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DHS Medicaid EDI Manual v 1.1 - Department of Human Services

1. essent 7 4 FAD Documentation cioe ouo a CUP EO AE DEG VERE SA ET ARD 74 8 DU II as see ddr ent n n RR E e IR REA RR AR TR oi ib nin Cini ur i December 7 2005 iii DHS Medicaid EDI Manual v 1 1 doc Hawaii Department of Human Services Med QUEST Division Change Log 1 Change Log and Summary This section is updated as each version is released Comments are included where applicable Version Release Date Comments if applicable 1 1 11 1 2005 This version of the EDI manual replaces the existing ECS manual The manual was produced in conjunction with the October 2003 HIPAA Transactions and Code Sets implementation Summary of Changes by version This section provides a summary of all changes to the manual They are listed in descending version order then by page and or section number A brief description of each change is also included Where document wide are indicated the Page Section column will designate global change There is no change summary for version 1 0 Version 1 1 Page Section Previously Stated Description of change 1 Change Log and Needs to include Version 1 1 Summary 3 1 Access codes and passwords For more information regarding the account creation process no text follows Replace with For more information regarding the account creation process please download the DHS Medicaid Online user manual found in the Provider R
2. t N 14 s ni v STATE OF HAWAII DEPARTMENT OF HUMAN SERVICES Med QUEST Division Electronic Data Interchange EDI Manual November 1 2005 I ntroduction Thank you for participating in the Hawaii Medicaid program Med QUEST a division of the Hawaii Department of Human Services DHS is responsible for administering the Title XIX Medicaid program for the State of Hawaii This Electronic Data Interchange EDI manual is intended to provide instructions for transmitting and receiving electronic transactions with Med QUEST and its fiscal agent ACS State Healthcare Previously referred to as the Electronic Claims Submission ECS manual it has been expanded to accommodate changes mandated by the Health Insurance Portability and Accountability Act HIPAA It now contains information about all HIPAA compliant transactions implemented by Med QUEST for the fee for service provider population Note The manual does not cover transactions used by QUEST health plans QUEST health plan providers should contact the plans directly for EDI requirements Health plans should refer to the Health Plan Manual for EDI requirements Change Log and Summary DHS Medicaid EDI Manual Table of Contents 1 Change Log and Summary iun ute esee ede ree sinis Re Deed pr nee SER ince en ea D oB edo Pe RUE 1 1 2 Before You Debt edo p iniit esent iu un qun i cauda Mieres 2 1 Zl Intended Audience ette tte PRISE 2 1 2 2
3. 30 Authorized Representative Name Title 31 Date 32 Signature Electronic Provider Agreement 1 Provider Vendor Organization hereafter called Provider hereby is authorized to submit claims data to the State of Hawaii Department of Human Services Med QUEST Division hereafter called the Agency for services rendered by the undersigned Provider in machine readable form as specified by the Agency The Provider certifies that the claims data so recorded and submitted as input data are in accordance with all procedures rules regulations or statutes now in effect If any of those procedures rules regulations or statutes are hereafter amended the Provider agrees to conform to those amendments of which the Provider has been notified Provider further certifies that it will retain and preserve all original documents as required by law submit all or any part of same or permit access to same for audit purposes as required by the State of Hawaii or any agency of the federal government or their representatives In consideration of the Agency acceptance of the Provider input data the Provider agrees to be responsible for any incorrect or delayed payments made to the Provider as a result of any error omission deletion or erroneous insert caused by the Provider in the submitted data In the event of any inconsistencies between the input data contained and underlying source documents whether set forth in claim forms
4. Trading Partners or Trading Partners retrieve production acknowledgement files 997 824 or TA1 from this folder SHIFTP FTP XXXXX CLAIMS ECSIN TEST Trading Partners place test 837 in this folder SHIFTP FTP XXXXX CLAIMS ECSOUT TEST Trading Partners or Trading Partners retrieve test acknowledgement files 997 824 TA1 from this folder The structure is outlined below where XXXXXX the Provider s ID Directory Structure 835 Use SHIERA FTP XXXXXX CLAIMS REMITSOUT PROD Trading Partners retrieve production remittance advice 835 from this folder SHIERA FTP XXXXXX CLAIMS REMITSOUT TEST Trading Partners retrieve test remittance advice 835 from this folder December 7 2005 5 1 DHS Medicaid EDI Manual v 1 1 doc Hawaii Department of Human Services Med QUEST Division Transmission Requirements DHS Medicaid EDI Manual Directory Structure 270 271 Use SHIERA FTP KXXXXX EDIAN PROD Trading Partners place the batch 270 production files in this folder SHIERA FTP XXXXXX EDIAN TEST Trading Partners place the batch 270 test files in this folder SHIERA FTP XXXXXX DI OUT PROD Med QUEST places the 271 batch production files in this folder SHIERA FTP XXXXXX EDI OUT TEST Med QUEST places the 271 batch test files in this folder ACS and Med QUEST work together to control access to the production and test directories Trading
5. I pswitch Inc 333 North Avenue Wakefield MA 01880 617 246 1150 E mail info ipswitch com http Avww ipswitch com December 7 2005 4 3 DHS Medicaid EDI Manual v 1 1 doc Hawaii Department of Human Services Med QUEST Division Technical Requirements DHS Medicaid EDI Manual Note The Cisco VPN Dialer does not include FTP capability This must be obtained with a separate product There are many FTP products available on the market and Med QUEST does not mandate use of a particular product WS_FTP by Ipswitch Inc has been evaluated and deemed satisfactory by Med QUEST December 7 2005 4 4 DHS Medicaid EDI Manual v 1 1 doc Hawaii Department of Human Services Med QUEST Division 5 Transmission Requirements This chapter describes the FTP directory structure and transaction standards It also describes transmission windows and thresholds 5 1 File Transfer Protocol FTP Directory Structure Med QUEST provides Trading Partners that have successfully completed the sign up process with two sets of directories test and production Each mirrors the other and is distinguished by PROD production and TEST test The structure is outlined below where XXXXX refers to the Trading Partner ID FTP User ID assigned by Med QUEST Directory Structure 837 Use SHIFTP FTP XXXXX CLAIMS ECSIN PROD Trading Partners place production 837 in this folder SHIFTP FTP XXXXX CLAIMS ECSOUT PROD
6. Partners submit successfully using 486 class workstations with 32 MB of RAM however Cisco recommends the following e PC compatible computer with Pentium processor e 18 MB of free drive space e 16 MB of RAM for Win95 98 32 MB for NT 4 0 64 MB for Win2000 XP e Ethernet network interface card or modem Internet firewall The Trading Partner must have a working Internet connection and any intervening firewalls must be configured to permit passage of the VPN traffic on TCP port 10000 Some Internet Service Providers ISP will not comply with this requirement in such cases Trading Partners must obtain a separate dialup account for VPN purposes The only known ISP issues encountered with AOL are with the free services that provide dialup Internet access 4 3 File Transfer Protocol FTP Standards After establishing a secure VPN connection Trading Partners should configure FTP software to point to the Med QUEST FTP server s with the following profile names depending on the transaction SHIERA 835 270271 SHIFTP 837 December 7 2005 4 2 DHS Medicaid EDI Manual v 1 1 doc Hawaii Department of Human Services Med QUEST Division Technical Requirements DHS Medicaid EDI Manual The ACS EDI Team will provide the Med QUEST FTP servers IP addresses during the registration and setup process Med QUEST does not provide FTP software for Trading Partners Most software vendors clearinghouses bundl
7. Pie Naming Standards sssstitasts tene E n nation tentus 6 5 6 9 8 Transmitting Transactions and Reviewing Results essen 6 6 6 3 4 Testing Thresholds by Transaction essent 6 6 6 3 5 Completing the Testing Process rara ae me n er tan 6 7 64 Testing Expectations eden ette e ee nne e Ite nre teens 6 8 6 4 1 What Trading Partners Can Expect From Med QUEST sese 6 8 6 4 What Med QUEST Expects From Trading Partners sss eee 6 8 7 Transaction OVERVIEW aeicecseeneeneeueduenne aenean nei ana an anda euRx a exi qnia n RIS 7 1 4l Inbound Iransactorns ence Pet Ree te ees 7 1 FLA 1897 Bee for Serowe Chim i e e CEDE b RC Ee ug 7 1 L1 2 cGlam Attachments sio hee ee eo boob ooo eO Oe bes 7 1 7 2 Qutbourd Transactions eR ERREUR ER TET VER TEE ai 7 2 21 835 Electronic Remittance Adice iuo eee beoe beoe eoo ooo eee 7 2 72 2 TAL Interchange Acknowledgement eant tn 7 2 7 2 3 409 7Z EunchonabAcknowledeetment n oe S Sen CU Een ore Rata a 7 3 7 2 4 824 Implementation Guide Reporting seen eene 7 3 7 3 Inbound Outbound Transactions eese nne trennen tnit 7 3 7 3 1 270 271 Health Care Eligibility Benefit Inquiry and Response sse 7 3 7 9 2 Future Inbound Outbound Transactions eee eene 7 3 7 4 Problem Reporting Resolution and Documentation sss 7 4 7 4 1 Problem Reporting and Resolution
