Claims EDI
Claims to the clearinghouse, acknowledgements and remittances back, and eligibility.
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EDI Files
Every X12 interchange with the clearinghouse: 837P and 837I claims and 270 inquiries out; 999, 277CA, 835 and 271 in. Control numbers, counts and the raw file.
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Remittances
Electronic remittance advice (835): the payment, the claims it pays, the adjustments and the patient's share, posted to the claims, and whether it all balances.
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Claim Adjustments
Every adjustment a payer made on a remittance, by group and reason code (CARC) with its remark codes (RARC).
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Eligibility Checks
Each 270 inquiry and the payer's 271 answer: coverage, plan, copay, deductible and what is left of it, coinsurance and out-of-pocket.
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Records
Clearinghouse Payers
The payer ids a clearinghouse routes to, and which transactions each takes.
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Records
Practice Sites
Where prescribers write from and claims bill from: the group NPI, tax id, taxonomy and address that NCPDP and X12 carry.
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