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This connectivity guide provides trading partners with instructions on how to successfully exchange electronic transactions with First Coast using the hypertext transfer protocol secure (HTTPS) Council for Affordable Quality Healthcare (CAQH) Committee on Operating Rules (CORE) compliant rules over the public internet.
This standard companion guide provides trading partner instructions related to transactions based on ASC X12 Implementation Guides, version 005010. [CR 7373]
These guides on the Centers for Medicare & Medicaid Services (CMS) website provide communication, connectivity, and transaction specific information to Medicare FFS trading partners and serve as the authoritative source for Medicare FFS-specific electronic data interchange (EDI) protocols. [CR 7373]
The Administrative Simplification Compliance Act (ASCA) is a law that requires all initial claims reimbursed under Medicare be submitted electronically, with limited exceptions.
A comprehensive guide to interpreting the CTX segments within the ASC X12N 999 transaction
Here are key steps to take if you receive an ASCA enforcement review letter.
Link to the Department of Health and Human Services' (DHHS) office for HIPAA privacy rule, which protects the privacy of individually identifiable health information.
Electronic Data Interchange (EDI) Web page on CMS.gov containing information on EDI transaction and corresponding paper claims requirements.
Health Insurance Portability and Accountability Act (HIPAA) related resources page on the Centers for Medicare & Medicaid Services (CMS) website.
Learn about the EDI Gateway and how it manages the exchange of electronic transactions with First Coast Service Options Inc.
The HETS is intended to allow the release of eligibility data to Medicare providers, suppliers, or their authorized billing agents for the purpose of preparing an accurate Medicare claim, determining beneficiary liability or determining eligibility for specific services.
First Coast Service Options (First Coast) strives to ensure that the information available on our provider website is accurate, detailed, and current. Therefore, this is a dynamic site and its content changes daily. It is best to access the site to ensure you have the most current information rather than printing articles or forms that may become obsolete without notice.