Frequently Asked Questions

What forms do I need to complete to be able to send HIPAA transactions? 
You must complete the Trading Partner Agreement and the EDIG Enrollment Form. If you represent a hospital, or are a doctor or other health care professional who will be transmitting transactions directly to us, you should complete these forms. If you are a clearinghouse, complete these forms.

I use a clearinghouse to process my transactions. So I do not need to do anything, right? 
Clearinghouses must complete and sign the Trading Partner Agreement and EDIG Enrollment form for clearinghouses. If you plan to use a vendor or clearinghouse to conduct your HIPAA transactions, please have them contact us as soon as possible if they have not already done so to ensure their transactions are compatible with our systems. You still must meet the separate HIPAA Privacy rules that went into effect on April 14, 2003.

What if I am not ready to transmit HIPAA transactions? 
If you need another method of filing claims to us, My Insurance ManagerSM is HIPAA compliant for institutional, professional and dental 837 claims filing. You can also use My Insurance Manager for HIPAA-compliant eligibility and benefits information (270/271) and claims status inquiries (276/277).

When will the 835 for electronic remittance advice files be ready? 
The 835 is available now. You must complete the appropriate Trading Partner Agreement and Enrollment form. There is one for hospitals and health care professionals and another for clearinghouses.

Will the 835 include line level payment information? 
The remittance will match the reimbursement methodology. For inpatient, all remits will show claim level payments. For outpatient, claim level payments will be shown until line level reimbursement is implemented (APCs) — at which time line level payments will be reflected on the remit.