conference: Dial-In Number: 877-497-8913 Conference Code: 1322819809# Please Mute Your

More information

The Availity Health Information Network

The Availity Health Information Network The Availity Health Information Network Streamline your workflow Michele Terry 2013 Availity is an independent company providing a wide variety of online tools that allow providers to access real-time

More information

BLUE CROSS AND BLUE SHIELD OF LOUISIANA DENTAL CLAIMS COMPANION GUIDE

BLUE CROSS AND BLUE SHIELD OF LOUISIANA DENTAL CLAIMS COMPANION GUIDE BLUE CROSS AND BLUE SHIELD OF LOUISIANA CLAIMS Table of Contents I. Introduction... 3 II. General Specifications... 4 III. Enveloping Specifications... 5 IV. Loop and Data Element Specifications... 7 V.

More information

EDI Solutions Your guide to getting started -- and ensuring smooth transactions empireblue.com/edi

EDI Solutions Your guide to getting started -- and ensuring smooth transactions empireblue.com/edi EDI Solutions Your guide to getting started -- and ensuring smooth transactions empireblue.com/edi 00175NYPEN Rev. 12/11 This brochure is a helpful EDI reference for both new and experienced electronic

More information

EDI Solutions Your guide to getting started -- and ensuring smooth transactions bcbsga.com/edi

EDI Solutions Your guide to getting started -- and ensuring smooth transactions bcbsga.com/edi EDI Solutions Your guide to getting started -- and ensuring smooth transactions 00175GAPENBGA Rev. 12/11 This brochure is a helpful EDI reference for both new and experienced electronic submitters. It

More information

Anthem Secure Email Mailbox Setup

Anthem Secure Email Mailbox Setup Anthem Secure Email Mailbox Setup What is Secure e-review Secure e-review is a way for providers and facilities to relay information electronically to Anthem for pre-authorizations No need to fax or phone.

More information

Credentialing and Provider Maintenance

Credentialing and Provider Maintenance Anthem Blue Cross and Blue Shield Credentialing and Provider Maintenance Stacy Smith stacy.smith@bcbswi.com May 25, 2011 Anthem Blue Cross and Blue Shield is the trade name of Blue Cross Blue Shield of

More information

837P Health Care Claim Professional

837P Health Care Claim Professional 837P Health Care Claim Professional Revision summary Revision Number Date Summary of Changes 6.0 5/27/04 Verbiage changes throughout the companion guide 7.0 06/29/04 Updated to include the appropriate

More information

837 Professional Health Care Claim Encounter. Section 1 837P Professional Health Care Claim Encounter: Basic Instructions

837 Professional Health Care Claim Encounter. Section 1 837P Professional Health Care Claim Encounter: Basic Instructions Companion Document 837P This companion document is for informational purposes only to describe certain aspects and expectations regarding the transaction and is not a complete guide. The details contained

More information

HIPAA Transaction Standard Companion Guide

HIPAA Transaction Standard Companion Guide HIPAA Transaction Standard Companion Guide American National Standards Institute (ANSI) ASC X12N 837 (005010X222A1) Professional Health Care Claim and Blue Care Network are nonprofit corporations and independent

More information

835 Health Care Claim Payment/Advice Companion Guide

835 Health Care Claim Payment/Advice Companion Guide 835 Health Care Claim Payment/Advice Companion Guide HIPAA/V5010X221A1/835 Version: 1.2 Company: Blue Cross of Idaho Created: 07/18/2014 1.1 Disclaimer Blue Cross of Idaho (BCI) created this Companion

More information

Chapter 5 Claims Submission Unit 1: Benefits of Electronic Communication

Chapter 5 Claims Submission Unit 1: Benefits of Electronic Communication Chapter 5 Claims Submission Unit 1: Benefits of Electronic Communication In This Unit Topic See Page Unit 1: Benefits of Electronic Communication Electronic Connections 2 Electronic Claim Submission Benefits

More information

XEROX EDI GATEWAY, INC.

