 |
|
|
Frequently Asked Questions Electronic Data Interchange (EDI) - General
Q. Where can I find the provider taxonomy codes? A. The provider taxonomy codes and other codes can be found by visiting the Washington Publishing Company Web site. Q. Are you capable of receiving the 837 version 4010A1 format mandated by HIPAA? If so, what software (name and version) do you use for this? A. At this time, DHS/OMAP is accepting claims for payment in the 837 Professional, Institutional and Dental formats fee-for-service and encounter. This does not include long-term care or nursing home inpatient facility charges in the 837 format. DHS/OMAP does not endorse or recommend any HIPAA software. Back to top Q. Does Oregon DHS require an agreement for HIPAA compliance between a health care provider and the state? A. Yes, DHS does require an agreement between a healthcare provider wishing to submit claims electronically and DHS for payment. Please see the FAQ on Trading Partner Agreements on our Web site for this information. Q. If I elect to receive the 835 Remittance Advice on the Trading Partner Agreement, but my software is not ready to receive and utilize the data I would receive back, can I still receive the paper RA OMAP currently generates? A. DHS/OMAP will continue to produce the paper RAs for 90 days after a provider begins receiving the 835 remittance advice. the immediate future. Back to top Q. Once approved, will we be required to begin submitting only the HIPAA-compliant format, or will DHS support one format or the other, but not both? A. DHS will support both formats to allow providers time to transition their systems over to the new standard until the end of our contingency timeframe on 12/31/05. Once a provider has successfully completed the business-to-business phase of testing and has been approved for production, DHS will continue to allow three months of dual access to the bulletin board as a backup, in case of system problems, until 12/31/05. Q. As a managed dental care organization, would we use only the 837 Dental, or can we use the current system on the bulletin board? A. Yes, the 837 Dental is the appropriate transaction for most of the services provided by a Managed Dental Care Organization. It is DHS' intention to maintain the bulletin board as trading partners transition over to the HIPAA-compliant transactions until 12/31/05. Back to top Q. What can DHS tell me about locating information on the new HIPAA Transaction and Codes Sets standards for health care claims payment? A. The 837 Dental (D), Institutional (I) and Professional (P) Implementation Guides (IG) detail the specifics of creating, and/or receiving electronic data interchange of health care claims/encounters information. These are electronic formats and no paper equivalent exists. While there are no forms specifically formatted for these transactions, they were based on commonly used paper forms such as the ADA Dental claim form for the 837 D, the CMS 1500, etc. The 837 Professional and Dental is used on the National Standard Format (NSF) version 3.01, and the 837 Institutional is used on the Universal Billing Form version 92 (UB-92). Even though the IGs are based on the above named forms, there is not a one to one relationship to the data on the forms and the data required by HIPAA. Since the HIPAA formats are new to most of the health care industry (DHS included), you will need to review the IGs and your current system to determine what changes your current system will require. The Department of Human Services (DHS) will be using the Final Addenda Version (4010A1) mandated February 2003. The Implementation Guides and Addendum can be downloaded from the Washington Publishing Company Web site. Federal law mandates that all electronic medical claims (dental, institutional and professional) must be transmitted using the HIPAA formats no later than October 16, 2003. #8 A. OMAP is currently accepting electronic claims using Oregon's version of the National Standard Format (NSF) version 1.04 and the Universal Billing-92 (UB-92) formats, but will begin denying access to FFS providers effective June 30, 2005, unless extraordinary circumstances exist, and for managed care until December 30, 2005. OMAP is accepting electronic claims using the HIPAA-compliant 837 P, I and D fee-for-service and encounter. OMAP will only establish new submissions for the HIPAA-compliant formats, not for the NSF or UB092. Q. I want to become an electronic submitter of claims with OMAP. Does OMAP have software available? A. DHS (OMAP) does not have software that can be used to submit electronic claims. We recommend contacting your local professional association, checking the Internet, CMS Web site, request information from our vendor fair regarding software, clearinghouses, etc., or see Organizations supporting HIPAA implementation links on our Web site.
|
|
