HIPAA 835 Transaction Standard Companion Guide - CareFirst
Carefrrst. .VFamily of health care plansHIPAA 835Transaction StandardCompanion GuideRefers to the Implementation Guidesbased on ASC X12 version 005010
Disclosure StatementThis Companion Guide is issued in an effort to provide Trading Partners of CareFirst BlueCross BlueShieldand CareFirst BlueChoice, Inc., collectively known as “CareFirst,” with the most up-to- date informationrelated to standard transactions. Any and all information in this guide is subject to change at any timewithout notice. Each time you test or receive a standard transaction, we recommend that you refer to themost recently posted Companion Guide to ensure you are using the most current information available.1
PrefaceThis Companion Guide to the v5010 ASC X12N Implementation Guides and associated errata adoptedunder HIPAA clarifies and specifies the data content when exchanging electronically with CareFirst.Transmissions based on this companion guide, used in tandem with the v5010 ASC X12N ImplementationGuides, are compliant with both ASC X12 syntax and those guides. This Companion Guide is intended toconvey information that is within the framework of the ASC X12N Implementation Guides adopted for useunder HIPAA. The Companion Guide is not intended to convey information that in any way exceeds therequirements or usages of data expressed in the Implementation Guides.2
Table of ContentsDisclosure Statement. . . . . . . . . . . . . . . . . 16. Control Segments/Envelope . . . . . . . . . 9Preface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26.1 ISA-IEA . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .91. Introduction. . . . . . . . . . . . . . . . . . . . . . . 46.2 GS-GE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .101.1 Scope . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .46.3 ST-SE. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .101.2 Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .41.3 References. . . . . . . . . . . . . . . . . . . . . . . . . . . . .47. CareFirst Business Rules andLimitations . . . . . . . . . . . . . . . . . . . . . . . . . 111.4 Additional information . . . . . . . . . . . . . . . . . .47.1 Real time processing mode . . . . . . . . . . . . .112. Getting Started . . . . . . . . . . . . . . . . . . . . 57.2 CareFirst claim adjudication systems . . . . .112.1 Working with CareFirst . . . . . . . . . . . . . . . . . .57.3 Limitations. . . . . . . . . . . . . . . . . . . . . . . . . . . .112.2 Trading partner registration . . . . . . . . . . . . . .58. Acknowledgements and/or Reports . 122.3 Testing & certification overview . . . . . . . . . . .58.1 Report inventory . . . . . . . . . . . . . . . . . . . . . .122.4 Production status . . . . . . . . . . . . . . . . . . . . . . .59. Trading Partner Agreements . . . . . . . 133. Testing . . . . . . . . . . . . . . . . . . . . . . . . . . . 69.1 Trading partners. . . . . . . . . . . . . . . . . . . . . . .134. Connectivity/Communications. . . . . . . 710. Transaction Information . . . . . . . . . . 144.1 Process flows . . . . . . . . . . . . . . . . . . . . . . . . . .710.1 The 835 health claim payment/advice . . .144.2 Transmission administrative procedures . . .711. Appendices . . . . . . . . . . . . . . . . . . . . . 184.3 Communication protocol specifications . . . .711.1 Implementation checklist . . . . . . . . . . . . . .184.4 Passwords . . . . . . . . . . . . . . . . . . . . . . . . . . . . .711.2 Business scenarios. . . . . . . . . . . . . . . . . . . .185. CareFirst Contact Information . . . . . . . 811.3 Transmission examples . . . . . . . . . . . . . . .185.1 EDI customer service . . . . . . . . . . . . . . . . . . . .811.4 Frequently asked questions . . . . . . . . . . . .185.2 EDI technical assistance . . . . . . . . . . . . . . . . .8Payment schedule . . . . . . . . . . . . . . . . . . . . . . . .205.3 Provider service number. . . . . . . . . . . . . . . . .811.5 Change summary. . . . . . . . . . . . . . . . . . . . .215.4 Applicable web-sites/email . . . . . . . . . . . . . . .83
