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This document serves as a comprehensive guide for the implementation and processing of the ASC X12 Health Care Claim Payment/Advice (835) transaction set for trading partners of PacifiCare. It details
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How to fill out pacificare electronic data interchange
How to fill out PacifiCare Electronic Data Interchange 835 Transaction Companion Guide
01
Step 1: Obtain the PacifiCare Electronic Data Interchange 835 Transaction Companion Guide document from the official PacifiCare website.
02
Step 2: Review the introduction section to understand the purpose and scope of the 835 transaction.
03
Step 3: Familiarize yourself with the key terms and definitions provided in the glossary.
04
Step 4: Follow the specifications in the guide to set up your software for 835 transactions.
05
Step 5: Pay attention to the segment structure and map out the required fields for data entry.
06
Step 6: Input the relevant data according to the guidelines for providers, payers, and other stakeholders.
07
Step 7: Validate the format and check for any errors before submission.
08
Step 8: Submit the completed 835 transaction to PacifiCare and monitor for confirmation.
Who needs PacifiCare Electronic Data Interchange 835 Transaction Companion Guide?
01
Healthcare providers who submit claims to PacifiCare and require payment information.
02
Billing departments and administrative staff within healthcare organizations that manage electronic claims and remittances.
03
Third-party billing services that handle financial transactions on behalf of providers.
04
IT personnel responsible for integrating EDI systems and ensuring compliance with transactional standards.
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People Also Ask about
What is an EDI companion guide?
Our Electronic Data Interchange (EDI) Companion Guides describe specific requirements for trading partners who exchange electronic transactions directly with Blue Shield of California Promise Health Plan (not through a vendor or clearinghouse).
What is claim status code 835?
HIPAA 835: The 835 transaction is a standard transaction mandated by the Health Insurance Portability and Accountability Act (HIPAA) and is used to transfer payment and remittance information for adjudicated professional and institutional health care claims.
What is the 835 format in medical billing?
The 835 (Health Care Claim Payment/Advice) is part of the ASC X12N 835 standard, which is a HIPAA-compliant electronic transaction format. It provides healthcare providers with essential payment details, including: Payment amounts for claims. Adjustments and denials.
What is the EDI transaction code 835?
What is EDI 835? EDI 835 is a transaction set for Healthcare Claim Payment and Remittance Advice. Insurance companies use it to communicate payment details to healthcare providers, including information on paid, denied, or adjusted claims, as well as deductibles, co-pays, and co-insurance.
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What is PacifiCare Electronic Data Interchange 835 Transaction Companion Guide?
The PacifiCare Electronic Data Interchange 835 Transaction Companion Guide is a document that provides detailed instructions and specifications for the electronic exchange of healthcare payment and remittance information between healthcare providers and payers, specifically designed for the 835 transaction format.
Who is required to file PacifiCare Electronic Data Interchange 835 Transaction Companion Guide?
Healthcare providers and billing organizations that engage in electronic transactions with PacifiCare for the purpose of receiving payment and remittance information are required to adhere to the specifications laid out in the PacifiCare Electronic Data Interchange 835 Transaction Companion Guide.
How to fill out PacifiCare Electronic Data Interchange 835 Transaction Companion Guide?
To fill out the PacifiCare Electronic Data Interchange 835 Transaction Companion Guide, users must follow the structured format provided in the guide, which includes completing the required fields with accurate patient, provider, and payment information as specified in the guidelines.
What is the purpose of PacifiCare Electronic Data Interchange 835 Transaction Companion Guide?
The purpose of the PacifiCare Electronic Data Interchange 835 Transaction Companion Guide is to facilitate standardization and streamline the electronic transmission of payment and remittance information, aiming to improve the efficiency of billing and payment processes in healthcare transactions.
What information must be reported on PacifiCare Electronic Data Interchange 835 Transaction Companion Guide?
The information that must be reported on the PacifiCare Electronic Data Interchange 835 Transaction Companion Guide includes details such as claim payment amounts, adjustments, patient account numbers, service dates, and provider information, ensuring all necessary financial data is accurately documented.
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