XEROX EDI GATEWAY, INC. XEROX EDI GATEWAY, INC. HEALTH CARE CLAIM PAYMENT/ADVICE COLORADO MEDICAL ASSISTANCE PROGRAM DEPARTMENT OF HEALTH CARE POLICY AND FINANCING (DHCPF) COMPANION GUIDE May 16 2014 2013 Xerox Corporation. All

More information

837I Health Care Claims Institutional

837I Health Care Claims Institutional 837 I Health Care Claim Institutional For Independence Administrators - 1 Disclaimer This Independence Administrators (hereinafter referred to as IA ) Companion Guide to EDI Transactions (the Companion

More information

837 I Health Care Claim HIPAA 5010A2 Institutional

837 I Health Care Claim HIPAA 5010A2 Institutional 837 I Health Care Claim HIPAA 5010A2 Institutional Revision Number Date Summary of Changes 1.0 5/20/11 Original 1.1 6/14/11 Added within the timeframes required by applicable law to page 32. Minor edits

More information

Administrative Services of Kansas

Administrative Services of Kansas Administrative Services of Kansas ANSI X12N 837D V4010A1 Health Care Claim Companion Guide - Dental, INC BlueCross BlueShield of Western New York BlueShield of Northeastern New York Last Updated March

More information

Horizon Blue Cross and Blue Shield of New Jersey

Horizon Blue Cross and Blue Shield of New Jersey Horizon Blue Cross and Blue Shield of New Jersey Companion Guide for Transaction and Communications/Connectivity Information Instructions related to Transactions based on ASC X12 Implementation Guides,

More information

Managed Care Trading Partner Testing Packet. Managed Care Trading Partners

Managed Care Trading Partner Testing Packet. Managed Care Trading Partners Managed Care Trading Partner Testing Packet Information in this ForwardHealth Managed Care Trading Partner Testing Packet is provided to ForwardHealth managed care s who intend to exchange electronic health

More information

837 I Health Care Claim Institutional

837 I Health Care Claim Institutional 837 I Health Care Claim Institutional Revision Number Date Summary of Changes 6.0 5/27/04 Verbiage changes throughout the companion guide 7.0 06/29/04 Updated to include the appropriate AmeriHealth qualifier

More information

Working with Anthem Subject Specific Webinar Series

Working with Anthem Subject Specific Webinar Series Working with Anthem Subject Specific Webinar Series E-Tools for Providers Access to Audio Portion of Conference: Dial-In Number: 877-497-8913 Conference Code: 1322819809# Please Mute Your Phone This presentation

More information

Open up Internet Explorer, Version 7 or above. Go to: https://hhin.hmsa.com

Open up Internet Explorer, Version 7 or above. Go to: https://hhin.hmsa.com Open up Internet Explorer, Version 7 or above. Go to: https://hhin.hmsa.com HMSA e-claim System: Call HMSA EDI Helpdesk at 948-6355 on Oahu or 1 (800) 377-4672 from the Neighbor Islands. Enter your HHIN

More information

HIPAA 5010 It is important to prepare now Deanna Stohl ETP Contracting and Relations e-business Interchange Group Blue Cross Blue Shield Michigan

HIPAA 5010 It is important to prepare now Deanna Stohl ETP Contracting and Relations e-business Interchange Group Blue Cross Blue Shield Michigan HIPAA 5010 It is important to prepare now Deanna Stohl ETP Contracting and Relations e-business Interchange Group Blue Cross Blue Shield Michigan August 31, 2011 1 Housekeeping Please place your phones

More information

Trading Partner guidelines for 837 5010 professional and institutional submissions. To be added to HN 837 companion guides.

Trading Partner guidelines for 837 5010 professional and institutional submissions. To be added to HN 837 companion guides. Health Net Trading Partner guidelines for 837 5010 professional and institutional submissions. To be added to HN 837 companion guides. Items covered by this document ST / SE Standards ISA / GS Standards

More information

WPS Insurance Corporation - WPS Commercial Business and Epic Life Insurance

WPS Insurance Corporation - WPS Commercial Business and Epic Life Insurance WPS Insurance Corporation - WPS Commercial Business and Epic Life Insurance Standard Companion Guide Trading Partner Information Instructions related to Transactions based on American National Standards

More information

Health Care Reform Administrative Simplification CAQH CORE Phase III EFT & ERA Operational Rules Ramp up to 01/01/14! Meg Barber

