| Q. |
What forms do I need to complete to be able to send HIPAA transactions? |
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You must complete the Trading Partner Agreement and the EDIG Enrollment Form. If you represent a hospital, or are a doctor or other healthcare professional who will be transmitting transactions directly to us, you should complete the forms located here. If you are a clearinghouse, complete the forms on this page.
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| Q. |
Have you developed a "Companion Guide" that address the "situational" fields? How may we obtain a copy? |
| A. |
Yes. We call our companion guides "Supplemental Implementation Guides" since they supplement the HIPAA Implementation Guides. These guides address the situational fields that HIPAA allows for and explain how we use these fields. You can find all of our guides here. |
| Q. |
I use a clearinghouse to process my transactions. So I do not need to do anything, right? |
| A. |
Clearinghouses must complete and sign the Trading Partner Agreement and EDIG Enrollment Form for clearinghouses. If you plan to use a vendor or clearinghouse to conduct your HIPAA transactions, please have them contact us as soon as possible if they have not already done so to ensure their transactions are compatible with our systems. You still must meet the separate HIPAA Privacy rules that went into effect on April 14, 2003.
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| Q. |
What if I am not ready to transmit HIPAA transactions by October 16, 2003? |
| A. |
HIPAA mandates that plans, clearinghouses, hospitals and healthcare professionals transmit transactions in a HIPAA-compliant format by that date. We do have a contingency plan that allows you to temporarily submit non-compliant claims. If you need another method of filing claims to us, My Insurance Manager will be HIPAA compliant for institutional, professional and dental 837 claims filing. You will also be able to use My Insurance Manager for HIPAA compliant eligibility and benefits information (270/271) and claims status inquiries (276/277).
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| Q. |
When will the 835 for electronic remittance advice files be ready? |
| A. |
The 835 is available now. You must complete the appropriate Trading Partner Agreement and Enrollment form. There is one for hospitals and healthcare professionals and another for clearinghouses. |
| Q. |
Will the 835 include line level payment information? |
| A. |
The remittance will match the reimbursement methodology. For inpatient, all remits will show claim level payments. For outpatient, claim level payments will be shown until line level reimbursement is implemented (APCs) -- at which time line level payments will be reflected on the remit.
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Also see the 837 claims frequently asked questions.
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