Thursday, September 25, 2008

RelayHealth offers direct connection with Kaiser Permanente

Kaiser Permanente of Southern California now offers a direct connection with RelayHealth Clearinghouse. Starting September 24th 2008 all claims can be submitted using CPID# 1703 & 4576.

1703 - Kasier Permanente of Southern California Professional CMS-1500 claim format
4576 - Kaiser Permanente of Southern California Institutional UB-04 claim format

No EDI Agreements required for the submission of electronic claims. Kaiser supports 277 unsolicited reports and the RelayHealth standardized payor reports.

Kaiser has specific edits to be aware of when submitting claims electronically. RelayHealth will kick out a claim prior to forwarding them on to Kaiser for these issues:

Edit 01 version 0096C: In Loop 2010CA, NM109 must be 8-12 numeric if present, otherwise Loop 2010BA, NM109 must be 8-12 numeric.
Fix: 2010CA is a patient Name field or 2010BA is the Subscriber Name field

EDIT HU version 0019C: In Loop 2010AA, NM108 must be equal to XX
FIX: 2010AA is the Reporting Billing Provider Identification Code Qualifier field

Edit HU version 0020C: In Loop 2010AB, NM108 must be equal to XX
Fix: 2010AB is Pay to Provider Identification Code Qualifier

Edit HU Version 0022C: In Loop 2310B (professional CMS-1500)/2310C (institutional UB-04), NM108 must be equal to XX
Fix: Referring Provider Identification Code Qualifier

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