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YOU MUST BE READY FOR HIPAA 5010 BY
JANUARY 1, 2012 TO AVOID YOUR MEDICAID PAYMENTS BEING IN
JEOPARDY!!
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
Payment
Exceptions 2011 January - December
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 are included in chapters 8
and 9 of the Provider Manuals; however
this information 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 EqualityCare Secure Provider Web
Portal or WINASAP.
- The ACS 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
EqualityCare
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 ACS 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
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