8. 3 DHS Medicaid EDI Manual v 1 1 doc Hawaii Department of Human Services Med QUEST Division Registration Requirements DHS Medicaid EDI Manual e Electronic Provider Agreement The agreement between the provider and Med QUEST to accept claims electronically This form will also be used for other electronic transactions mandated by HIPAA such as prior authorizations and claim attachments e Electronic Remittance Advice Registration This form relates specifically to the 835 Electronic Remittance Advice and enables the provider to receive Automated Clearinghouse ACH payments e Electronic Claim Data Authorized Signature Used when the Trading Partner s signatory personnel changes occur e Med QUEST 270271 Batch Health Care Eligibility Benefit Inquiry and Response Trading Partner Registration Form Registration form to process 270 271 Batch Health Care Eligibility Benefit Inquiry and Response transactions with Med QUEST Use the chart below to determine which forms to complete and mail These Trading Partners Complete these Forms Trading Partner that transmits electronic claims and other related transactions and receives an electronic remittance advice e Provider Vendor Electronic Claims Submission Notification e Electronic Provider Agreement e Electronic Remittance Advice Registration Trading Partner that transmits electronic claims and other related transactions but does NOT receive an e
9. Partners with more than 5 000 claims should send multiple 837 transactions December 7 2005 5 3 DHS Medicaid EDI Manual v 1 1 doc Hawaii Department of Human Services Med QUEST Division Transmission Requirements DHS Medicaid EDI Manual The SHIERA FTP is used for test and production batch 270271 Trading Partner There is a limit of 999 files per day per provider Unzipped files have a file size limit of 25mb Files that are zipped must have an extension of zip The tmp extension is not acceptable 5 4 2 Transmission Frequency Due to the new file naming standards implemented as part of the October 16 2003 Transactions and Code Sets TCS Implementation trading partners can submit multiple batches 837 transactions per day Trading partners are reminded to note the file naming conventions documented in Section 5 2 Transaction Naming and Transmission Standards Med QUEST has not yet determined the maximum number of daily transactions accepted by a single Trading Partner based on Trading Partner ID December 7 2005 5 4 DHS Medicaid EDI Manual v 1 1 doc Hawaii Department of Human Services Med QUEST Division 6 Testing This chapter outlines testing strategy and provides useful information for trading partners testing the following transactions e 837 fee for service claims professional institutional dental e 835remittance advice e 27071 Batch eligibility request and response e Acknowledgement transactions A
10. Publishing Company at http vww wpc edi com hipaa HIPAA 40 asp Med QUEST has developed an 837 Companion Document which can be downloaded from the Med QUEST HIPAA EDI page at http ned quest us HIPAA documentsanddeliverables Aechnical html 7 1 2 Claim Attachments Because the electronic submission specifications contained in this manual do not allow for the submission of claim attachments the claims for the following services claim types Situations must be submitted in hard copy with the appropriate attachments December 7 2005 7 1 DHS Medicaid EDI Manual v 1 1 doc Hawaii Department of Human Services Med QUEST Division Transaction Overview DHS Medicaid EDI Manua Service Claim Type Situation Required Attachment Sterilization Sterilization Consent form Hysterectomy Hysterectomy Consent form Claims with eligibility coupons Coupon Hospital outpatient claims Itemized statement if charges exceed 2 000 Miscellaneous DME and supplies Invoice for E1399 and 99070 procedure codes Timely Filing Exceptions Exception letter 7 2 Outbound Transactions This section provides a summary of outbound transactions currently supported by Med QUEST and ACS For outbound transactions the following transaction delimiters apply e Element delimiter changed from the e Composite delimiter the pipe no change Segment delimiter a tilde no change 7 2 1 835 Electronic
11. Remittance Advice The 835 is intended to meet the particular needs of the health care industry for the payment of claims and transfer of remittance information The 835 can be used to make a payment send an Explanation of Benefits EOB remittance advice or make a payment and send an EOB remittance advice from a health care payer to a health care provider either directly or through a Depository Financial Institution Med QUEST currently recognizes the ASC X12N 835 004010X91A1 version of the 835 Trading partners should download the appropriate Implementation Guides IG from the Washington Publishing Company at http Avwww wpc edi com hipaa HIPAA 40 asp Med QUEST has developed an 837 Companion Document which can be downloaded from the Med QUEST HIPAA EDI page at http ned quest us HIPA A Mocumentsanddeliverables Aechnical html 7 2 2 TA1 Interchange Acknowledgement The TA1 is used to report the status of processing a received interchange header and trailer or non delivery by a network provider For the TA1 Med QUEST complies with the instructions provided in the 837 and 270 Implementation Guides see appendix The IG can be downloaded from the Washington December 7 2005 7 2 DHS Medicaid EDI Manual v 1 1 doc Hawaii Department of Human Services Med QUEST Division Transaction Overview DHS Medicaid EDI Manual Publishing Group Web site at http Avww wpc edi com hipaa HIPAA 40 asp Med QUEST did not develop a c
12. information transmitted to the State is accurate and complete This electronic agreement correlates to a signature on a paper claim which attests to the accuracy of the data provided December 7 2005 3 2 DHS Medicaid EDI Manual v 1 1 doc Hawaii Department of Human Services Med QUEST Division Registration Requirements DHS Medicaid EDI Manual The table below outlines the process for EDI sign up with Med QUEST and ACS Step Action Result 1 Contact ACS The ACS Provider Inquiry Unit PIU can be reached at 808 952 5570 800 235 4378 for Neighbor Islands PIU Associate will collect basic information from the caller and forward request to the ACS EDI Team The ACS EDI Team will then send the EDI and VPN manuals to the requestor 2 Access Web site The Med QUEST Web site at www med quest us hipaa provides detailed information about EDI and HIPAA At this site interested parties can download the EDI manual learn about transaction use helpful links and find out more about the testing process The site also features numerous Contact us links which go directly to ACS 3 Complete and mail form s Please see Section 3 2 2 Determining Which Forms to Complete and Section 3 3 Completing the EDI Forms for complete instructions Please note ACS must receive original signed copies of these forms A mailing address is provided in Section 3 2 3 Submitting Forms and Receiving Respo
13. the Med OUEST SHIFTP FTP server FIP XXXXX CLAIMS ECSIN PROD or ECSIN TEST 6 3 2 File Naming standards The file naming standards used for the 270271 and 276 277 is the same for both production and test Please refer to section 5 2 Replace with For Inbound production and test batch 270 files submitted via the SHIERA FTP server IN folder 270 PPPPPP YYMMDD HHHHHHBHHETXT Where 270 Transaction PPPPPP 6 digit Provider ID YYMMDD Date THHHHHHHHE 9 digit Inbound ISA13 Interchange Control number TXT File extension or ZIP For Outbound production and test 271 batch response files available in the OUT folder YYMMDD 4HHHHHHHHE 271 Where THHHHHHHHE 9 digit outbound ISA 13 Interchange Control number Acknowledgment files 997 824 or TA1 will be sent in response to the inbound 270 For example 072505 000456789 824 072405 123456789 997 Please refer to the 270 271 Companion document for additional information 6 3 3 Transmitting transactions and Reviewing results The daily processing cycles begin at 4 00 p m AST Results from the current day s run will be available the next business day Please note the HIPAA testing team located in Hawaii operates Replace with The daily processing cycles begin at 6 00 p m HST Results from the current day s run will be available the next business day three hours behind AST 6 3 4 Testing 837P LD Update to T
14. to accept claims electronically This form will also be used for other Electronic Claim Data i electronic transactions mandated by HIPAA such as prior Authorized Signature EE authorizations and claim attachments Electronic Remittance Advice Registration This form The purpose of the first form is relates specifically to the 835 Electronic Remittance Advice and to document the relationship enables the provider to receive Automated Clearinghouse between provider and vendor ACH payments te identity thie Trading Partisi Electronic Claim Data Authorized Signature Used when an capte a HEY the Trading Partner s signatory personnel changes occur contact information The second form serves as an agreement Med QUEST Batch 270 271 Health Care Eligibility Benefit between the provider and Inquiry and Response Trading Partner Registration Form Med QUEST to accept claims Registration form to process Batch 270 271 Health Care electronically This form will Eligibility Benefit Inquiry and Response transactions with also be used for other Med QUEST electronic transactions mandated by HIPAA such as prior authorizations and claim attachments The third form relates specifically to Electronic Remittance Advices 835 and enables the provider to receive Automated Clearinghouse ACH payments The fourth form is used when provider endor signatory personnel changes occur 3 2 2 Determining Use the chart below to Revised chart to includ
15. 000 unique 9 character Interchange Control Number 997 Functional Acknowledgement MMDDYY 000000000 997 MMDDYY process date 000000000 unique 9 character Interchange Control Number 824 Implementation Guide Reporting MMDDYY 000000000 824 MMDDYY process date 000000000 unique 9 character Interchange Control Number 5 3 Production Transmission Window 5 3 1 Inbound Transactions Electronic claims 837 must be submitted midnight 6 00 p m Hawaii Standard Time HST Monday through Thursday and midnight 4 00 p m HST on Friday Transmissions received in their entirety will be processed by the next business day Batch 270 request file s submitted via the Med QUEST SHIERA FTP server must be uploaded by 6 00p m HST for processing that evening Files are processed 7 days a week 5 3 2 Outbound Transactions Financial cycles resulting in production of either the 835 or paper Remittance Advice are run weekly 271 and 277 bath responses will be available to the Trading Partner by 8 00 a m HST the following calendar day 5 4 Transmission Thresholds This section describes transmission thresholds for inbound transactions 5 4 1 Minimum Maximum Submission Med QUEST and ACS set a minimum number of five 5 claims per transaction file for system efficiency For the Maximum number of claims the recommendation from the 837 Implementation Guide is there should be no more than 5 000 claims per transaction Trading