1. IntroductionPlease use the most current version of theCompanion Guide available at carefirst.com/electronicclaims Claims Submission CompanionGuides. CareFirst is not responsible for theperformance of software outside of its installations.Under the Administrative Simplification provisions ofthe Health Insurance Portability and AccountabilityAct (HIPAA) of 1996, the Secretary of the Departmentof Health and Human Services (HHS) is directedto adopt standards to support the electronicexchange of administrative and financial health caretransactions. The purpose of the AdministrativeSimplification portion of HIPAA is enable healthinformation to be exchanged electronically and toadopt standards for those transactions.1.3 ReferencesThis companion guide is an adjunct to the NationalElectronic Data Interchange Transaction SetImplementation Guide Health Care Claim Payment/Advice ASC X12N (005010X221A1)1.1 Scope1.4 Additional informationThis companion guide is intended for CareFirstTrading Partners interested in receiving HIPAAcompliant X12 835 electronic Health Claim payment/advice transaction with CareFirst. It is intended to beused in conjunction with the X12N ImplementationGuide and is not intended to contradict or exceedX12 standards. It contains information about specificCareFirst requirements for processing the X12 835transaction.Please be sure to always use the most currentversion of the companion guide available atcarefirst.com/electronicclaims Claims Submission Companion Guides.Always feel free to contact CareFirst as described inSection 5.1.2 OverviewThis Companion Guide is issued in an effort toprovide the CareFirst trading partners with themost up-to-date information related to standardtransactions. Any and all information in this guide issubject to change at any time without notice.This Companion Guide is applicable to all lines ofbusiness within CareFirst.This document is designed to assist both technicaland business areas of trading partners who wishto receive HIPAA standard 835 transactions withCareFirst, Inc. It contains specifications for thetransactions, contact information, and otherinformation that is helpful.All instructions in this document are written usinginformation known at the time of publication andare subject to change.4
2. Getting Started2.1 Working with CareFirst2.3 Testing & certification overviewIn general, there are three steps to receivingstandard 835 transactions from the CareFirstproduction environment:CareFirst requires all potential receivers toparticipate in testing to ensure that transactionsproduce the desired results. CareFirst suppliesthe test data and access information to the testsystem. Successful completion and validation is anindication that all systems can properly send andreceive the transactions. Registration Testing & certification Production statusCareFirst sends X12 standard transactions toany HIPAA covered entity with which it has anagreement. Prior to approving the transmission ofthe 835 transactions, the transactions are testedaccording to a specific test plan. Results are verifiedby both parties. Once test results are verified andapproved, CareFirst advises the Trading Partnerabout receiving remittances from the productionenvironment.2.4 Production statusThe EDI Operations Support Group will advise thenew receiver when all conditions are satisfied andtransmission of production transactions can begin.At that time a production certificate of trust will beissued by CareFirst to the Trading Partner.A receiver is typically a company that has TradingPartner status with CareFirst and is acting onbehalf of a group of HIPAA covered entities (e.g., aservice bureau or clearinghouse).All potential CareFirst submitters must contactthe EDI Operations Support Group (refer to theCareFirst Contact Information in Section 5) toinitiate action and authorization and to receive thenecessary information for proceeding.2.2 Trading partner registrationTo register to receive 835 electronic transactions, aTrading partner must contact CareFirst accordingto the instructions in Section 5.The requested information on Trading PartnerInformation Form (see Section 3) must be filledout by the Trading Partner and emailed to theEDI Operations Support Group address listed inSection 5.5
