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EDI |
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EMD supports submitting electronic data
via billing clearing houses and direct
payers. Our EDI broker and SDK provide
the ability to build CNS-1500 ASC X12
EDI data message, transmit the EDI
message, receive EDI message, and
process received EDI messages. Our EDI
technology is most commonly used to
provide HIPAA compliant insurance
claims, insurance claim status,
insurance eligibility (270), and
insurance authorization (278).
EMD is an active member of ASC X12. This
ensures that we are fully up to date and
knowledgeable about the progression and
use of the EDI standard.
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EDI STANDARS |
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Electronic data interchange (EDI) is the
structured transmission of data between
organizations by electronic means, which
is used to transfer electronic documents
or business data from one computer
system to another computer system, i.e.
from one trading partner to another
trading partner without human
intervention. It is more than mere
e-mail; for instance, organizations
might replace bills of lading and even
cheques with appropriate EDI messages.
In 1996, the National Institute of
Standards and Technology defined
electronic data interchange as "the
computer-to-computer interchange of
strictly formatted messages that
represent documents other than monetary
instruments. EDI implies a sequence of
messages between two parties, either of
whom may serve as originator or
recipient. The formatted data
representing the documents may be
transmitted from originator to recipient
via telecommunications or physically
transported on electronic storage
media." It distinguishes mere electronic
communication or data exchange,
specifying that "in EDI, the usual
processing of received messages is by
computer only. Human intervention in the
processing of a received message is
typically intended only for error
conditions, for quality review, and for
special situations. For example, the
transmission of binary or textual data
is not EDI as defined here unless the
data is treated as one or more data
elements of an EDI message and it is not
normally intended for human
interpretation as part of online data
processing."
EDI can be formally defined as the
transfer of structured data, by agreed
message standards, from one computer
system to another without human
intervention.
http://tools.ietf.org/html/rfc3335
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INSURANCE CLAIM |
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Electronic Claims Submission is also
known as EDI. This allows health care
providers to automatically send and
receive health care claims information.
Insurance company’s portal syncs with
all HIPAA - compliant electronic
transactions and the benefits are
multiple.
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Claim forms are not
required |
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Postage expenses are done
away |
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Shores up administrative
tasks and office productivity |
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Faster yet accurate
processing |
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Saves the use of paper and
conservers nature |
Claims can be made by taking recourse to
two methods, either directly to
insurance provider or through a third
party clearing house.
In the insurance business the
submission of claims will be one of the
most occurring, time-consuming and
complex tasks in an office. With the
introduction of electronic method or EDI
there is more accuracy of claims, better
tracking and improved office
productivity. There is easy
identification of errors and hence
claims can be easily corrected before
submission. The end result is fewer
payer rejections and complications which
means faster claim payments.
EDI facilitates easy submission and
faster claim payments
The BMC HealthNet Plan makes it
convenient for BMC HealthNet Providers
to submit claims electronically. This
has vastly reduced their administrative
costs and the claims get paid faster by
more than a week compared to manual
submission. More than 90 percent of the
network medical, behavioural health and
hospital providers are submitting claims
electronically, and reaping the
benefits.
The benefits include:
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Faster turnaround on claims |
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Speedy payment process |
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Less of submission errors |
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Reduced administrative
costs |
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Corrections can be carried
out online |
As far as from 2003, BMC HealthNet Plan
has been receiving and processing
provider claims online using
clearinghouses such as Allscripts/Payerpath,
Capario (ProxyMed/MedAvant), Emdeon
(WebMD/Envoy), Gateway EDI, Relay Health
(Mckesson), or the SSI Group. EDI claims
from providers who submit claims through
NEHEN, and providers who submit claims
directly are accepted. BMC HealthNet
Plan can also provide electronic
remittance advices to those providers
who submit electronic claims. It
takes only five minutes to submit the
claim electronically.
If you are associated with Emdeon, NEHEN,
Capario, Gateway EDI, RelayHealth,
Allscripts/Payerpath, The SSI Group, or
any other clearinghouse or billing
agency, then you can contact their
representative and let know that you
would like to start submitting claims
electronically to BMC HealthNet Plan.
Most importantly, direct submission of
claims using 837 claims submission
format is promoted by us.
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INSURANCE CLAIM STATUS |
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This page is under construction, please check back shortly.
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INSURANCE ELIGIBILITY (270) |
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Electronically confirm the status of a
patient’s insurance within seconds. This
process is facilitated via an EDI
interface with a Clearing House.
Additionally, the eligibility can be
manually tracked and entered.
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INSURANCE AUTHORIZATION (278) |
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Processing insurance pre-authorizations
can be tricky business without a
sophisticated management system. Our
applications records all the staff
member who obtained the authorization,
authorization number, referral number,
effective date, expiration date, issue
date, and notes. Authorizations are tied
directly to the patient and the exam.
The authorization status is updated to
the application dashboard to inform
front desk staff of a patient's
authorization status.
The requirement for pre-authorization
can be configured based on the CPT code
ordered and the insurance carrier
entered for the patient.
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EMD EDI SDK |
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EMD supports submitting electronic data
via billing clearing houses and direct
payers. Our EDI broker and SDK provide
the ability to build CNS-1500 ASC X12
EDI data message, transmit the EDI
message, receive EDI message, and
process received EDI messages. Our EDI
technology is most commonly used to
provide HIPAA compliant insurance
claims, insurance claim status,
insurance eligibility (270), and
insurance authorization (278).
EMD is an active member of ASC X12. This
ensures that we are fully up to date and
knowledgeable about the progression and
use of the EDI standard.
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