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Advance Insurance Company of Kansas logo

Getting Started

 

 

What is EDI?

EDI is the computer-to-computer transmission of business data in a standard format, which replaces a traditional paper business document.

Who can use ASK services?

ASK can accept claims directly for these payers at no cost.

TRANSACTIONS BENEFITS

Claims

  • 837P – Professional
  • 837I  - Institutional
  • 837D – Dental

Primary and Secondary

  • Eliminate paper forms
  • Increase your office’s efficiency
  • EDI Edits eliminate claim errors
  • Acknowledgements assure your claims were received
  • Get claims paid faster

Eligibility Inquiry/Benefit

  • 270 – Request

May be done as a Batch or Real Time transaction

  • Electronically verify patient eligibility and benefits
  • Designed to automatically generate and update your management system

Claims Status

  • 276 – Request

May be done as a Batch or Real Time transaction

  • Automatically generate request to check status of claim
  • Check aging status in one transaction

Payment Advice (Remittance Advice)

  • 835
  • Designed for automatic posting to management system
  • Store remittance advice electronically
  • End paper remits

What are the benefits of a Real Time transaction?

  • In real time mode the sender remains connected while the receiver processes the transaction.  The receiver immediately returns a response transaction to the sender.

What are your next steps?

  • Contact your software vendor regarding the support of these transactions.
  • Complete an enrollment form
    • An 835 (electronic remittance) enrollment must be completed for this transaction. 
    • Current trading partners may request additional transactions by completing the Change Form.

Note:  EDI Midwest Clearinghouse offers electronic claims filing to more than 900 additional payers.

  • EDI 101
    • Acknowledgements Manual
    • Code lists (offsite link)
    • EDI Transactions by Payer
    • HIPAA

      What is HIPAA?

      The Health Insurance Portability and Accountability Act of 1996. The Administrative Simplification provisions of HIPAA are intended to reduce the costs and administrative burdens of health care by making possible the standardized, electronic transmission of many transactions that are carried out manually on paper or have several different formats for each.

      There are several transactions that have been standardized as a result of HIPAA. Trading Partners are encouraged to contact their vendors about the possible use of these transactions.

      Note: Effective Monday, October 24, 2016 all Trading Partner Agreements and accompanying Business Associate Riders, entered into between Administrative Services of Kansas, Inc. and a trading partner between the dates of July 1, 2002 and June 30, 2004 are no longer in effect.

    • Implementation Guides (offsite link)
    • Life of a Claim

      Providers submitting claims to a clearinghouse may or may not be sent to the payer the same day. Clearinghouses may impose separate editing prior to submitting your claims to the payer. In this diagram the Trading Partner represents the entity responsible for submitting your claims.

      1. Claim Sent by Trading Partner
      2. Claims received by EDI System and stored in mailbox directory
      3. Transaction identified 837I, 837P, 837D
      4. Claim level editing performed
      5. Acknowledgement sent to TP mailbox
        • Rejected claims will need to be corrected and resubmitted
      6. Accepted claims sent to payer

      Once a file has been submitted by a Trading Partner the Life of a Claim process can not be interrupted.

    • National Provider Identifier (NPI)

      The administration simplification provisions of HIPAA require the Secretary of Health and Human Services (HHS) to adopt a national standard identifier for covered health care providers. The National Provider Identifier (NPI) will be the standard identifier and CMS is developing the National Plan and Provider Enumeration System (NPPES) to identify providers and assign NPIs.

      The NPI is ten-digit number and is used to submit claim transactions to all government and non-government payers. NPI replaced existing provider numbers assigned by these entities and CMS will discontinue the UPIN enumeration process.

      Providers who are required to obtain an NPI include:

      • physicians
      • non-physician healthcare practitioners
      • other suppliers and certified providers such as institutions
      • home health agencies
      • skilled nursing facilities

      Each individual practitioner will receive one NPI. However, an organization provider may obtain an NPI for each of its subparts.

      A subpart can be considered:

      • a separate physical location of an organization health care provider
      • member of a chain
      • an organization health care provider separately licensed or certified

      For additional informational and to complete an application, visit https://nppes.cms.hhs.gov on the Web.

    • Products and Services

      ASK provides products and services for customers in Kansas, Northwestern Missouri, Western New York, and Northeastern New York.

      These products are designed to help Trading Partners increase the number of transactions they send electronically.

      • EDI Midwest– Learn how to send claims to over 900 additional payers.
      • ABILITY | PC-ACE® – Learn more about free claims filing software available from ASK.
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