Health Care Reform Administrative Simplification CAQH CORE Phase III EFT & ERA Operational Rules Ramp up to 01/01/14! Meg Barber Health Care Reform Administrative Simplification CAQH CORE Phase III EFT & ERA Operational Rules Ramp up to 01/01/14! Meg Barber E-Solutions Business Consultant WellPoint, Inc. Margaret.Barber@Wellpoint.com

More information

837 Professional Health Care Claim. Section 1 837P Professional Health Care Claim: Basic Instructions

837 Professional Health Care Claim. Section 1 837P Professional Health Care Claim: Basic Instructions Companion Document 837P This companion document is for informational purposes only to describe certain aspects and expectations regarding the transaction and is not a complete guide. The details contained

More information

A Reference Manual for Group Administrators. Connecticut. with Prime and Complete Dental Programs. www.anthem.com

A Reference Manual for Group Administrators. Connecticut. with Prime and Complete Dental Programs. www.anthem.com A Reference Manual for Group Administrators with Prime and Complete Dental Programs Connecticut www.anthem.com TABLE OF CONTENTS WELCOME TO ANTHEM BLUE CROSS AND BLUE SHIELD DENTAL PROGRAM / EMPLOYER SERVICES..1

More information

Enrollment Guide for Electronic Services

Enrollment Guide for Electronic Services Enrollment Guide for Electronic Services 2014 Kareo, Inc. Rev. 3/11 1 Table of Contents 1. Introduction...1 1.1 An Overview of the Kareo Enrollment Process... 1 2. Services Offered... 2 2.1 Electronic

More information

EDI Support Frequently Asked Questions

EDI Support Frequently Asked Questions EDI Support Frequently Asked Questions Last revised May 17, 2011. This Frequently Asked Question list is intended for providers or billing staff who may or may not have a technical background. General

More information

Provider Electronic Solutions Trading Partner Testing Packet

Provider Electronic Solutions Trading Partner Testing Packet Provider Electronic Solutions Trading Partner Testing Packet Information in this ForwardHealth Provider Electronic Solutions (PES) Trading Partner Testing Packet is provided to s who intend to exchange

More information

Ancillary Providers General Billing Requirements

Ancillary Providers General Billing Requirements Introduction... 2! Claims Settlement Practices and Provider Dispute Resolution Mechanism Regulations (Assembly Bill 1455)...2 Claim Submission Instructions... 2 Dispute Resolution Process for Contracted

More information

2014 Provider Expo. Karen Geiger Associate General Counsel, Anthem Blue Cross and Blue Shield of Wisconsin

2014 Provider Expo. Karen Geiger Associate General Counsel, Anthem Blue Cross and Blue Shield of Wisconsin Change 2014 Provider Expo Karen Geiger Associate General Counsel, Anthem Blue Cross and Blue Shield of Wisconsin This presentation contains proprietary information of Anthem Blue Cross and Blue Shield.

More information

September 2014. Subject: Changes for the Institutional 837 Companion Document. Dear software developer,

September 2014. Subject: Changes for the Institutional 837 Companion Document. Dear software developer, September 2014 Subject: Changes for the Institutional 837 Companion Document Dear software developer, The table below summarizes the changes to companion document: Section Description of Change Page Data

More information

EDI Support Services

EDI Support Services EDI Support Services Billing Medicare Secondary Payer (MSP) Claims Electronically For All Medicare Part A Trading Partners To bill Medicare Secondary Payer (MSP) claims electronically, the following four

More information

Security Health Plan 837 Companion Guide (Professional) Companion Guide. Health Care Claim. 837 Companion Guide Professional

Security Health Plan 837 Companion Guide (Professional) Companion Guide. Health Care Claim. 837 Companion Guide Professional Companion Guide Health Care Claim 837 Companion Guide Professional Refers to the ASC X12N 837 Technical Report Type 3 Guide (Version 005010X222) June 2016 1 Disclosure Statement Security Health Plan 837

More information

Standard Companion Guide Transaction Information

Standard Companion Guide Transaction Information Standard Companion Guide Transaction Information Instructions Related to 837 Health Care Institutional & Professional Claims Transactions Based on ASC X12 Implementation Guides, Version 005010 ASC X12N

