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This document serves as a comprehensive guide for the implementation and use of the ASC X12 Health Care Claim Payment/Advice transaction (835) within the PacifiCare system, clarifying processing standards
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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
Obtain the PacifiCare Electronic Data Interchange 835 Transaction Companion Guide from the official website or your representative.
02
Review the guide's structure and sections to understand how to navigate through it.
03
Locate the specific sections relevant to your business or claims processing needs.
04
Fill out the provider information accurately, including NPI and tax identification numbers.
05
Enter the patient and claim details according to the defined fields within the guide.
06
Validate the data against the requirements specified in the guide to ensure accuracy.
07
Use the correct codes for diagnoses, procedures, and modifiers as outlined in the guide.
08
Review the payment information and calculate any adjustments or denials if necessary.
09
Submit the completed 835 transaction electronically as per PacifiCare's submission guidelines.
10
Keep a copy of all submitted documents for future reference and reconciliation.
Who needs PacifiCare Electronic Data Interchange 835 Transaction Companion Guide?
01
Healthcare providers and organizations that bill PacifiCare for services rendered.
02
Billing departments or staff responsible for processing electronic claims.
03
Healthcare software vendors who develop platforms for electronic claims submission.
04
Accountants or financial teams managing healthcare reimbursements.
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People Also Ask about
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 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 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 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 instructions and guidelines for using the 835 transaction set, which is used for electronic remittance advice in healthcare payment processes.
Who is required to file PacifiCare Electronic Data Interchange 835 Transaction Companion Guide?
Healthcare providers, payers, and clearinghouses that engage in electronic transactions with PacifiCare are required to adhere to the guidelines outlined 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 should follow the step-by-step instructions provided in the guide, ensuring all required fields are completed accurately according to PacifiCare's specifications for electronic remittance advice.
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 accurate and efficient electronic communication of payment information between healthcare providers and PacifiCare, streamlining the payment process and minimizing errors.
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 payment amounts, patient details, claim numbers, and adjustments to ensure accurate reconciliation of healthcare claims.
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