EDI
Coordination of Benefits
National Provider Indentifier (NPI)
The Provider Identifier mandated by HIPAA
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HIPAA
EDI HIPAA Transaction Set Contact Information:
EDI HIPAA Transaction Set Contact Information:
For all HIPAA Testing Setup and Production assistance, please call the following
EDI Support Numbers:
(540) 767-7020 for VA/WV
(414) 459-5999-Option 3 for all others
Revised timelines for HIPAA Transaction Sets (Effective 08/01/06)
The CMS/UGS Contingency Plan for Medicare claims ended October 1, 2005. Non-HIPAA
compliant claims are no longer being processed.
UGS is receiving 100% of its claims in the HIPAA 837 format. In addition, UGS
is creating and sending 100% of ERAs in the HIPAA 835 format.
Watch the UGS EDI Web Page for ongoing updates.
X12N 837
Inbound (Claims) |
100% of the 2,421 UGS electronic claim submitters (representing
9,938 providers) are in production with the 837 4010 A1. |
X12N 835
Outbound (ERA) |
100.0% of the 1,833 UGS ERA receivers (representing 5,181 providers)
are in production with the 835 4010 A1. |
X12N 837
Outbound (COB) |
All commercial COB Trading Partners have transitioned to the
National COBC. All Medicaid partners will transition to the COBC by the
end of September 2006. |
X12N 276/277
(Claim Status)
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UGS is pilot testing with a small group of providers. We anticipate
going to full scale testing and full production in 2006.
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X12N 270/271
(Bene Eligibility) |
Testing continues with the selected national clearinghouses (WebMD
and HDX). Please reference the January 2005 Medicare Memo, elsewhere on
this web site, for complete details.
CMS made changes to its IT infrastructure to address standards for Medicare
beneficiary eligibility inquiries which will result in a centralized real
time HIPAA compliant health care eligibility inquiry and response transaction.
The HIPAA compliant system is now available.
All electronic X12 270 eligibility inquiry files will be processed at
a CMS data center and the data center will use a consolidated national
eligibility database to issue the X12 271 response. CMS will be using
a phased approach:
- The extranet (Medicare Data Communication Network or MDCN) is currently
available. Clearinghouses and providers must complete the 270/271
Access Form
to obtain access to the MDCN.
- Limited Internet access is expected to be provided some time in 2006.
Instructions on accessing eligibility data via this method will be issued
prior to the time Internet access becomes available.
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