More information

WellPoint Cancer Care Quality Program Provider FAQs

WellPoint Cancer Care Quality Program Provider FAQs WellPoint Cancer Care Quality Program Provider FAQs WellPoint Cancer Care Quality Program What is the WellPoint Cancer Care Quality Program? Anthem Blue Cross and Blue Shield (Anthem) is pleased to bring

More information

Instructions for submitting Claim Reconsideration Requests

Instructions for submitting Claim Reconsideration Requests Instructions for submitting Claim Reconsideration Requests A Claim Reconsideration Request is typically the quickest way to address any concern you have with how we processed your claim. With a Claim Reconsideration

More information

Electronic Transaction Manual for Arkansas Blue Cross and Blue Shield FEDERAL EMPLOYEE PROGRAM (FEP) Dental Claims

Electronic Transaction Manual for Arkansas Blue Cross and Blue Shield FEDERAL EMPLOYEE PROGRAM (FEP) Dental Claims Electronic Transaction Manual for Arkansas Blue Cross and Blue Shield FEDERAL EMPLOYEE PROGRAM (FEP) Dental Claims HIPAA Transaction Companion Document Guide Refers to the X12N Implementation Guide: 005010X224A2:

More information

Agreement to send electronic Colorado Medicaid medical claims

Agreement to send electronic Colorado Medicaid medical claims Agreement to send electronic Colorado Medicaid medical claims This agreement must be completed and approved by Colorado Medicaid prior to sending electronic Colorado Medicaid claims through Secure EDI.

More information

BlueCross BlueShield of Tennessee Electronic Provider Profile

BlueCross BlueShield of Tennessee Electronic Provider Profile Date: Business Name: SECTION 1 PURPOSE FOR PROFILE Please PLACE A CHECK MARK using blue or black ink by the purpose for completing the. The chart below indicates with an X the sections that need to be

More information

****************************************** **************ATTENTION************** ******************************************

****************************************** **************ATTENTION************** ****************************************** 4/4/2006 Cover Page 1 PAYER ID: SKNJ0 SUBMITTER: 9902201 NEW JERSEY MEDICAID MEDICAL **************ATTENTION************** THIS PAYER EDI AGREEMENT MUST BE PROCESSED THROUGH EMDEON S PAYER ENROLLMENT DEPARTMENT.

More information

Electronic Data Interchange (EDI) 5010 Clearinghouse Services Guide

Electronic Data Interchange (EDI) 5010 Clearinghouse Services Guide Electronic Data Interchange (EDI) 5010 Clearinghouse Services Guide A PUBLICATION OF THE EDI DEPARTMENT OF BLUE CROSS AND BLUE SHIELD OF LOUISIANA 18NW1935 R02/12 Blue Cross and Blue Shield of Louisiana

More information

Colorado Medical Assistance Program DSH EDI UPDATE FORM

Colorado Medical Assistance Program DSH EDI UPDATE FORM Current DSH EDI Trading Partner ID: DSH EDI UPDATE FORM DSH EDI Submitters may change/update the following sections of the DSH Electronic Data Interchange (EDI) Submitter Enrollment & Agreement I no longer

More information

Xerox EDI Direct Claims Gateway Communication Document for ASC X12N 837 Health Care Claim Transaction Submission

Xerox EDI Direct Claims Gateway Communication Document for ASC X12N 837 Health Care Claim Transaction Submission Xerox EDI Direct Claims Gateway Communication Document for ASC X12N 837 Health Care Claim Transaction Submission Supporting Institutional, Professional and Dental Transactions for Select Payers Updated

More information

Requirements for HIPAA 5010: Testing & Implementation

Requirements for HIPAA 5010: Testing & Implementation Requirements for HIPAA 5010: Testing & Implementation A PUBLICATION OF THE EDI DEPARTMENT OF BLUE CROSS AND BLUE SHIELD OF LOUISIANA 18NW1906 R04/12 Blue Cross and Blue Shield of Louisiana incorporated

More information

Implementing End-to-End Process Controls To Assure HIPAA 5010 Compliance

Implementing End-to-End Process Controls To Assure HIPAA 5010 Compliance Implementing End-to-End Process Controls To Assure HIPAA 5010 Compliance Executive Summary Client: Health Insurance Payer Industry: Healthcare Insurance Challenges: Compliance mandates were costly to achieve

More information

837 Professional Health Care Claim

837 Professional Health Care Claim Companion Document 837P 837 Professional Health Care Claim Basic Instructions This section provides information to help you prepare for the ANSI ASC X12N 837 Health Care transaction for professional claims.

