Lesson 3 Summary
- EDI makes claim processing faster by moving data electronically. It also is generally lower cost than paper transactions.
- To use Medicare EDI, complete a Medicare EDI Enrollment Form and the EDI registration form. These are required for all EDI transactions with Medicare, whether direct or through a billing service or clearinghouse.
- Third parties must meet Medicare’s rules.
- HIPAA requires everyone to follow the same electronic health data rules.
- NPI is an ID for health care businesses, and they can get an NPI in multiple ways.
- Software for claims must follow specific rules. Some are free or low-cost.
- ASC X12 837 Format is the standard way to send claims to Medicare electronically.
- Guides can help you understand rules, including those specific to Medicare.
- Standard Transactions mainly deal with the 837P claim, but there are other options too.