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HIPAA 5010

YOU MUST BE READY FOR HIPAA 5010 BY JANUARY 1, 2012 TO AVOID YOUR MEDICAID PAYMENTS BEING IN JEOPARDY!!

***Attention***Attention***Atention***Attention***Attention***Attention***Attention*** 

Wyoming has implemented the HIPAA Operating Rules

As of July 12, 2013, Wyoming Medicaid has completed changes to meet the

Affordable Care Act (ACA) required CORE Operating Rules for the following

Standard Electronic Health Care Administrative Transactions:

  •  Eligibility Inquiry and Response (270/271)
  •  Claims Status Inquiry and Response (276/277)

Additionally, Wyoming Medicaid has taken the necessary steps to meet the

requirements of the Electronic Funds Transfers (EFT) and Electronic Remittance

Advice (ERA) transactions Operating Rules that have a required compliance

date of January 1, 2014.

 

As a reminder, Wyoming Medicaid currently processes the following HIPAA Transactions:

  •  Eligibility Inquiry and Response (270/271)
  •  Claim Status Inquiry and Response (276/277)
  •  Claims Acknowledgement (277CA)
  •  Health Care Services Request for Review and Response (278)
  •  Electronic Remittance Advice (835)
  •  Electronic Claims, Professional (837P), Institutional (837I) and Dental (837D)
  •  Implementation Acknowledgement (999)

 ***Attention***Attention***Attention***Attention***Attention***Attention***

***HIPAA 5010 affects you if you or your software vendor/clearinghouse/billing agent process the following electronic transactions:

  • 270/271 Health Care Eligibility Inquiry and Response
  • 276/277 Health Care Claim Status Request and Response
  • 278/278 Health Care Services Request for Review and Response; Health Care Services Notification and Acknowledgement
  • 835 Health Care Claim Payment/Advice
  • 837 Health Care Claim (Professional, Institutional, and Dental) including coordination of benefits (COB) and subrogation claim

What you can do to continue to receive your Medicaid payments after January 1, 2012:

  • If your office uses a software vendor/clearinghouse/billing agent
    • Discuss your business needs with your vendor/clearinghouse/billing agent; the HIPAA 5010 Electronic Newsletter  contains questions to consider discussing with them.
  • Update your transactions
    • Ensure your transactions conform to the 5010 standards as outlined in the national ASC X12N Standard for Electronic Data Interchange Technical Report Type 3 (TR3).  The TR3 can be purchased from Washington Publishing Company 
    • Ensure your transactions conform to the Wyoming HIPAA 5010 Electronic Specifications (formerly known as Companion Guides). These specifications will become chapters 8 and 9 of the Provider Manuals; however these currently are a stand-alone document that should be used in conjunction with the TR3 documents.

Testing

  • All Submitters, software vendors, billing agents, providers and clearinghouses are required to test all their software transactions to ensure HIPAA 5010 compliance prior to submitting production claims to Wyoming Medicaid. This does not apply to the Wyoming Medicaid Secure Provider Web Portal or WINASAP.
  • The Xerox EDI Call Center will be ready to test November 2011.
  • For detailed testing information refer to the Wyoming HIPAA 5010 Electronic Specifications Section 9.5.

Phase 2 EDI Clearinghouse Testing

EDI Submitter HIPAA 5010 Testing Information

Wyoming Medicaid Electronic Billing Applications

Wyoming Medicaid is not requiring re-enrollment for HIPAA 5010 Transactions. The forms below are only required to be completed by new submitters, software vendors, billing agents, providers and clearinghouses or anyone that is currently enrolled that needs to update their electronic billing information.
Wyoming Medicaid Clearinghouse Authorization Form
Wyoming Medicaid Clearinghouse Application
EDI Enrollment Application and Agreement

Coming in December

Wyoming Medicaid Secure Provider Web Portal (HIPAA 5010)

  • The Secure Web Portal will be compliant with HIPAA 5010 by January 1, 2012
  • Training Tutorials will be updated accordingly

WINASAP (HIPAA 5010)

For Questions About HIPAA 5010 Contact Xerox EDI Call Center

Additional Links and Notifications
Reminder of Contingency and Payment Dates
Waiver Provider Bulletin 11/28/2011
Request for Extension of HIPAA Compliance
EDI Submitter HIPAA 5010 Information
5010 Testing and Implementation FAQ
HIPAA 5010 Electronic Newsletter
Purchase the Technical Report Type 3 (TR3) to be used in conjunction with the Wyoming HIPAA 5010 Electronic Specifications
CMS HIPAA 5010
An Introductory Overview for HIPAA 5010