Question

list the electronic data interchange (EDI) transaction and corresponding paper claims requirement using the

Medicare claims processing manual that contains information on these types of transaction.

Answer 1

EDI for medicare claims has submission and processing of claims related transaction, it include provider EDI enrollment, coordination of benefits, beneficiary eligibility, security, and privacy concerns. The requirement for EDI with medicare must have complete and submit paper CMs from 855 or providers enrollment, chain, and ownership system through internet-based application. The information for medicare provider interest, business trade partner and other medicare structure and its EDI policies. this information to determine the medicare fee for services EDI practices. To implement the HIPAA process medicare FFS should adopt the Accredited standard committee (ASC)and the national council for prescription drug program transaction standards(NCPDP) as a part of the EDI acknowledgment model.