16. 5 Testing Concurrent testing will be conducted for entities participating in 837 and 835 testing The process mirrors production in that an 835 transaction is produced weekly and contains information related to all 837 test claims processed during that week Please note claims that do not pass through translator edits will not be processed in HPMMIS and will therefore not display on that week s 835 835 Testing Only Trading partners may elect to complete testing for the 835 For these providers vendors a maximum of two weekly test remittance advices will be placed in the test folder of the FIP server During the test period providers will continue to receive a hard copy remittance advice Once testing has been completed the hard copy remittance advice will be sent along with the 835 for two consecutive weeks At the end of the two week period the hard copy remittance advice will be discontinued and only the 835 will be produced 6 3 5 Completing the Testing Process Trading Partners that have successfully completed applicable test cycles will be notified by ACS that they are certified to e Submit 837 Production files e Receive 835 Production files e Submit and Receive Batch 270 271 Production files The contents of the e mail will indicate successful completion of the testing phase by transaction Batch 270271 transactions In the production environment Trading Partners will be able to submit and receive the 270771 Eligibility Veri
17. Contact Information eee eee free ice hee crire ede 2 2 2 9 Prerequisites eee Ree eth tenait A eiae ii T HR re 2 3 3 Registration RequicemebEs a ao uer b eate etu EE ism iuse nada 3 1 Biko Access Codes and Passwords ee eeepc e ea tese enint ec 3 1 9 2 Signieup Procedures eee tee qr eee eterne te aba d pe RARE 3 2 3 21 7 PrOCOSSIOUETOIEU cR EGIT AO REOR se Deci iit eoa abe UR A dra Pulp doit as oie dk d 3 2 3 2 2 Determining Which Forms to Complete sse eene 3 3 3 2 3 Submitting Forms and Receiving Responses sss eeneenennnnnnes 3 4 3 3 Completing the EDI Forms sss ntententntenennen nennen 3 5 3 3 1 Provider Vendor Electronic Claims Submission Notification css 3 5 3 3 2 Electronic Provider Agreement sss nete 3 6 3 8 8 Electronic Remittance Advice Registration eee 3 7 3 3 4 Electronic Claim Data Authorized Signature sss 3 7 3 8 5 Instructions for Med QUEST Batch 270 271 Health Care Eligibility Benefit Inquiry and Response Trading Partner Registration Form sse eene 3 8 4 Technical Requitements c cncscccissesesccesndensssndccadscecssscseoedescsondsesseeaecvcoensecssenesee 4 1 4 1 Internet Connectivity or a e E A tentent A nenne ntentennet 4 1 4 2 Virtual Private Network VPN Standards eese 4 1 4 3 File Transfer Protocol FTP Standards sss 4 2 44 Conimunications Software Eee
18. Partners can submit and receive only those transactions for which they are testing test directories or have completed testing production directories 5 2 Transaction Naming Standards This section describes naming standards by transaction Note Trading partners should use the most current Companion Document as the official source for file naming and layout standards This EDI manual is intended only as a general reference the Companion Document contains the most up to date specifications for a particular transaction To access Companion Documents please refer to Chapter 7 Transaction Overview Med QUEST recognizes the following naming standards Transaction Naming Standard 837 fee for service claim CLM MMDDYY HHMMSS 837 835 remittance advice HI 835 01 YYYYMMDD Full Provider ID location code w leading zeros txt Supplemental file HI 835 02 YYYYMMDD Full Provider ID location code w o leading zeros txt 270 271 Eligibility Verification Transaction and Naming standard 270 PPPPPP YYMMDD JAHHEHHEHHHHETXT PPPPPP 6 digit Provider ID 000000000 unique 9 character Interchange Control Number December 7 2005 DHS Medicaid EDI Manual v 1 1 doc Hawaii Department of Human Services Med QUEST Division Transmission Requirements DHS Medicaid EDI Manual Transaction Naming Standard TA1 Interchange Acknowledgement MMDDYY 000000000 TA1 MMDDYY process date 000000
19. Services Med QUEST Division Testing DHS Medicaid EDI Manual Acknowledgment files 997 824 or TA1 will be sent in response to the inbound 270 For Example 072505 000456789 824 072405 123456789 997 Please refer to the 270 271 Companion document for additional information The 270 batch file should be placed in the Med QUEST SHIERA FTP server FTP XXXXXX EDIAN TEST where xxxxxxx the 6 digit provide id The folder EDI AN TEST is used for inbound 270 batch transactions while the folder EDIJOUT TEST is used for outgoing 271 batch transactions For production 270 271 batch transactions the folders EDIAN PROD or EDI OUT PROD is used Please refer to Section 5 2 Transaction Naming Standards for the naming standards of other outbound transactions For incoming transactions any character from the Basic and or Extended Character Set can be used providing it is not used in a data element value following the interchange header 6 3 3 Transmitting Transactions and Reviewing Results After the test file is placed in the test folder please email the ACS EDI Team via hi ecstest acs inc com Include the file name and the date and time that the file was submitted In addition include the original claim batch submission date when the original file was sent to production This information will allow ACS to identify selected claims in the Med QUEST production region and compare it to the test results The daily processing
20. able of Testing Thresholds to include 270 271 Thresholds by 835 Transaction 270 Transaction Submissions Receipts Required Minimum of 2 batch submissions December 7 2005 1 7 DHS Medicaid EDI Manual v 1 1 doc Hawaii Department of Human Services Med QUEST Division Change Log and Summary DHS Medicaid EDI Manual Page Section Previously Stated Description of change Testing Requirements Minimum of 25 eligibility enrollment inquiries Transaction 271 Submissions Receipts Required Minimum of 2 batch responses Testing requirements In conjunction with batch 270 testing 6 3 4 835 Testing For these providers Vendors Only a maximum of two weekly production remittance advices will be placed in the test folder of the FTP server At the end of the two week period the hard copy remittance advice will be discontinued and only the ERA will be produced Replace production with test Replace with Once testing has been completed the hard copy remittance advice will be sent along with the ERA for two consecutive weeks At the end of the two week period the hard copy remittance advice will be discontinued and only the ERA will be produced 6 3 5 Completing the Trading partners that have Testing Process successfully completed applicable test cycles see Testing Thresholds below should submit an email to the ACS EDI Team at hi ecstest acsinc com Repla
21. about each transaction and where applicable a link to the Med QUEST Companion Document December 7 2005 2 3 DHS Medicaid EDI Manual v 1 1 doc Hawaii Department of Human Services Med QUEST Division 3 Registration Requirements This chapter describes how to sign up to exchange EDI with Med QUEST and ACS It includes the following sections e Access codes and passwords e Sign up procedures e Completing EDI forms 3 1 Access Codes and Passwords To submit and receive electronic transactions with Med QUEST and ACS Trading Partners must be set up with a series of IDs and passwords It is the responsibility of the State to assign the IDs and communicate this to ACS Types of IDs include e ID password granting access to the Trading Partner s folder on the File Transfer Protocol FTP server e ID password for the Virtual Private Network VPN protecting the FTP server It is important to understand these access codes relate to the Trading Partner who may or may not be the provider A provider may contract with a clearinghouse to transmit electronic transactions If that clearinghouse bundles transactions from one or more providers and submits them to Med QUEST the clearinghouse is assigned a set of IDs passwords By contrast a provider using software to submit receive transactions directly with Med QUEST will be assigned his or her own set of IDs passwords Providers are encouraged to communicate with their software developers bi
22. alancing and T4 Inter segment Data Relationships How can I get certified Your software developer will send test transactions to a qualified certification entity Below is a partial list of certifying agencies Please be aware that Med QUEST and ACS not recommend one agency over another nor do we require trading partners to use a particular certification entity www hipaatesting com www edifecs com www claredi com How can I demonstrate certification Trading partners can use any of the following methods to demonstrate certification e Response from certification entity indicating an 837 transaction has successfully passed Level IV certification e Verification the trading partner is currently in production with at least one other payer e Other please contact the ACS EDI team at hi ecstest acs inc com Note Trading partner is synonymous with Trading Partner for testing purposes 6 1 2 Securing a Testing Window To the extent possible ACS will allow Trading Partners to select their own testing windows However it is extremely important to understand that successful testing typically involves frequent interaction between the Trading Partner and the ACS EDI Team For this reason ACS may be required to schedule testing during peak times Trading Partners are encouraged to contact ACS early during the testing process to discuss testing windows and establish effective communications 6 2 Preparing Tes