3. TestingThe information below should be provided toCareFirst for setup so CareFirst can begin testingwith Submitters. CareFirst will need to receive thisinformation at least 30 days in advance.CareFirst requires all potential receivers toparticipate in testing to ensure that transactionsproduce the desired results. Successful completionand validation is an indication that all systems canproperly transmit and receive the transactions.Trading Partner Name:The CareFirst EDI Operations Support Groupcoordinates the testing activities and provides adetailed test plan and test data. Additional testcases may be added by the receiver.Primary EDI Support Contact:Primary EDI Support Contact Phone #:Primary EDI Support Contact Email:Primary EDI Support Contact Address:Test time is available from 9 a.m. to 5 p.m. EST,Monday–Friday.TP Test/Production IP Address(es) SubmittingTransactions:The successful completion of testing is to beverified and approved by the EDI OperationsGroup.Security is verified with a certificate of trustattached to each transaction and verification ofthe receiving IP address. CareFirst will providea certificate of trust to the receiving TradingPartner. A separate certificate will be available fortesting. A production certificate will be issued atthe successful completion of testing. The TradingPartner must provide the IP address(es) usedfor both testing and production submission oftransactions.6
4. Connectivity/Communications4.1 Process flowsClaims are receivedby CareFirstCore Platformsadjudicate claims andcreate payment filesIndividual remitsarrive at ConsolidatedGateway TP returns AS2 and999 responseRemits are batchedand transmitted toTPConsolidatedGateway directsremit to a TPPartners will be expected to provide 2 securitycertificates, one for Test and one for Production.Additional setup information such as the IP addressof the receiving system and the Trading PartnerIdentifier will be requested.The above illustrates the basic creation steps andflow of the 835 remittance transactions.4.2 Transmission administrativeprocedures4.2.1 Schedule, availability and downtimenotification4.4 PasswordsLogon and passwords are replaced by the use ofsecurity certificates and verification of submittingIP addresses. CareFirst will transmit the certificatesupplied by the Trading Partner with everytransaction. There are separate certificates for testand production.The CareFirst production system is available24 hours per day, 7 days per week for the 835remittance transaction. There are occasionaldowntimes for system maintenance that arescheduled outside of normal business hours.4.2.2 Re-transmission proceduresCareFirst security is maintained on three levels:CareFirst will retransmit a transaction when theTrading Partner returns an MDN that indicates theoriginal transmission failed.1. Verification of a certificate of trust attached toeach transaction.2. Verification of the IP address submitting thetransaction (supplied by the submitter).4.3 Communication protocolspecifications3. Verification of the Trading Partner ID (in theISA segment) supplied by CareFirst.CareFirst uses TIBCO BusinessConnect enterprise-level B2B as the gateway to exchangeHIPAA transactions via AS2 protocol. Trading7
5. CareFirst Contact Information5.1 EDI customer service5.4 Applicable web-sites/emailAll inquiries and comments regardinginitiation, set-up, testing, and receipt ofHIPAA transactions should be directed toEDIdirectsubmission@carefirst.com.All inquiries and comments regardinginitiation, set-up, testing, and submissionof HIPAA transactions should be directed toEDIdirectsubmission@carefirst.com.Support for all EDI Transactions isprovided by the HelpDesk during normalbusiness hours at (877) 526-8390 or atEDIdirectsubmission@carefirst.com.Support for all EDI Transactions isprovided by the HelpDesk during normalbusiness hours at (877) 526-8390 or atEDIdirectsubmission@carefirst.com.5.2 EDI technical assistanceThe most current version of this companionguide is available on the CareFirst website atcarefirst.com/electronicclaims Claims Submission Companion Guides.All inquiries and comments regardinginitiation, set-up, testing, and receipt ofHIPAA transactions should be directed toEDIdirectsubmission@carefirst.com.Support for all EDI Transactions isprovided by the HelpDesk during normalbusiness hours at (877) 526-8390 or atEDIdirectsubmission@carefirst.com.5.3 Provider service numberAll inquiries and comments regardinginitiation, set-up, testing, and receipt ofHIPAA transactions should be directed toEDIdirectsubmission@carefirst.com.Support for all EDI Transactions isprovided by the HelpDesk during normalbusiness hours at (877) 526-8390 or atEDIdirectsubmission@carefirst.com.All inquiries and comments regarding adjudicationoutcomes, such as service line payment amount,service line denial, patient liability, etc., shouldbe directed to Provider Services. Appropriatecontact information is available online atcarefirst.com/providers.8
6. Control Segments/Envelope6.1 ISA-IEAThis section describes the values utilized by CareFirst in the ISA and IEA segments.IG PageReferenceX12 Element NameLengthValid Values/Notes/CommentsC.4ISA01Authorization InformationQualifier2Must be “00”—no authorization informationpresent.C.4ISA03Security Information Qualifier2Must be “00”—no security informationpresent.C.4ISA05Interchange ID Qualifier2Must be “ZZ”—Mutually definedC.4ISA06Interchange Sender ID15Must be “CFGATEWAY”—the CareFirst SenderID. The value is left justified and space filled.C.5ISA07Interchange ID Qualifier2Must be “ZZ”C.5ISA08Interchange Receiver ID15Must be the Trading Partner ID. The value isleft justified and space filled.C.5ISA09Interchange Date6Must be YYMMDDC.5ISA10Interchange Time4Must be HHMMC.5ISA11Repetition Separator1Must be “{“C.5ISA12Interchange Control VersionNumber5Must be “00501”C.5ISA13Interchange Control Number99 digit unique number. ISA13 must beidentical to the value in IEA02.C.6ISA14Acknowledgement Indicator1Must be “0”—no interchangeacknowledgement requested.C.6ISA15Usage Indicator1Must be “T” or “P”. NOTE: test system rejectsP; Production system rejects T.C.6ISA16Component Element Separator1Must be “:”C.10IEA01Number of included FunctionalGroups1/5Must be “1”C.10IEA02Interchange Control Number9/9IEA02 must be identical to ISA139
6. Control Segments/Envelope6.2 GS-GEThis section describes the values utilized by CareFirst in the GS and GE segments.IG PageReferenceX12 Element NameLengthValid Values/Notes/CommentsC.7GS01Functional Identifier Code2/2Must be “HP”—Health Care Claim Payment/AdviceC.7GS02Application Sender’s Code2/15Must be “CFGATEWAY”—the CareFirst SenderID.C.7GS03Application Receiver's Code2/15Must be the Trading Partner ID.C.8GS04Date8/8CCYYMMDD—Functional group creationdate.C.8GS05Time4/8HHMMSSC.8GS06Group Control Number1/9The Functional Group Control Number inGS06 must be identical to GE02.C.8GS07Responsible Agency Code1/2Must be “X”C.8GS08Version/ Release/ IndustryIdentifier Code1/12Must be “005010X221A1”C.9GE01Number of Transaction SetsIncluded1/6Must be populatedC.9GE02Group Control Number1/9The Functional Group Control Number inGE02 must be identical to GS06.6.3 ST-SECareFirst utilizes standard HIPAA values in the ST and SE segments.IG PageReferenceX12 Element NameLengthValid Values/Notes/Comments61ST01Transaction Set Identifier Code3/3Must be “835”61ST02Transaction Set Control Number4/9The Transaction Set Control Numbers in ST02and SE02 must be identical.62ST03Implementation ConventionReference1/35Not used200SE01Number of Included Segments1/10Count of data segments including ST and SESegments.200SE02Transaction Set Control Number4/9The Transaction Set Control Numbers in ST02and SE02 must be identical.10
7. CareFirst Business Rules and Limitations7.1 Real time processing mode7.3 LimitationsCareFirst does not support real time 835transactions.CareFirst can issue an administrative check usinga manual process that is not part of the claimadjudication cycle. An administrative check will notgenerate a corresponding 835 Health Care ClaimPayment/Advice.7.2 CareFirst claim adjudicationsystemsCareFirst generates payments from 3 separatecore claim adjudication systems. The systems areFacets, FEP, and NASCO. Each core claim systemhas an independent schedule to pay a givenprovider. See the payment schedule in Section 11for specific details.Each core claim system has separate business rulesto group together claims for a payment within thepayment cycle. Claims from different systems willnever be grouped together to produce a combined(single) payment.Each core claim system has separate businessrules to label a payment with the primary provideridentifier (NPI).11
8. Acknowledgements and/or ReportsThe recipient of an 835 Health Claim Payment/Advice must return a 999 to acknowledge receipt ofall transactions.The TA1 Interchange Acknowledgement isused to indicate a rejection (aka a negativeacknowledgement) of the ISA/IEA Interchangecontaining the 835 Health Claim Payment/Advice.8.1 Report inventoryThere are no reports regarding the 835 transactionavailable to trading partners.12
9. Trading Partner Agreements9.1 Trading partnersAll inquiries and comments regarding tradingpartner relationships with CareFirst should beaddressed by contacting CareFirst using theinformation in Section 5.13
10. Transaction Information10.1 The 835 health claim payment/adviceThis section describes the values utilized by CareFirst.IGPageLoopIDReference X12 Element NameCodesLengthValid Values/Notes/Comments70NABPR01Transaction Handling codeH, I1/2CareFirst will only use H(notification) or I (remittanceinformation only).71NABPR03Credit/Debit Flag codeC1/1CareFirst will always use C(credit).72NABPR04Payment Method CodeACH, CHK,NON3/3CareFirst will use ACH forpayments by EFT, CHK forpayments by check, and NONfor no payment.72NABPR05Payment Format CodeCCP1/10CareFirst will use CCP when thepayment method is ACH.73NABPR06DFI ID Number Qualifier012/2CareFirst will use 01 when thepayment method is ACH.73NABPR09Account Number1/35CareFirst will use separateaccount numbers for CFMI andGHMSI payments.74NABPR10Originating Company Identifier10/10CFMI: 1521385894GHMSI: 1530078070BlueChoice: 1530078070,1521358219Dental Network HMO:1521840919First Care: 152196237675NABPR12DFI ID Number Qualifier012/2CareFirst will use 01 when thepayment method is ACH.76NABPR14Account Number QualifierDA, SG1/3CareFirst will support both DAand SG.77NATRN02Check or EFT Trace NumberVariableby Coreclaimsystem1/50Facets: Voucher number if thereis a payment; date internaltracking number if there is nopayment.FEP: Check number if thereis a payment; date internalsequence number if there isno payment. NASCO: Checknumber if there is a payment;F financial document serialnumber if there is no payment.14
10. Transaction InformationIGPageLoopIDReference X12 Element Name77NATRN03CodesOriginating Company IdentifierLengthValid Values/Notes/Comments10/10CFMI: 1521385894GHMSI: 1530078070BlueChoice: 1530078070,1521358219Dental Network HMO:1521840919First Care: 1521962376871000AN102Payer Name1031000BN103Payee Identification CodeQualifier1031000BN104Payee Identification CodeXX, FI1/60GHMSI, CAREFIRST BLUECHOICE,CAREFIRST BLUE CHOICE,CAREFIRST OF MARYLANDINC, CAREFIRST BLUECROSSBLUESHIELD OF MD, NATIONALACCOUNTS DEDICATED SERVICE,THE DENTAL NETWORK HMO,FIRST CARE, INC.1/2CareFirst will use XX when thebilling NPI is available at theremittance level, and FI whenthe NPI is not available.2/80Facets: The NPI from theprovider source system(associated with the internallegacy provider ID).FEP: Claims are grouped bybilling. NPI. Claims that donot have an NPI are groupedtogether, and the tax ID willbe used.NASCO: The NPI from the firstclaim in the remittance.1071000BREF01Payee Additional TJ, PQ2/3CareFirst will use TJ when theprimary payee identification isNPI, and PQ when the primaryidentification is the Tax ID.Payee Additional Identifier1/50CareFirst will use the TaxID when the primary payeeidentification is NPI, andCareFirst legacy ID when theprimary identification is the TaxID.CLP01Patient Control Number1/38CareFirst will use the patientcontrol number from theoriginating 837, or the valuesubmitted on a paper claim.Otherwise, CareFirst willuse zero.CLP02Claim Status Code1/2CareFirst will use 1 whenprocessing as primary, 2 whenprocessing as secondary, 3 whenprocessing as tertiary, 4 whenall services are denied, and22 when reversing a previouspayment.1, 2, 3, 4,2215
10. Transaction InformationIGPageLoopIDReference X12 Element Name1272100CLP07CodesPayer Claim Control NumberLength1/50Valid Values/Notes/CommentsFacets: The claim DCN assignedby CareFirst, including a twoposition adjustment level suffix.FEP: The claim DCN assigned byCareFirst.NASCO: The claim DCN assignedby NASCO (see REF*F8 forthe claim DCN assigned byCareFirst).1392100NM108Patient identification codequalifier1392100NM109Patient identification codeMI1/2CareFirst will always use MI—membership identificationnumber.2/80Facets: Subscriber ID plus atwo position suffix. Prefix isexcluded. FEP: Subscriber ID(R 8 numerics).NASCO: Subscriber ID (includingprefix)1432100NM1Corrected patient/ insurednameFacets: Future release.FEP: Sent when applicable.NASCO: Sent when applicable.1482100NM108Service provider identificationcode qualifierXX, FI1/2CareFirst will send XX if therendering NPI is available, and itwas used for claims processing.CareFirst will send FI if therendering NPI and billing NPI arenot available, and the segmentis not suppressed. The segmentis suppressed if the providerdoes not have a roster ofpractitioners.1702100REF02Original Reference Number(REF01 F8)1/50NASCO: The claim DCN assignedby CareFirst for NASCO claims.2062110REF02Line item control number(REF01 6R)1/50Facets: Future release.FEP: Sent when applicable.NASCO: Sent when applicable16
10. Transaction InformationIGPageLoopIDReference X12 Element Name218N/APLB03-2CodesProvider Adjustment Identifier(Overpayment recovery)Length1/50Valid Values/Notes/CommentsFacets before Aug. 9, 2015: Theclaim DCN if applicable, else theA/R number.Facets on or after Aug. 9,2015: A composite identifier ifapplicable: Facets claim DCN, aspace, patient control number (ifpresent).FEP before July 16, 2018: FEPclaim DCN, a space, patientcontrol number(if present).FEP on or after July 16, 2018:FEP claim DCN, or TRN02 checknumber.NASCO: A composite identifierif applicable: A/R number, aspace, NASCO claim DCN, aspace, patient control number (ifpresent).17
11. Appendices11.1 Implementation checklistThere is no published checklist at this time. Pleaserefer to section 2 ‘Getting Started’.The provider receives a paper voucher. Willhe continue to receive a paper voucher afterhe enrolls for ERA/835?11.2 Business scenariosYes, the paper voucher will continue to beproduced.There are no Business Scenarios at this time.The provider receives a paper voucher. Willhe continue to receive a paper voucher afterhe enrolls for EFT?11.3 Transmission examplesThere are no Transmission Examples at this time.No, the paper voucher will no longer be producedand mailed, after the provider is enrolled forEFT. Your Electronic Remittance Advice (ERA/835)delivered by your clearinghouse will be yournew payment voucher. A copy of the ERA/835information can also be retrieved online throughthe CareFirst provider portal.11.4 Frequently asked questionsHow does a provider enroll with CareFirst toreceive ERA/835s?The provider must work with their Trading Partnerto submit enrollment information to CareFirst. TheTrading Partners agree to collect information incompliance with CORE rule 382. Trading Partnerswill send information to CareFirst in accordancewith the CareFirst submitter guide to set-up aprovider to receive an ERA/835.The provider is missing a specific ERA/835.How can the provider locate the “missing”remittances?The provider should contact their Trading Partnerfirst. If the Trading Partner is not able to locate theremittance, they will contact the CareFirst EDI