More information

Section Description of Change Page

Section Description of Change Page July 2012 Subject: Changes for the Professional 837 and 835 Companion Document Dear software developer, A revised, updated copy of the ANSI ASC X12N 837 & 835 Professional Health Care Claim & Health Care

More information

HIPAA X 12 Transaction Standards

HIPAA X 12 Transaction Standards HIPAA X 12 Transaction Standards Companion Guide 837 Professional/ Institutional Health Care Claim Version 5010 Trading Partner Companion Guide Information and Considerations 837P/837I June 11, 2012 Centene

More information

Electronic Data Interchange (EDI) EDI Claim Confirmation Report

Electronic Data Interchange (EDI) EDI Claim Confirmation Report Electronic Data Interchange (EDI) EDI Claim Confirmation Report Recent upgrades to Blue Shield of California s electronic data interchange (EDI) system offer improved reporting to claims trading partners.

More information

ancillary claims filing requirements: DME claims

ancillary claims filing requirements: DME claims ancillary claims filing requirements: DME claims Presented by: Ian Bautista, Network Manager Ancillary & Specialty Networks Blue Shield of California September 27, 2012 agenda Objectives for this presentation:

More information

CMS. Standard Companion Guide Transaction Information

CMS. Standard Companion Guide Transaction Information CMS Standard Companion Guide Transaction Information Instructions related to the 837 Health Care Claim: Professionals based on ASC X Technical Report Type 3 (TR3), version 00500A Companion Guide Version

More information

2011 Provider Workshops. EDI Presents

2011 Provider Workshops. EDI Presents 2011 Provider Workshops EDI Presents 1 Electronic Transaction Exchange The electronic format you exchange with BCBSLA today is referred to as: ANSI 4010A1, HIPAA 4010A1 or 4010 Changes have been made and

More information

837 Health Care Claim: Institutional Companion Guide. HIPAA version 5010

837 Health Care Claim: Institutional Companion Guide. HIPAA version 5010 837 Health Care Claim: Institutional Companion Guide HIPAA version 5010 Version 1.6.3 Status: Published October 28, 2015 Blue Cross & Blue Shield of Rhode Island is an independent licensee of the Blue

More information

APEX BENEFITS SERVICES COMPANION GUIDE 837 Institutional Health Care Claims. HIPAA Transaction Companion Guide 837 Institutional Health Care Claim

APEX BENEFITS SERVICES COMPANION GUIDE 837 Institutional Health Care Claims. HIPAA Transaction Companion Guide 837 Institutional Health Care Claim HIPAA Transaction Companion Guide 837 Institutional Health Care Claim Refers to the Implementation Guides Based on X12 version 004010 Addendum Companion Guide Version Number: 1.3 May 23, 2007 Disclaimer

More information

DENTAL COLORADO MEDICAID EDI UPDATE

DENTAL COLORADO MEDICAID EDI UPDATE 220 Burnham Street South Windsor CT 06074 Vox 888-255-7293 Fax 860-289-0055 DENTAL COLORADO MEDICAID EDI UPDATE PAYER ID NUMBER CKCO1 ELECTRONIC REGISTRATIONS Agreements Required PROVIDER ENROLLMENT FORM

More information

Update on Anthem Cyber Attack General Information for Clients and Brokers

Update on Anthem Cyber Attack General Information for Clients and Brokers Update on Anthem Cyber Attack General Information for Clients and Brokers February 20, 2015 What happened? Anthem, Inc. was the victim of a cyber attack. Anthem discovered that one of its database warehouses

More information

To access the claims transaction tools, select the claims tab on the homepage.

To access the claims transaction tools, select the claims tab on the homepage. Anthem HealthKeepers Medicare-Medicaid Plan (MMP), a Commonwealth Coordinated Care plan website user guide: https://mediproviders.anthem.com/va/pages/home.aspx Claims transaction tools The claims transaction

More information

837 Institutional Health Care Claim. Section 1 837I Institutional Health Care Claim: Basic Instructions

837 Institutional Health Care Claim. Section 1 837I Institutional Health Care Claim: Basic Instructions Companion Document 837I 837 Institutional Health Care Claim This companion document is for informational purposes only to describe certain aspects and expectations regarding the transaction and is not

More information

ActivHealthCare EDI User Guide

ActivHealthCare EDI User Guide ActivHealthCare EDI User Guide Table of Contents Page Enrollment 2 Preparing Your Management Software 3 Claims Submission for AHC Network Affiliates 4 Online Entry Tool 7 Claims Follow-Up 8 Frequently

More information

Pre-processor rejections Error descriptions U277 details Claims resolution instructions A B C D F A3 21 A3 454 2400.SV101-2 A3 21 A3 454 A3 21 A3 454

Pre-processor rejections Error descriptions U277 details Claims resolution instructions A B C D F A3 21 A3 454 2400.SV101-2 A3 21 A3 454 A3 21 A3 454 P0001a Procedure Code P0001a Procedure on service line is invalid. Please correct and A3 21 A3 454 2400.SV101-2 The procedure submitted on the claim was in a valid procedure. P0001b Procedure Code P0001b

More information

UnitedHealthcare West. HIPAA Transaction Standard Companion Guide

UnitedHealthcare West. HIPAA Transaction Standard Companion Guide UnitedHealthcare West HIPAA Transaction Standard Companion Guide Refers to the Technical Report Type 3 (TR3) Implementation Guides Based on ASC X12 Version 005010X223A2 Health Care Claim: Institutional

More information

Wright State University. How to Get the Most Out of Your Medical & Pharmacy Plans

Wright State University. How to Get the Most Out of Your Medical & Pharmacy Plans Wright State University How to Get the Most Out of Your Medical & Pharmacy Plans Strength in numbers And when you combine that with the power of Blue, we re virtually unstoppable 97% of hospitals 92% of

More information

RAILROAD MEDICARE PRE- ENROLLMENT INSTRUCTIONS MR018

RAILROAD MEDICARE PRE- ENROLLMENT INSTRUCTIONS MR018 RAILROAD MEDICARE PRE- ENROLLMENT INSTRUCTIONS MR018 TO COMPLETE THIS FORM YOU WILL NEED to use Internet Explorer to Open Links. Railroad Medicare Provider Number (PTAN) Billing NPI on file with Palmetto

More information

Understanding the impact of the Affordable Care Act (ACA) on vision coverage and care delivery

Understanding the impact of the Affordable Care Act (ACA) on vision coverage and care delivery Understanding the impact of the Affordable Care Act (ACA) on vision coverage and care delivery July 28, 2015 Presented by: Jeff Spahr, VP Specialty Business 1 1 The vision insurance market: pre-aca Benefit

More information

CMS-1500 Claim Form/American National Standards Institute (ANSI) Crosswalk for Paper/Electronic Claims

CMS-1500 Claim Form/American National Standards Institute (ANSI) Crosswalk for Paper/Electronic Claims There are two ways to file Medicare claims to CGS - electronically or through a paper form created by the Centers for Medicare & Medicaid Services (CMS-1500). The required information is the same regardless

More information

Connectivity and Communications

Connectivity and Communications Chapter 5 Connectivity and Communications This chapter provides information to establish an electronic communications session with Anthem and to submit and receive files. Important: Do not send duplicate

More information

Physical Therapy/Occupational Therapy Utilization Management Program FAQs November 2015

Physical Therapy/Occupational Therapy Utilization Management Program FAQs November 2015 Physical Therapy/Occupational Therapy Utilization Management Program FAQs November 2015 Background: Effective November 1, 2015, Anthem Blue Cross and Blue Shield (Anthem) implemented a physical therapy

More information

ARIZONA FOUNDATION FOR MEDICAL CARE ANSI X12 837 V.5010 COMPANION GUIDE. 1 Arizona Foundation for Medical Care

ARIZONA FOUNDATION FOR MEDICAL CARE ANSI X12 837 V.5010 COMPANION GUIDE. 1 Arizona Foundation for Medical Care ARIZONA FOUNDATION FOR MEDICAL CARE ANSI X12 837 V.5010 COMPANION GUIDE 1 Arizona Foundation for Medical Care TABLE OF CONTENTS EDI Communication...3 Getting Started...3 Testing...4 Communications...4

