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This document provides detailed specifications for the MACSIS 837 Professional Claim format, including definitions, usage guidelines, and examples for each data segment within the file.
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How to fill out macsis 837 professional claim
How to fill out MACSIS 837 Professional Claim v5010 Information Guide
01
Obtain the MACSIS 837 Professional Claim v5010 Information Guide from the official website or relevant source.
02
Review the instructions thoroughly to understand the required fields and formatting.
03
Gather patient information including name, date of birth, and insurance details.
04
Enter provider information such as name, NPI, and any relevant credentials.
05
Complete the claim details including procedure codes, diagnosis codes, and service dates.
06
Check for any required attachments or documentation that need to accompany the claim.
07
Review the completed form for accuracy and compliance with claim submission requirements.
08
Submit the filled-out claim form electronically or via the method specified in the guide.
Who needs MACSIS 837 Professional Claim v5010 Information Guide?
01
Healthcare providers who intend to bill for services rendered to patients using the MACSIS system.
02
Billing specialists and administrative staff in healthcare organizations that require MACSIS claims processing.
03
Organizations participating in Medicaid or other government-funded health programs.
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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 ASC X12N 837P v 5010 transaction?
ASC X12N 837 v.5010 Health Care Claim Formerly known as CMC, the ASC X12N 837 v. 5010 transaction is used to submit professional and institutional medical claims, billing information and other information to Medi-Cal.
What is the 837 electronic claim format for professional claims?
The 837P is the standard format health care professionals and suppliers use to submit health care claims electronically. The ANSI ASC X12N 837P Version 5010A1 is the current electronic claim version.
What is the EDI 837 format?
Professional Paper Claim Form (CMS-1500)
What is the 837 claim process?
EDI 837 is submitted by healthcare providers after services are rendered to request payment from the insurance provider. This transaction contains details about the services provided, diagnosis, and charges. Claim Status Check: If needed, the provider sends EDI 276 to check the status of the submitted claim.
Which claim form is used for professional claims?
The 837I is the standard format institutional providers use to submit health care claims electronically.
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What is MACSIS 837 Professional Claim v5010 Information Guide?
The MACSIS 837 Professional Claim v5010 Information Guide is a document that provides detailed instructions on how to submit professional claims electronically using the MACSIS system in accordance with the 5010 format.
Who is required to file MACSIS 837 Professional Claim v5010 Information Guide?
Providers who render services to individuals eligible for Medicaid and other health care programs managed by MACSIS are required to file the MACSIS 837 Professional Claim v5010.
How to fill out MACSIS 837 Professional Claim v5010 Information Guide?
To fill out the MACSIS 837 Professional Claim v5010, providers must follow the formatting requirements outlined in the guide, ensuring that all fields are completed accurately, including patient information, service details, and provider identifiers.
What is the purpose of MACSIS 837 Professional Claim v5010 Information Guide?
The purpose of the MACSIS 837 Professional Claim v5010 Information Guide is to standardize the submission of professional claims, ensuring compliance with federal and state regulations, and facilitating efficient processing and payment of claims.
What information must be reported on MACSIS 837 Professional Claim v5010 Information Guide?
The MACSIS 837 Professional Claim v5010 requires reportable information including patient demographics, the provider's NPI, service codes, dates of service, amounts billed, and any other pertinent details relevant to the claim.
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