HelpDesk, or contact the EDI department. See section5.1 for contact information and further details.How does a provider enroll with CareFirst toreceive Electronic Funds Transfer (EFT)?The provider must work with their Trading Partnerto submit enrollment information to CareFirst. TheTrading Partners agree to collect information incompliance with CORE rule 380. A provider must beenrolled to receive an ERA/835 in order to receivepayment by EFT.If a provider does not receive a papervoucher, and the ERA/835 is delayed ormissing, is there an alternative way for theprovider to obtain payment information?The provider can access CareFirst Direct to see ERAinformation. A copy of the ERA/835 information canbe retrieved online through the provider portal.Is a provider able to enroll for ERA/835 andfor EFT at the same time?CareFirst requires that a provider be enrolled inthe CareFirst system for ERA/835 first. When theenrollment for ERA/835 is complete at CareFirst, ifthe enrollment for EFT was also received it will thenbe processed by CareFirst. The Trading Partner willmanage the sequence of enrollment steps.After a provider is registered for ERA/835,will the provider receive an ERA for allpayments from CareFirst?No. There are exception cases where an ERA/835 isnot created. CareFirst can issue an administrativecheck using a manual process that is not part of theclaim adjudication cycle. An administrative checkwill not generate a corresponding ERA.18
11. AppendicesHow many claim adjudication systems doyou have at CareFirst?Will a Claim Adjustment Reason Codealways be paired with a Remittance RemarkCode?CareFirst has three core adjudication systems—Facets, FEP, and NASCO. Two CareFirst legacyadjudication systems, CARE and FLEXX, were retiredin 2014.No. Remark codes are only used for some services.A provider has a question about thepayment or denial of a service. Who shouldbe contacted?Does your Electronic Remittance Advice(ERA/835) combine claims from severalsystems?All inquiries and comments regarding adjudicationoutcomes, such as service line payment amount,service line denial, patient liability, etc., shouldbe directed to Provider Services. Appropriatecontact information is available online atcarefirst.com/providers.No. Each system produces a separate electronicremittance advice (ERA).How does each claim system group claimstogether to create a payment?Does CareFirst require a 999Acknowledgement in response to an 835transaction?Each system has unique rules to group claimstogether. Facets and NASCO use an internalCareFirst legacy ID. FEP uses the billing NPI. If aclaim does not have a billing NPI, FEP uses aninternal CareFirst legacy ID.Yes, under the Core rule 382 recipientsof an ERA/835 are required to send a 999Acknowledgement. The clearinghouse should sendthis upon receipt of the ERA/835.Does the ERA/835 include claims that weresubmitted on paper?What is your schedule for producingERA/835s?Yes. The ERA/835 includes electronic, paper andMedicare crossover claimsSee the Payment schedule charts at the end of thisappendix.Will the paper voucher use the HIPAA codesets, or non-standard codes?The paper voucher will continue to show thecurrent proprietary codes.19
11. AppendicesPayment scheduleFacetsMonday remitsgo to:Tuesday remitsgo to:Wednesday remitsgo to:Thursday remitsgo to:Friday remitsgo to:Professional providerswith remittanceaddresses in Marylandzip code range211–212 (i.e., the first3 positions of the zipcode)Professional providerswith remittanceaddresses in any otherMaryland zip codeProfessional providerswith remittanceaddresses in thefollowing states: AK ARCA CO DE FL GA IAID IL IN KS LA MOMO MS MT NE NJ NMNY OK OR PR SC SD UTVA VI VTProfessional providerswith remittanceaddresses in any otherzip code or territoryincluding the Districtof ColumbiaInstitutional providersCheck date: MonEFT date: TuesCheck date: TuesEFT date: WedCheck date: WedEFT date: ThurCheck date: ThurEFT date: FriCheck date: FriEFT date: next MonMonday remitsgo to:Tuesday remitsgo to:Wednesday remitsgo to:Thursday remitsgo