More information

835 Dental Health Care Claim Payment / Advice. Section 1 835D DentalHealth Care Claim Payment / Advice: Basic Instructions

835 Dental Health Care Claim Payment / Advice. Section 1 835D DentalHealth Care Claim Payment / Advice: Basic Instructions Companion Document 835D 835 Dental Health Care Claim Payment / Advice This companion document is for informational purposes only to describe certain aspects and expectations regarding the transaction and

More information

Background. What You Need to Do to Get Ready for Electronic Billing

Background. What You Need to Do to Get Ready for Electronic Billing 9645 Granite Ridge Drive Suite 230 San Diego, California 92123 support@e- dsi.com http://www.e- dsi.com Electronic Transactions Enrollment Step by Step A guide to the steps necessary for new clients to

More information

HMSA e-claims. Training Manual

HMSA e-claims. Training Manual HMSA e-claims Training Manual Table of Contents Chapter 1: INTRODUCTION... 2 About HMSA e-claim... 2 Accessing HMSA e-claim System... 3 Chapter 2: DASHBOARD... 4 HMSA e-claim Dashboard... 4 Generate Claim...

More information

Claims Training Guide

Claims Training Guide Claims Training Guide For exclusive use by Last Revised on 6-13-2007 10:50:00 AM Welcome... 3 Rejected Claims Dashboard... 6 Claims... 8 Editing Claims... 13 Working Claim Rejections... 16 Batches... 20

More information

. NOTE: See Chapter 5 - Medical Management System for conditions that must be met in CHAPTER 6. ELECTRONIC CLAIMS PROCESSING MODULE

. NOTE: See Chapter 5 - Medical Management System for conditions that must be met in CHAPTER 6. ELECTRONIC CLAIMS PROCESSING MODULE Electronic Claims Processing Module 6-1 CHAPTER 6. ELECTRONIC CLAIMS PROCESSING MODULE Processing claims electronically is an option that may be selected in place of or in conjunction with the processing

More information

Anthem Blue Cross and Blue Shield (Anthem) BadgerCare Plus

Anthem Blue Cross and Blue Shield (Anthem) BadgerCare Plus Anthem Blue Cross and Blue Shield (Anthem) BadgerCare Plus Resources and tools Anthem Blue Cross and Blue Shield (Anthem) provider website Member identification (ID) card Call center Claims payments Remittance

More information

Introduction. Companion Guide to X12 Transactions version 5010

Introduction. Companion Guide to X12 Transactions version 5010 Introduction Companion Guide to X12 Transactions version 5010 Introduction: Table of Contents Table of Contents: Introduction Overview... 1 Purpose... 1 Content... 1 Document Structure... 1 Term Usage...

More information

EDI REPORTS USER GUIDE

EDI REPORTS USER GUIDE EDI REPORTS USER GUIDE BlueCross BlueShield of South Carolina is an independent licensee of the Blue Cross and Blue Shield Association EDI REPORTS USER GUIDE Electronic claim filers can access EDI claim

More information

Member Medical History Plus: How MMH+ Can Help You Transform Your Practice

Member Medical History Plus: How MMH+ Can Help You Transform Your Practice Member Medical History Plus: How MMH+ Can Help You Transform Your Practice MMH+ is designed around you MMH+ provides patient-based personal health information online MMH+ is easy to use: Practices don

More information

(Delaware business only) HIPAA Transaction Standard Companion Guide

(Delaware business only) HIPAA Transaction Standard Companion Guide AmeriHealth (Delaware business only) HIPAA Transaction Standard Companion Guide Refers to the Implementation Guides Based on ASC X12 Implementation Guides, version 005010 February 2014 February 2014 005010

More information

Your Guide to Anthem HealthKeepers Plus Web Updates and Other Changes

Your Guide to Anthem HealthKeepers Plus Web Updates and Other Changes Your Guide to Anthem HealthKeepers Plus Web Updates and Other Changes Effective November 1, 2013, we have made some great changes to our provider website and a few of our tools. Recently, we announced