23. ansactions Outbound transactions such as the 835 Electronic Remittance Advice and 271 Eligibility Verification Response batch are predicated upon submission of valid inbound transactions December 7 2005 6 3 DHS Medicaid EDI Manual v 1 1 doc Hawaii Department of Human Services Med QUEST Division Testing DHS Medicaid EDI Manual Med QUEST and ACS understand that some providers may use a different vendor for claims and electronic remittance advices this complicates but does not prohibit the testing process 835 trading partners should perform one of the following to prepare for testing e Submit a sufficient number of 837 transactions to generate an 835 that can be tested and validated or e Prepare a set of test claims and work with ACS to generate transactions that can be used to produce an 835 Med QUEST has produced a sample 835 transaction that can be downloaded and reviewed by any interested party Please note the sample transaction is useful only to test transaction formatting to complete 835 testing trading partners must submit 837 transactions or work with ACS to develop test claims which can be used to produce the 835 Note Med QUEST and ACS have no control over the extent to which trading partners test outbound transactions For this reason providers and their vendors are strongly encouraged to test beyond mere transaction compliance format and layout and attempt to validate the data provided on the
24. ant format the following morning The appropriate acknowledgement file will also be returned December 7 2005 1 10 DHS Medicaid EDI Manual v 1 1 doc Hawaii Department of Human Services Med QUEST Division Change Log and Summary DHS Medicaid EDI Manual Page Section Previously Stated Description of change viewed up until the end of day processing In the nightly process a mainframe program will process the request and the response will be available for download in a HIPAA compliant format the following morning The response will also be available to view online however data viewed online requires data compliance not format compliance Therefore the batch response returned the following day to the Trading Partner would not be in the same format as the file available online The ability to view and or download a response file is restricted to the Trading Partner of the request 7 3 2 278 Prior Authorization Request and Response The 278 Health Care Services Review Notification handles the transmission of unsolicited health care service review information to trading partners This information can take the form of copies of health service review outcomes or notification of the beginning or end of treatment The following events can be handled by this transaction Patient arrival notice Patient discharge notice Certification change notice Notification of certification to pri
25. ature of Trading Parnter If not provider Authorized signature of Trading Partner if different from the Provider Date Enter the date the form was signed by the Trading Partner Provider s Signature The Provider s signature Date Enter the date the form was signed by the Provider December 7 2005 3 9 DHS Medicaid EDI Manual v 1 1 doc Hawaii Department of Human Services Med QUEST Division 4 Technical Requirements This chapter describes hardware and software requirements for EDI It contains the following sections e Internet connectivity e Virtual Private Network VPN standards e File Transfer Protocol FTP standards e Communications software 4 1 Internet Connectivity Internet connectivity is secured through use of a VPN Users must establish an Internet connection and connect to a secured VPN After establishing a secured connection users will be able to run FTP to initiate file transfers with Med QUEST Usernames and passwords are required for FTP access and for the VPN They are maintained by the State and communicated to Trading Partners by ACS Please refer to Chapter 2 Sign up Procedures for more information The DHS Medicaid Online web application requires that you use Microsoft Internet Explorer 6 0 or higher to access data through the Internet This requirement helps ensure the Med QUEST standards for privacy reliability and flexibility If you encounter difficulties when att
26. bre he beor eae bre ee eit iere 4 3 5 Transmission Requirements acc er E XR UR RA RESORT UR URN EN ERR RR HI Re 5 1 5 1 File Transfer Protocol FTP Directory Structure sse 5 5 2 Transaction Naming Standards sse 5 2 5 3 Production Transmission Window sse etn 5 3 5 9 T Inbound Transactions RR AS ON EET 5 3 5 8 2 Outbound Transactions RR RU ates ETUR 5 3 5 4 Transmission Ihresholds 55 ntt irren tete erinit 5 3 5 411 Minimum Maximum Submission eese eene eene nnne nnne nennen 5 3 DAZ ATHAWSHISSIOIBETE THE CI SS s oceania none Ncc NU NC CO MON o C MUT 5 4 6 Leste eese ho n s i Oi a a ne M CY ER XR oa Gen RA ve RE Sees 6 1 December 7 2005 ii DHS Medicaid EDI Manual v 1 1 doc Hawaii Department of Human Services Med QUEST Division Change Log and Summary DHS Medicaid EDI Manual 6 1 Notifying ACS of the Intent to Begin TestEITIB s aei otov brc raa 6 1 6 t T Demonstrating X12 Certification oem bete pn a 6 1 61 2 Securing a Testing Window eee bedeuten e DD teet 6 2 6 2 Preparing Test Data oio ee perte ur ERR TER Reina 6 2 6 2 1 Preparing for Inbound Transactions eene nnn 6 3 6 2 2 Preparing for Outbound Transactionsic as E EPA TRUE 6 3 0 2 3 Testing Lips and Guidelines sa e DR n DA NOR 6 4 6 3 Exchanging Test TransaCHhoNS stissi saie EAE tentent 6 4 6 3 1 Testing Cycles and Transmission Schedules sss 6 5 6 3 2
27. ce with Trading Partners that have successfully completed applicable test cycles will be notified by ACS that they are certified to Submit 837 Production files Receive 835 Production files Submit and receive Batch 270 271 Production files The contents of the e mail will indicate successful completion of the testing phase by transaction Batch 270271 transactions In the production environment Trading Partners will be able to submit and receive the 270 271 Eligibility Verification Request and Response files in the HIPAA compliant format via the SHIERA FTP server Trading Partner 7 1 3 Future Inbound The following transactions are Transactions proposed or currently under development 277 275 The Health Care Claim Status Notification 277 transaction set will be used as an unsolicited Health Care Claim Request for Additional Information In this scenario this would be a 275 transaction The 275 transaction Additional Removed December 7 2005 1 8 DHS Medicaid EDI Manual v 1 1 doc Hawaii Department of Human Services Med QUEST Division Change Log and Summary DHS Medicaid EDI Manual Page Section Previously Stated Description of change Information to Supporta Health Care Claim or Encounter Attachments is intended to send additional information abouta daim orencounter when a responding toa payers request for additional information or b accompanying the submiss
28. cycles begin at 6 00 p m HST Results from the current day s run will be available the next business day The ACS EDI Team will describe how to review and discuss testing results as trading partners contacts them to announce their intentions to begin testing 6 3 4 Testing Thresholds by Transaction At a minimum trading partners must adhere to the testing thresholds described in the table below Transaction Transmissions Required Testing Requirements 837 P 1 D Minimum of 2 batch submissions Minimum of 25 claims batch Maximum of 500 claims batch At least one exchange should include replacements voids 835 Minimum of 2 In conjunction with 837 exchanges 270 Minimum of 2 batch submissions Minimum of 25 eligibility enrollment inquiries December 7 2005 6 6 DHS Medicaid EDI Manual v 1 1 doc Hawaii Department of Human Services Med QUEST Division Testing DHS Medicaid EDI Manua Transaction 3 Transmissions Required Testing Requirements 271 Minimum of 2 batch responses In conjunction with 270 batch testing Trading partners responsible for 835 transactions only should contact ACS via email to discuss testing options Trading partners that share responsibility across functional teams for 837 and 835 development are required to coordinate their communication to facilitate the testing validation process Please ensure ACS has appropriate contact information Joint 837 and 83
29. dicaid EDI Manual v 1 1 doc Hawaii Department of Human Services Med QUEST Division 2 Before You Begin This section provides important information for those interested in exchanging electronic transactions with Med QUEST and ACS It includes the following sections Intended Audience Contact Information Prerequisites 2 1 Intended Audience The DHS Medicaid EDI Manual intended for individuals or companies that intend to exchange electronic transactions with the State of Hawaii Department of Human Services Med QUEST Division MOD Its purpose is to provide the reader with information covering all aspects of fee for service EDI including electronic claims submission electronic remittance advice electronic eligibility verification response and other HIPAA mandated electronic transactions This manual provides the following Registration requirements including signup procedures Transaction descriptions technical requirements and transmission requirements Testing information including tips thresholds and an overview of the testing process Contact information and links to the Med QUEST HIPAA EDI Web site December 7 2005 2 1 DHS Medicaid EDI Manual v 1 1 doc Hawaii Department of Human Services Med QUEST Division Before You Begin DHS Medicaid EDI Manual 2 2 Contact I nformation ACS the Med QUEST fiscal agent is responsible for assisting Trading Partners with EDI related issues The ACS Provider Call Cent