to:Friday remitsgo to:All institutionalproviders. Professionalproviders with legacyIDs that end with AAto 22.All institutionalproviders. Professionalproviders with legacyIDs that end with 23to 44.All institutionalproviders. Professionalproviders with legacyIDs that end with 45to 66.All institutionalproviders. Professionalproviders with legacyIDs that end with 67to 88.All institutionalproviders. Professionalproviders with legacyIDs that end with 89to 99.Check date: MonEFT date: TuesCheck date: TuesEFT date: WedCheck date: WedEFT date: ThurCheck date: ThurEFT date: FriCheck date: FriEFT date: next MonFEPNASCOAll providers are processed Friday night. Remittances are delivered Saturday. The check date is Friday. TheEFT deposit date is the following Wednesday.For all systems, CareFirst holidays and banking holidays can alter the day of the week that an ERA/835 isprocessed, and/or the date of the EFT deposit.20
11. Appendices11.5 Change summaryThe following chart includes the summary of changes made to the Companion /20131.008/06/20152.01710.1Publish using CORE TemplateUpdate notes for PLB0308/06/20152.01811.4Update FAQ8/12/20163.01510.1Update Company Identifier, PayerName9/20/20184.015, 1710.1Update TRN02, PLB03-2 for FEPCareFirst BlueCross BlueShield is the shared business name of CareFirst of Mary
standard 835 transactions from the CareFirst production environment: Registration Testing & certification Production status. CareFirst sends X12 standard transactions to any HIPAA covered entity with which it has an agreement. Prior to approving the transmission of the 835 transactions, the transactions are tested according to a specific test plan.
MVPHealth Care 835 Health Care Payment/Advice HIPAA Transaction Standard Companion Guide Refers to the ASC X12N 835 (Version 005010X221A1) CORE v5010 Companion Guide: Version 4.0 . November 24, 2015 . November 24, 2015 005010 4.0 . Page 1
Overview of HIPAA How Does HIPAA Impact EMS? HIPAA regulations affect how EMS person-nel use and transfer patient information HIPAA requires EMS agencies to appoint a “Compliance Officer” and create HIPAA policy for the organization to follow HIPAA mandates training for EMS personnel and administrative support staffFile Size: 229KB
Chapter 1 - HIPAA Basics A-1: Discussing HIPAA fundamentals 1 Who's impacted by HIPAA? HIPAA impacts health plans, health care clearinghouses, and health care providers that send or receive, directly or indirectly, HIPAA-covered transactions. These entities have to meet the requirements of HIPAA.
What is HIPAA? HIPAA is the Health Insurance Portability and Accountability Act of 1996. HIPAA is a Federal Law. HIPAA is a response, by Congress, to healthcare reform. HIPAA affects the health care industry. HIPAA is mandatory.
Basics of HIPAA and HITECH 4 What exactly is HIPAA? 4 Covered entities v. business associates 5 The HIPAA Omnibus Rule 6 7 H C E T I H HIPAA Compliance Simplified 8 Five security-thought-leader tips for HIPAA Compliance 8 Three specific HIPAA tips you need to know post-omnibus 11 Checklist: How to Make Sure You're Compliant 13
Tel: 515-865-4591 email: Bob@training-hipaa.net HIPAA Compliance Template Suites Covered Entity HIPAA Compliance Tool (Less than 50 employees) . HIPAA SECURITY CONTINGENCY PLAN TEMPLATE SUITE Documents in HIPAA Contingency Plan Template Suite: . Business Impact Analysis Policy includes following sub document (12 pages) Business .
Tel: 515-865-4591 email: Bob@training-hipaa.net HIPAA Compliance Template Suites Covered Entity HIPAA Compliance Tool (Less than 50 employees) . HIPAA SECURITY CONTINGENCY PLAN TEMPLATE SUITE Documents in HIPAA Contingency Plan Template Suite: . Business Impact Analysis Policy includes following sub document (12 pages) Business Impact .
The module scst_user API is de ned in scst_user.h le. 3 IOCTL() functions There are following IOCTL functions aailable.v All of them has one argument. They all, except SCST_USER_REGISTER_DEVICE return 0 for success or -1 in case of error, and errno is set appro-priately. 3.1 SCST_USER_REGISTER_DEVICE
