 |
In order to ensure a smooth migration for all Trading Partners, Highmark Blue Shield is issuing the following notifications: Effective August 1, 2003, Highmark Blue Shield will only accept Trading Partners into HIPAA production using the ASC X12N 4010A1 formats for HIPAA transactions. Trading Partners already in HIPAA production for the ASC X12N 4010 formats will not automatically be migrated to the ASC X12N 4010A1 formats on this date.
As part of Highmark Blue Shield's implementation of HIPAA 837 Health Care Claim Transactions, we have introduced the use of a 277 Health Care Claim Acknowledgement Transaction to report the acceptance or denial of claims submitted.The 277 Health Care Claim Acknowledgement transaction replaces the proprietary 6000 Series - Submission Analysis Reports generated for electronic claim submissions in the current non-HIPAA compliant formats. In addition, this claim acknowledgement process is applicable only to production claims submitted via the 837 Health Care Claim-Professional and 837 Health Care Claim-Institutional Transactions. The 277 Health Care Claim Acknowledgement Transaction is not generated when 837 Health Care Claim transactions are submitted during the testing process with Highmark Blue Shield. If you have not already obtained your copy of the 277 Health Care Claim Acknowledgement Guide, please select the link below. If you are interested in Trading Partner Testing with Highmark Blue Shield and would like more detailed information, please visit our EDI Web pages at: https://www.highmarkblueshield.com/health/pbs-professionals/edi-services/signup.html
Before conducting electronic data interchange (EDI) for HIPAA electronic transactions with Highmark Blue Shield, trading partners must complete a new authorization process. This process includes completing an EDI Transaction Application form and executing an EDI Trading Partner Agreement with Highmark Blue Shield. To request authorization for the exchange of HIPAA EDI transactions, select the link below. Highmark Blue Shield trading partner EDI sign-up
HIPAA Validator™ is a new Web-based testing process available free of charge to our trading partners who have executed a new EDI Trading Partner Agreement. Highmark Blue Shield has contracted with Foresight Corp. to use a customized version of its Validator™ product. Validator™ is designed to make HIPAA syntax and validation testing fast, simple and secure by using a Web-based environment. Testers will receive detailed error analysis reports or a notice of successful validation. The EDI Transaction Application Forms include a section to request authorization to perform Validator™ testing. This product performs the following types of edits:
Validator™ testing will be available for the following transactions:
If you need help during Validator™ testing, call the EDI Operations Help Desk toll-free at 1-800-992-0246 or e-mail us at hmhipaatst@highmark.com. Support staff is available Monday through Friday, 8:00 a.m. to 5:00 p.m. Eastern time to assist with HIPAA Validator™ testing questions. Click here to see a current list of clearinghouses, software vendors and billing services that have completed testing with the Validator process. The ASC X12N 4010 implementation guides are available free of charge from the Washington Publishing Company’s Web site: http://www.wpc-edi.com/hipaa. In addition, Highmark Blue Shield has published a set of companion documents to the national implementation guides that specify business requirements and clarifications for submitting transactions to Highmark Blue Shield. These documents also identify what parts of the transactions Highmark Blue Shield uses, sends or doesn't need as part of processing. The Provider EDI Reference Guide is Highmark Blue Shield’s companion document for the Claim, Claim Acknowledgement, Claim Payment Advice, Claim Status, Eligibility and Services Review HIPAA transactions. The Employer / Sponsor EDI Reference Guide is Highmark Blue Shield’s companion document for the Enrollment and Premium Payment HIPAA transactions. As updates to these documents are made periodically, both guides’ appendices that outline any changes from the previous version. To access the EDI Reference Guides, go to the EDI Services Specifications page by selecting the link below. While the guidelines within these documents apply to both the 4010 non-addenda and the 4010A1 addenda versions of the standard, the documents do not list all of the differences between the two standards. Instead, the guidelines only list segments where payer specific requirements or clarifications apply. |
|
HIPAA FAQs:
