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This document serves as a companion guide for the ASC X12 Health Care Claim Payment/Advice (835) transaction set, providing detailed specifications and instructions to minimize variability in the
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How to fill out PacifiCare Electronic Data Interchange 835 Transaction Companion Guide

01
Obtain the PacifiCare Electronic Data Interchange 835 Transaction Companion Guide from the official website or contact support.
02
Review the table of contents to understand the structure and sections of the guide.
03
Read the introduction to familiarize yourself with the purpose of the 835 transaction.
04
Follow the instructions in Section 1 for setting up your software to accept 835 transactions.
05
Refer to Section 2 for specific data fields and their definitions, ensuring you know how to map your data accordingly.
06
Use the sample formats provided in Section 3 to correctly format your 835 transactions.
07
Test the 835 transaction process as per the testing guidelines outlined in Section 4.
08
Review the Frequently Asked Questions and troubleshooting section to clarify any concerns before going live.

Who needs PacifiCare Electronic Data Interchange 835 Transaction Companion Guide?

01
Healthcare providers who bill PacifiCare for services rendered.
02
Billing companies that process claims on behalf of healthcare providers.
03
Healthcare organizations needing to reconcile payments received from PacifiCare.
04
Anyone involved in managing electronic claims and payments for PacifiCare clients.
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People Also Ask about

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.
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 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.
Companion Guides (CGs) may contain two types of data, instructions for electronic communications with the publishing entity (Communications/Connectivity Instructions) and supplemental information for creating transactions for the publishing entity while ensuring compliance with the associated ASC X12 IG (Transaction
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.
Companion Guides are designed to reinforce online course material, helping students focus on important concepts and organize their study time for quizzes and exams.
Use of EDI transactions allows a provider to submit transactions faster and be paid for claims faster, and to accomplish this at a lower cost than is generally the case for paper or manual transactions.
This Companion Guide to the ASC X12 Benefit Enrollment and Maintenance (834) transaction, based on the 005010X220A1 addenda adopted under HIPAA specifies the data format and content requirements for electronic data interchange between Washington Health Benefit Exchange (HBE) and participating carriers.

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The PacifiCare Electronic Data Interchange 835 Transaction Companion Guide is a document that provides instructions and specifications for the use of the 835 transaction format, which is used for electronically transmitting payment and remittance information between healthcare providers and insurers.
Healthcare providers, billing companies, and any entities involved in the electronic transmission of healthcare payment and remittance information to and from PacifiCare are required to utilize the PacifiCare Electronic Data Interchange 835 Transaction Companion Guide.
To fill out the PacifiCare Electronic Data Interchange 835 Transaction Companion Guide, users must follow the outlined formats and requirements for each field specified in the guide, ensuring to accurately input payment details, remittance information, and other relevant data as directed.
The purpose of the PacifiCare Electronic Data Interchange 835 Transaction Companion Guide is to standardize the electronic exchange of healthcare payment data, streamline billing processes, and enhance communication between healthcare providers and payers.
The information that must be reported includes details such as claim payment amounts, adjustments, patient information, service dates, provider identifiers, and any relevant payment reason codes.
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PacifiCare 835 transaction Health Care Claim Payment Electronic Data Interchange HIPAA compliance EDI remittance advice trading partners health information transaction processing

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