30. e FTP software with their EDI software packages Please refer to Section 4 4 Communications Software for information about an FTP package available through a third party vendor Med QUEST recommends the use of WS FTP see Section 4 4 Communications Software and will provide the URL from which it can be downloaded While the FTP Client is not supported by Med QUEST ACS may be able to assist Trading Partners with difficulties encountered installing or using the WS FTP Client Note Med QUEST does not support anonymous FTP Trading Partners must supply a valid Username and password to connect to the FTP server Please refer to Chapter 2 Sign up Procedures for information on obtaining the appropriate user IDs and passwords 4 4 Communications Software Med QUEST has evaluated the following software packages and provides vendor contact information for them Cisco VPN Dialer Cisco Systems Inc 170 West Tasman Drive San Jose CA USA 800 553 NETS 6387 within the U S and Canada http www cisco com Cisco provides the VPN Client software free of charge because the Med QUEST VPN Concentrator is a Cisco product It is important to note the Cisco VPN Client software may be used only for communicating with the Med QUEST communications server Med QUEST will provide copies of the software upon request with the understanding that it is to be used only for communicating with the Med QUEST communications server WS FTP
31. e in the column Complete these Which Forms to determine which forms to forms December 7 2005 1 2 DHS Medicaid EDI Manual v 1 1 doc Hawaii Department of Human Services Med QUEST Division Change Log and Summary DHS Medicaid EDI Manual Page Section Previously Stated Description of change Complete complete and mail Med QUEST Batch 270 271 Health Care Eligibility Benefit Inquiry and Response Trading Partner Registration Form Electronic Provider Agreement 3 3 5 Batch 270271 New Include new form Health Care Med QUEST Batch 270271 Health Care Eligibility Benefit Eligibility Benefit Inquiry and Response Trading Partner Registration Form Inquiry and This is a registration form to send and receive the Batch Response Med 270 271 Health Care Eligibility Benefit Inquiry and Response QUEST Trading transaction This form should be completed by the Provider Partner Registration and faxed to ACS before sending 270 Batch transaction files Form to Med QUEST for processing Insert table for explanation of fields See end of Change summary 4 1 Internet Connectivity Consult your own technical support resources for more information if necessary or use the link pictured below on the homepage to download and install Microsoft Internet Explorer 6 0 Replace with Consult your own technical support resources for more information if necessary or use the link pictured below on the home
32. empting to connect to the web site be sure that you have met these minimum browser requirements Consult your own technical support resources for more information if necessary or use the link pictured below on the homepage to download and install the latest version of Microsoft Internet Explorer 4 2 Virtual Private Network VPN Standards Trading Partners must install VPN Client software on the computer used to submit or receive the transmissions Trading Partners that apply for and receive a VPN ID and December 7 2005 4 1 DHS Medicaid EDI Manual v 1 1 doc Hawaii Department of Human Services Med QUEST Division Technical Requirements DHS Medicaid EDI Manual password are also given a Uniform Resource Locator URL which can be used to download the client software from Med QUEST s SHIERA or SHIFTP FTP servers Please refer to Chapter 2 Sign up Procedures for instructions ACS may be able to provide Trading Partners with assistance installing the VPN Client The following are hardware and software requirements for installing and using the VPN Client Hardware Software Category Requirement Operating System e Windows 95 B amp C may require dial up networking upgrade 1 3 e Windows 98 Windows 98 SE e Windows NT Workstation SP3 or higher e Windows XP e Windows 2000 Professional It is not known whether the VPN Client is compatible with Windows ME Hardware Hardware requirements are modest and some Trading
33. er is staffed from 7 30 a m until 5 00 p m Hawaii Standard Time Monday through Friday They can be reached at the following numbers 808 952 5570 Oahu and Mainland 800 235 4378 Neighbor I slands The ACS EDI Team can also be reached via e mail at hi ecstest acs inc com Issue Resolution Although ACS and Med QUEST work hard to make the EDI process as smooth as possible Trading Partners may encounter difficulty or require assistance during sign up testing or with production transmissions Any problems encountered in the electronic submission of claims to MOD and or the electronic receipt of remittance advices should be directed to the ACS Provider Call Center at the number s listed above Alternatively the Trading Partner may contact the ACS EDI Team directly by e mail The Trading Partner should be prepared to supply the following information e Topic of call for instance the transaction ID e Name e Organization and Trading Partner ID if applicable e Phone number e Nature of problem or question FTP server connection receipt status etc This information will be logged and the Call Center will transfer the caller to the appropriate staff member If a staff member is not immediately available the call will be returned as soon as possible Note It is recommended that Trading Partners contact the ACS EDI team via e mail during the testing process This enables the Trading Partner to attach examples of errors for in
34. es to Med QUEST for processing Field Name Instructions Provider Information Section Please Select One Provider to select what option Batch 270 271 will be handled for production and whether the request is an add change or delete Provider Name Enter the name of the Provider Provider ID If applicable enter the Provider ID number assigned by MQD Street Address1 Enter the Provider s street address Street Address2 Enter the Provider s street address City State ZIP Enter the Provider s city state and zip code Trading Partner s Information Section Vendor Name Enter the name of the Vendor that will be submitting the 270 271 Batch transaction on behalf of the Provider If no vendor leave blank Contact Person Name Enter the name of the Trading Partner s contact person Phone Enter the Trading Partner s telephone number Fax Phone Enter the Trading Partner s fax number Contact Email Address Enter the Trading Partner s contact s e mail address Street Address1 Enter the Trading Partner s street address Street Address2 Enter the Trading Partner s street address City State ZIP Enter the Trading Partner s city state and zip code December 7 2005 3 8 DHS Medicaid EDI Manual v 1 1 doc Hawaii Department of Human Services Med QUEST Division DHS Medicaid EDI Manual Field Name Instructions Authorized Sign
35. esources section of the Med QUEST website www med quest us December 7 2005 1 1 DHS Medicaid EDI Manual v 1 1 doc Hawaii Department of Human Services Med QUEST Division Change Log and Summary DHS Medicaid EDI Manual Page Section Previously Stated Description of change 3 2 Sign up Submitters are also referred lt Removed gt procedures to as trading partners throughout this manual Trading partner is a HIPAA term 3 2 1 Process New Replaced With Overview Trading Partners who have questions about their Trading Partner ID password or folder or who require information about the File Transfer Protocol FTP process used by Med QUEST should contact the ACS EDI Team 3 2 1 Process The MQD Systems Office will Replace with Overview provide FTP folder s Access The ACS EDI Team will provide the FTP folder s Access code s to the appropriate code s to the Provider s appropriate Contact Person on the Contact Person on the forms forms 3 2 2 Determining Provider Vendor Electronic Trading Partner Electronic Claims Submission Notification Which Forms to Claims Submission Documents the relationship between provider and vendor Complete Notification to identify the Trading Partner and to capture all necessary Electronic Provider Agreement contact information Electronic Remittance Advice Electronic Provider Agreement The agreement between Registration the provider and Med QUEST
36. essed 271 and 277 batch responses will be available to the Trading Partner by 8 00 a m HST the following day Replace with The 837 and 270 test files will be accepted and processed through all adjudication and Ar validation processes on a daily basis 837 and 270 test files will be accepted for the current day s test processing until 3 00 p m Hawaii Standard Time HST The appropriate acknowledgement file will be returned 6 3 1 Transmission Window for the 837 Electronic claims submissions will be accepted for the current day s test processing between 6 00 a m and 4 00 p m Arizona Standard Time AST Please note this is three 3 hours ahead of Hawaii Standard Time HST lt Delete gt 6 3 1 Transmitting Transactions and Reviewing Results The daily processing cycles begin at 4 00 p m AST Results from the current day s run will be available the next business day Please note the HIPAA testing team located in Hawaii operates lt Delete gt December 7 2005 1 6 DHS Medicaid EDI Manual v 1 1 doc Hawaii Department of Human Services Med QUEST Division Change Log and Summary DHS Medicaid EDI Manual Page Section Previously Stated Description of change three hours behind AST 6 3 2 File Naming standards The file should be placed in 170 68 41 129 FIP XXXXX CLAIMS ECSIN or ECSOUT TEST Replace with The 837 file should be placed in