More information

WPS Health Insurance

WPS Health Insurance WPS Health Insurance HIPAA Transaction Standard Companion Guide Refers to the Implementation Guides Based on ASC X12 version 005010X222A1 and 005010X223A2 Companion Guide Version Number: V2.2 November

More information

BLUE CROSS BLUE SHIELD OF NORTH EAST NEW YORK PRE ENROLLMENT INSTRUCTIONS 00800

BLUE CROSS BLUE SHIELD OF NORTH EAST NEW YORK PRE ENROLLMENT INSTRUCTIONS 00800 BLUE CROSS BLUE SHIELD OF NORTH EAST NEW YORK PRE ENROLLMENT INSTRUCTIONS 00800 HOW LONG DOES PRE ENROLLMENT TAKE? 3 to 5 business days WHERE SHOULD I SEND THE FORMS? Fax the form to 785 290 0720 WHAT

More information

Chapter 4: Process Flow

Chapter 4: Process Flow Chapter 4 Process Flow The Enterprise EDI Gateway (Gateway) is a critical component to the process of exchanging electronic transactions with trading partners. Its programs expedite the movement of transactions

More information

HIPAA 5010 March 30 th National Call: Provider Testing and Readiness Resource Mailbox Questions and Answers

HIPAA 5010 March 30 th National Call: Provider Testing and Readiness Resource Mailbox Questions and Answers HIPAA 5010 March 30 th National Call: Provider Testing and Readiness Resource Mailbox Questions and Answers Background: As mentioned on previous HIPAA 5010 national calls, there is a resource box that

More information

GETTING STARTED WITH EDISS AND TOTAL ONBOARDING (TOB)

GETTING STARTED WITH EDISS AND TOTAL ONBOARDING (TOB) GETTING STARTED WITH EDISS AND TOTAL ONBOARDING (TOB) Table of Contents What is an electronic transaction?...2 What forms will be required for EDISS registration now that TOB is effective for most lines

More information

HP SYSTEMS UNIT. Companion Guide: Electronic Data Interchange Reports and Acknowledgements

HP SYSTEMS UNIT. Companion Guide: Electronic Data Interchange Reports and Acknowledgements HP SYSTEMS UNIT I N D I A N A H E A L T H C O V E R A G E P R O G R A M S Companion Guide: Electronic Data Interchange Reports and Acknowledgements L I B R A R Y R E F E R E N C E N U M B E R : CLEL1 0

More information

National Provider Identifier (NPI) Frequently Asked Questions

National Provider Identifier (NPI) Frequently Asked Questions National Provider Identifier (NPI) Frequently Asked Questions I. GETTING, SHARING, AND USING NPI GENERAL QUESTIONS II. TYPE 1 (INDIVIDUAL) VS TYPE 2 (ORGANIZATIONAL) III. ELECTRONIC CLAIM SUBMISSION IV.

More information

EZClaim Advanced 9 ANSI 837P. Capario Clearinghouse Manual

EZClaim Advanced 9 ANSI 837P. Capario Clearinghouse Manual EZClaim Advanced 9 ANSI 837P Capario Clearinghouse Manual EZClaim Medical Billing Software December 2013 Capario Client ID# Capario SFTP Password Enrollment Process for EDI Services 1. Enroll with the

More information

5010 Gap Analysis for Dental Claims. Based on ASC X12 837 v5010 TR3 X224A2 Version 2.0 August 2010

5010 Gap Analysis for Dental Claims. Based on ASC X12 837 v5010 TR3 X224A2 Version 2.0 August 2010 5010 Gap Analysis for Dental Claims Based on ASC X12 837 v5010 TR3 X224A2 Version 2.0 August 2010 This information is provided by Emdeon for education and awareness use only. Even though Emdeon believes

More information

835 Health Care Claim Payment / Advice

835 Health Care Claim Payment / Advice Companion Document 835 835 Health Care Claim Payment / Advice This companion document is for informational purposes only to describe certain aspects and expectations regarding the transaction and is not

More information

Colorado Medical Assistance Program

Colorado Medical Assistance Program Provider ID: Colorado Medical Assistance Program EDI UPDATE FORM Provider s Current Trading Partner ID: Providers may change/update the following sections of the ELECTRONIC DATA INTERCHANGE PROVIDER ENROLLMENT

More information