37. fication Request and Response files in the HIPAA compliant format via the SHIERA FTP server December 7 2005 6 7 DHS Medicaid EDI Manual v 1 1 doc Hawaii Department of Human Services Med QUEST Division Testing DHS Medicaid EDI Manual 6 4 Testing Expectations 6 4 1 What Trading Partners Can Expect From Med QUEST Med QUEST has assembled a testing team to assist B2B participants and trading partners during the testing phases The team is comprised of personnel with deep knowledge of X12 HPMMIS and implementation large scale testing efforts The HIPAA testing team will review all inbound and outbound data and will interface directly with the trading partners and jor providers When necessary the team will forward issues to other technical personnel and will manage the resolutions of such issues Testing participants may contact the testing team at the following email address hi ecstest acs inc com The HIPAA testing team monitors the inbox for this address constantly throughout the business day It is our intention to respond promptly to queries sent to this address and to provide information to all testing participants through email and through publications on our Web site located at http Avww med quest us HIPAA Andex html The Web site contains Companion Documents and other relevant technical information The site is updated several times each month Please contact us via email with comments or suggestions about the s
38. g claims If the Trading Partner is retrieving 835s on behalf of other providers enter the names and ID numbers assigned by MQD of the providers for which the Trading Partner will be retrieving 835s Attach additional sheets of paper if necessary 30 Enter the name and title of the Provider Vendor authorized representative 31 Enter the date the form was signed 32 Authorized signature 3 3 2 Electronic Provider Agreement The Electronic Provider Agreement is an agreement between the Provider Vendor and MOD which authorizes MQD to accept claims data electronically The agreement also includes the Provider Vendor responsibility for submitting this data in accordance with applicable rules and regulations and within Electronic Claim Submission specifications Field No Instructions December 7 2005 3 6 DHS Medicaid EDI Manual v 1 1 doc Hawaii Department of Human Services Med QUEST Division Registration Requirements DHS Medicaid EDI Manual Enter the name of the Provider Vendor Enter the date the form was signed Enter the name and title of the Provider Vendor authorized representative If applicable enter the Provider ID number assigned by MQD OP jo je Signature of the Provider Vendor authorized representative 3 3 3 Electronic Remittance Advice Registration This form should be completed and mailed to the Fiscal Agent to register to receive the 835 Electronic Remit
39. gibility Interactive 270 271 and Replace with Verification Requestand 276 277 Testers will beable Batch 270 271 Upon successful completion of testing Response and to MAE On a recipient S Providers will be able to submit batch 270 request files in the 276 217 Claim statis eligibility inf rmiatiori by HIPAA compliant format via the Med QUEST SHIERA FTP Request and using any one of the In the nightly process a mainframe program will process Response following search options the request and the batch 271 response will be available for HAWI ID SSN or by using the recipient s Name DOB and Gender In response to an eligibility request the web application will return eligibility enrollment and other Medicaid information for a recipient In response to a claims status request the web application will return information on the claim s status and its accounting details The response to the user is returned in real time It is not a HIPAA requirement for the interactive 270271 transaction to be format compliant however the data content returned is HIPAA compliant Batch 270 271 and 276277 Once implemented providers will be able to submit their 270 and 276 batch request in the HIPAA compliant format via DHS Medicaid Online The Trading Partner will have the ability to view the uploaded and unprocessed batch request online in the format submitted The request file can only be download in a HIPAA data compli
40. he 837 and 270 test files will be accepted and processed through all adjudication and or validation processes on a daily basis 837 and 270 test files will be accepted for the current day s test processing until 3 00 p m Hawaii Standard Time HST The appropriate acknowledgement file will be returned Financial cycles resulting in production of either the 835 Remittance Advice or paper Remittance Advice will be run weekly Trading partners may submit multiple batches per day 6 3 2 File Naming Standards 837 transactions will use the following naming standard CLM MMDDYY HHMMSS 837 The 837 file should be placed in the Med QUEST SHIFTP FTP server FTP XXXXX CLAIMS ECSIN PROD or ECSIN TEST where xxxxxx the trading partner s 5 digit Trading Partner ID For Inbound production and test batch 270 files submitted via the SHIERA FTP server IN folder 270 PPPPPP YYMMDD 7HHHHHHHHET XT Where 270 Transaction PPPPPP 6 digit Provider ID YYMMDD Date 000000000 unique 9 character Interchange Control Number TXT File extension or ZIP For Outbound production and test 271 batch response files available in the OUT folder YYMMDD IFHHHHHHHE271 Where 000000000 unique 9 character Interchange Control Number YYM MDD HHHHHHHHE 270 Where 000000000 unique 9 character Interchange Control Number and 270 error file December 7 2005 6 5 DHS Medicaid EDI Manual v 1 1 doc Hawaii Department of Human
41. ion of an originalclaim for payment In this scenario the 277 is the outbound transaction and the 275 is theinbound transaction 7 2 2 Future Outbound Transactions The following transactions are proposed or currently under development 277 275 The Health Care Claim Status Notification 277 transaction set will be used as an unsolicited Health Care Claim Request for Additional Information In this scenario this would be a 275 transaction The 275 transaction Additional Information to Support a Health Care Claim or Encounter Attachments is intended to send additional information about a claim or encounter when a responding to a payer s request for additional information or b accompanying the submission of an original claim for payment In this scenario the 277 is the outbound transaction and the 275 is the inbound transaction Removed December 7 2005 1 9 DHS Medicaid EDI Manual v 1 1 doc Hawaii Department of Human Services Med QUEST Division Change Log and Summary DHS Medicaid EDI Manual Page Section Previously Stated Description of change 7 3 1 270271 Eligibility 731270271 Eligibility Verification Replace with Verification Requestand Requestand Response and 7 3 1 270 271 Health Care Eligibility Benefit Inquiry and Response and 276 277 Claim Status Request Response 276 277 Claim Status and Response Request and Response 7 3 1 270271 Eli
42. ission ECS documents on behalf of the Provider Vendor December 7 2005 3 7 DHS Medicaid EDI Manual v 1 1 doc Hawaii Department of Human Services Med QUEST Division Registration Requirements DHS Medicaid EDI Manual Under no circumstances will MOD accept ECS documents from anyone other than the Provider Vendor authorized signatories Field No nstructions Enter the name of the Provider Vendor If applicable enter the Provider ID number assigned by MQD Enter the position title of the persons authorized to sign ECS documents Enter the name of the persons authorized to sign ECS documents The authorized signatories sign their name Enter the position titles of the persons to be removed from authorization Enter the names of the persons to be removed from authorization Enter the dates the contact persons should no longer be authorized to sign ECS documents Enter the name and title of the Provider Vendor authorized representative Enter the date the form was signed Authorized signature 3 3 5 Instructions for Med QUEST Batch 270 271 Health Care Eligibility Benefit I nquiry and Response Trading Partner Registration Form This is a registration form to send and receive the Batch 270 271 Health Care Hligibility Benefit Inquiry and Response transaction This form should be completed by the Provider and faxed to ACS before sending 270 Batch transaction fil
43. ite Med QUEST thanks its trading partners for their participation in the Hawaii Medicaid program and their support for Hawaii Med QUEST providers Please note this process is designed to support Hawaii Medicaid providers We are pleased to make documentation available to any developer however we will not test with a clearinghouse Vendor that is not contracted to provide services with a Hawaii Medicaid provider 6 4 2 What Med QUEST Expects From Trading Partners Med QUEST expects trading partners to download and review applicable Companion Documents from the Med QUEST HIPAA Web site Med QUEST also requires trading partners to submit HIPAA compliant transactions per the Implementation Guide using valid Med QUEST test data valid provider ID recipient ID procedure codes etc Trading partners are strongly encouraged to provide adequate and current contact information to Med QUEST Med QUEST assumes that trading partners are maintaining adequate communications with the providers they support Prior to submitting test data using a valid Med QUEST provider ID Med QUEST asks that the trading partner demonstrate they have been in contact with the provider in question Med QUEST asks trading partners and providers to use the email address provided to submit questions and report problems The inbox will be monitored constantly throughout business hours state and federal holidays excepted Answers will be provided in writing Questions and answer
44. its e ACS can validate the HIPAA compliant transaction meet HPMMIS processing standards e The Trading Partner trading partner can demonstrate to the provider that the electronic transactions such as claims process the same as a paper claim ACS may deny access to the production environment to any Trading Partner that declines to participate in this level of testing For the purposes of the 270 271 Transaction an asterisk cannot be used as a delimiter As a standard practice if the first name of the recipient is more than 10 characters HPMMIIS truncates the remaining letters and replaces the 10 character with an asterisk This asterisk is then passed through all transactions indicating that the name was longer than appears Use of an asterisk as a delimiter causes translation issues Note It cannot be stressed strongly enough that inbound transactions must be compliant and must contain the data necessary to process correctly in the Medicaid system In particular the 837 fee for service claim transaction is extremely complicated and offers Trading Partners multiple ways of submitting the same data The Med QUEST Companion Document for the 837 identifies file layout requirements specific to HPMMIS The only way to fully test this functionality is to provide test claims that contain valid test data and if possible compare them to production claims that contain the same or similar data 6 2 2 Preparing for Outbound Tr
45. itting 837 claims and retrieving 835s Forms 2 and 3 must also be completed 835 Only if the Provider Vendor will be retrieving 835s and not submitting 837 claims Form 3 must also be completed 5 Enter the Provider Vendor street address 6 Enter the Provider Vendor city state and zip code 7 Enter the Provider Vendor telephone and fax numbers 8 Enter the name of the Provider Vendor contact person 9 Enter the Provider Vendor contact s telephone number 10 Enter the Provider Vendor contact s e mail address 11 Enter the name of the Provider Vendor technical support representative 12 Enter the Provider Vendor technical support rep s telephone number 13 Enter the Provider Vendor technical support rep s e mail address 14 Enter the position title of the persons authorized to act as signatory 15 Enter the name of the persons authorized to act as signatory 16 The authorized signatories sign their name 17 Monthly estimate of average and maximum volume of HCFA 1500 claims that will be submitted electronically to MQD 18 Monthly estimate of average and maximum volume of UB 92 claims that will be submitted electronically to MQD 19 Monthly estimate of average and maximum volume of Dental claims that will be submitted electronically to MQD 20 29 If the Trading Partner is a billing service or clearinghouse enter the names and ID numbers assigned by MQD of the providers for which the Trading Partner will be submittin
46. laim documents It also furnishes an estimate of the volume of claims to be submitted and lists those providers that will be included in the submissions The Trading Partner must complete this notification form before testing and submitting electronic claims data to MOD or retrieving ERAs from MOD Where a provider is utilizing a billing service or clearinghouse for claims transmission or other inbound transactions this form is to be completed by the billing service or clearinghouse Where a provider is retrieving ERAs directly this form is to be completed by the provider Field No Instructions 1 Enter the name of the Provider or Vendor 2 If applicable enter the Provider ID number assigned by MQD December 7 2005 3 5 DHS Medicaid EDI Manual v 1 1 doc Hawaii Department of Human Services Med QUEST Division Registration Requirements DHS Medicaid EDI Manual Field No Instructions 3 Enter the date the Provider Vendor will begin submitting electronic claims to MQD or retrieving ERAs from MQD Note that it will require up to 10 business days from receipt of this form for the Provider Vendor to obtain a Trading Partner ID user ID and password 4 Check one of the following 837 Only if the Provider Vendor will be submitting 837 claims and not retrieving 835s Form 2 must also be completed 837 and 835 if the Provider Vendor will be subm
47. lectronic remittance e Provider Vendor Electronic Claims Submission Notification e Electronic Provider Agreement Trading Partner that receives an electronic remittance but does not transmit electronic claims and other related transactions e Provider Vendor Electronic Claims Submission Notification e Electronic Remittance Advice Registration Trading Partner currently exchanging EDI submitting and or receiving that incurs changes in personnel that are authorized to sign documents related to electronic claims related inbound transactions and electronic remittance advices e Electronic Claim Data Authorized Signature Trading Partner that transmits eligibility requests but does not transmit electronic claims and other related transactions Med QUEST 270 271 Batch Health Care Eligibility Benefit Inquiry and Response Trading Partner Registration Form e Electronic Provider Agreement 3 2 3 Submitting Forms and Receiving Responses Med QUEST requires original signatures on the forms Completed forms can be mailed to the following address ACS Fiscal Agent P O Box 1220 Honolulu HI 96807 1220 December 7 2005 3 4 DHS Medicaid EDI Manual v 1 1 doc Hawaii Department of Human Services Med QUEST Division Registration Requirements DHS Medicaid EDI Manual Receipt of the form s will be acknowledged by email if a valid email address is provided on the Provider Vendor Electronic Claim
48. lling agents and Ar clearinghouses to understand the relationship as it relates to assignment of access codes and passwords To access the DHS Medicaid Online web application log onto the DHS Medicaid Online website at https hiweb statemedicaid us Users will need to establish a user account prior to using the system For more information regarding the account creation process please download the DHS Medicaid Online user manual found in the Provider Resources section of the Med QUEST website www med quest us December 7 2005 3 1 DHS Medicaid EDI Manual v 1 1 doc Hawaii Department of Human Services Med QUEST Division Registration Requirements DHS Medicaid EDI Manua Note Testing cannot begin until Trading Partners have applied for and received the appropriate IDs and passwords To apply please refer to Section 3 2 Sign up Procedures Med QUEST will not assign IDs passwords to anyone who is not a current Med QUEST provider or an authorized representative e g contracted billing agent software developer or clearinghouse of a current Med QUEST provider ACS must understand the relationship between a provider and a billing service software vendor clearinghouse before IDs and passwords can be issued 3 2 Sign up Procedures Trading Partners must sign up which includes filling out the appropriate form s documenting relationship s between providers and their billing service Software developer cleari
49. mary provider s other provider s and UMOs The 278 transaction is intended to serve as both an inbound and outbound transaction request and notification of receipt In the Medicaid arena the 278 is analogous to the prior authorization a process currently handled through hard copy receipt a response via letter lt Removed gt December 7 2005 1 11 DHS Medicaid EDI Manual v 1 1 doc Hawaii Department of Human Services Med QUEST Division Change Log and Summary DHS Medicaid EDI Manual Page Section Previously Stated Description of change Med QUEST conducted an extensive review of the 278 and determined itdid not contain data necessary to processing prior authorizations in the Medicaid system For this reason trading partners were discouraged from submitting 278 transactions to Med QUEST Future versions of the 278 are proposed that will contain the data Med QUEST requires When the specifications are published Med QUEST will begin work on 278 compliance Until then trading partners are urged tosubmithard copy prior authorization requests 7 3 3 Future Inbound Outbound Transactions Med QUEST expects the updated 278 to be published some time in 2004 Replace with 276 277 Health Care Claims Status Inquiry and Response 7 4 1 TA1 Interchange Acknowledgement For the TA1 Med QUEST complies with the instructions provided in the 837 Implementation Guide
50. nbound Transactions Partners should use valid recipient IDs procedure Miagnosis codes provider IDs and other vital data to submit an inbound transaction such as an 837 Fee for Service Claims 270 Eligibility Verification Request or 276 Claim Status Request batch At a minimum Trading Partners should use valid recipient IDs procedure Miagnosis codes provider IDs and other vital data to submit an inbound transaction such as an 837 Fee for Service Claims or 270 Eligibility Verification Request 6 2 2 Preparing for Outbound Transactions Outbound transactions such as the 835 Electronic Remittance Advice 271 Eligibility Verification Response batch and the 277 Claim Status Response batch are predicated upon submission of valid inbound transactions Outbound transactions such as the 835 Electronic Remittance Advice and 271 Eligibility Verification Response batch are predicated upon submission of valid inbound transactions 6 2 3 Testing Tips and Guidelines Include Please ensure that ISA15 Usage Indicator indicates the correct file type T Test or P Production 6 2 3 Testing Tips and Guidelines Of particular note are the following documents Replace with Of particular note is the following document 6 2 3 Testing Tips and Guidelines Helpful Hints for TPs found under the Asking Questions link http med quest us HIPAA festing ques tions html Update documen
51. nghouse and receiving the necessary access codes and passwords prior to beginning the testing process This section covers the following topics e Process overview e Determining which forms to complete e Submitting forms and receiving responses Note A Trading Partner is defined as a provider or vendor who will be directly connecting to the Med QUEST FTP server to transmit or receive EDI A Trading Partner can be a billing service clearinghouse or provider 3 2 1 Process Overview Med QUEST requires basic information about the Trading Partner provider and for software developer billing service Alearinghouse and a signed agreement prior to beginning the testing process In many cases the information passed between the Trading Partner and the State contains Protected Health Information PHI and other confidential data The State has authorized ACS to prohibit any Trading Partner who does not complete the appropriate paperwork from participating in the EDI process Accurate completion of this paperwork provides the following benefits e Provides an agreement specific to Med QUEST and the Trading Partner for the submission acceptance and processing of electronic transactions including electronic claims and remittance advices e Assists in monitoring the relationship between a provider and vendor billing service or clearinghouse and provides ACS with contact information e Signifies the Trading Partner verifies the
52. nses 4 Be available to answer The ACS EDI Team can be reached at 808 955 4900 or questions provide via e mail at hi ecstest acs inc com additional information 5 Receive Access codes The ACS EDI Team will provide the FTP folder s Access and Client software for code s to the Trading Partner s appropriate Contact Person VPN on the forms The ACS EDI Team will provide the VPN Manual which includes the VPN Access code 6 Install Client software for The VPN Manual will include instructions on how Trading VPN and verify Partners can install the VPN software The ACS EDI Team accessibility can be reached at 808 955 4900 if Trading Partners encounter any problems when installing the VPN software Note Failure to comply with the steps above including providing complete and accurate information upon request may result in a delay of the registration process Trading Partners who have questions about their Trading Partner ID password or folder or who require information about the File Transfer Protocol FTP process used by Med QUEST should contact the ACS EDI Team 3 2 2 Determining Which Forms to Complete Med QUEST uses four forms to authorize EDI and assign access codes and passwords These forms are e Trading Partner Electronic Claims Submission Notification Documents the relationship between provider and vendor to identify the Trading Partner and to capture all necessary contact information December 7 2005 3
53. of testing Providers will be able to submit batch 270 request files in the HIPAA compliant format via the Med QUEST SHIERA FTP In the nightly process a mainframe program will process the request and the batch 271 response will be available for download in a HIPAA data compliant format the following morning The appropriate acknowledgement fie will also be returned 7 3 2 Future I nbound Outbound Transactions 276277 Health Care ClaimsStatus Inquiry and Response December 7 2005 7 3 DHS Medicaid EDI Manual v 1 1 doc Hawaii Department of Human Services Med QUEST Division Transaction Overview DHS Medicaid EDI Manual 7 4 Problem Reporting Resolution and Documentation Acknowledgement transactions can relate to inbound or outbound transactions This section describes the acknowledgement transactions used by Med QUEST 7 4 1 Problem Reporting and Resolution All problems and their resolution must be documented in writing Email to the HIPAA testing team at hi ecstest acs inc comis the preferred media Trading partners must provide the HIPAA testing team with a document containing the following Type of Transaction 837 Professional 835 etc A detailed explanation of the problem A date and time of when the problem occurred Contact name and phone number A batch or file identifier of where the input records can be found A listing of the exact input X12 records Any output records as a result from the p
54. or otherwise the Agency shall rely on the input data only The Provider further agrees to hold the Agency harmless from any and all claims of liability including but not limited to consequential damages reimbursement of erroneous billings and reimbursement of attorney fees incurred as a consequence of any such error omission deletion or erroneous input data The Agency shall not be responsible for any incorrect or delayed payments to the Provider resulting from any error omission deletion or erroneous input that does not meet the standard prescribed by the Agency Erroneous input data shall be returned to the Provider for correction and resubmission within limited time frame prescribed by the Agency at the Provider s cost The Provider herewith authorizes the Agency to 1 make administrative corrections on submitted claims data to enable the automated processing of the same and 2 accept as original evidence of services rendered claim data in a form appropriate for automated data processing The Provider agrees and certifies that the Provider s certification appearing on all claim forms in use as of a given submission date are incorporated by reference in this agreement shall remain valid and applicable to all claim data submitted and herewith are adopted by the Provider as though individually executed 2 Date 3 Authorized Provider Representative Name Title 4 Provider Number if applicable 5 Authorized Provider Re
55. orresponding Companion Document 7 2 3 997 Functional Acknowledgement This transaction is used to define the control structures for a set of acknowledgments to indicate the results of the syntactical analysis of the electronically encoded documents such as the 837 For the 997 Med QUEST complies with the instructions provided in the 837 and 270 Implementation Guides see appendix The IG can be downloaded from the Washington Publishing Group Web site at http vww wpc edi com hipaa HIPA A 40 asp Med QUEST did not develop a corresponding Companion Document 7 2 4 824 Implementation Guide Reporting The 824 is used to notify the Trading Partner that the transaction contained errors what the errors are and if applicable what action the Trading Partner should take For the 824 Med Quest complies with the instructions provided in the 837 and 270 Implementation Guides see appendix The 824 IG can be downloaded from the Washington Publishing Group Web site at http www wpc edi com hipaa HIPAA 40 asp Med QUEST did not develop a corresponding Companion Document 7 3 Inbound Outbound Transactions This section provides a summary of inbound outbound transactions currently supported by Med QUEST and ACS Inbound outbound transactions refer to those transactions that occur in pairs e g request and response 7 3 1 270 271 Health Care Eligibility Benefit nquiry and Response Batch 270 271 Upon successful completion
56. ow Replace with window 5 3 Production Transmission Window 5 3 Transmission window 270 and 276 batch request must be submitted by 6 00 p m HST for processing that night Batch 270 request file s submitted via the Med QUEST SHIERA FTP server must be uploaded by 6 00p m HST for processing that evening Files are processed 7 days a week 5 3 1 Inbound Transactions Transmissions received in their entirety by 6 00 p m Monday Thursday and by Replace with Transmissions received in their entirety will be processed by December 7 2005 1 4 DHS Medicaid EDI Manual v 1 1 doc Hawaii Department of Human Services Med QUEST Division Change Log and Summary DHS Medicaid EDI Manual Page Section Previously Stated Description of change 4 00 p m on Friday will be the next business day loaded to the Med QUEST system on the day of receipt 5 4 1 The 270 and 276 transactions Replace with Minimum Maximu are limited each to 1 batch m Submission request submission per day The SHIERA FIP is used for test and production batch 270 271Trading Partner There is a limit of 999 files per day per provider Unzipped files have a file size limit of 25mb Files that are zipped must have an extension of zip The tmp extension is not acceptable 6 Testing 276 277 Batch claim status lt Removed gt request and response 6 2 1 Preparing for Ata minimum Trading Replace with I
57. page to download and install the latest version of Microsoft Internet Explorer 4 2 Virtual Private Trading Partners that reply Replace with Network VPN for and receive a YEN ID and Trading Partners that apply for and receive a VPN ID and Standards password are also given a password are also given a Uniform Resource Locator URL Uniform Resource Locator which can be used to download the client software from URL which can be used to Med QUEST s SHIERA or SHIFTP FTP servers download the client software from a Med QUEST server 4 3 File Transfer After establishing a secure Replace with Protocol FTP VPN connection Trading After establishing a secure VPN connection Trading Standards Partners should configure FIP software to point to the Med QUEST FTP server IP address 170 68 41 129 Partners should configure FTP software to point to the Med QUEST FTP server s with the following profile names depending on the transaction SHIERA 835 270271 SHIFTP 837 The ACS EDI Team will provide the Med QUEST FTP servers IP addresses during the registration and setup process December 7 2005 1 3 DHS Medicaid EDI Manual v 1 1 doc Hawaii Department of Human Services Med QUEST Division Change Log and Summary DHS Medicaid EDI Manual Page Section Previously Stated Description of change 5 1 FTP Directory Create separate tables for each FTP server and update directory St
58. presentative Signature Electronic Remittance Advice and Automated Clearing House Registration Form 1 Provider Vendor Name 2 ID Number I am interested in receiving the MQD Fee For Service Remittance Advice in an electronic format while having reimbursement check s delivered by the U S Postal Service to the pay to address es on file with the MQD Provider Registration Unit I am interested in having my MQD Fee For Service reimbursement check s deposited electronically to my designated bank account via an Automated Clearing House ACH I understand that if I elect to receive ACH deposits I am required to accept electronic Remittance Advices 3 Tax ID Required 4 Provider Vendor Street Address 5 City State amp Zip Code 6 Telephone amp Fax Number 7 Contact Person Name 8 Contact Person Phone No 9 Contact Person E mail FOR ACH PROVIDERS ONLY 10 Bank Name and Account Number 11 Bank Address 12 Bank Phone Number 13 Business Name on Bank Account 14 Bank Federal Reserve Routing Number 15 Authorized Representative Name Title 16 Date 17 Signature Electronic Claim Data Authorized Signature Form 1 Provider Vendor Name 2 ID Number The following individuals are authorized to sign Electronic Claim Submission documents for the above mentioned Provider Vendor 3 Po
59. roblem A cross reference to the problem identifier formulated by the testing group Reporting of the error and copies of the input records in X12 format in electronic form should be made available to the HIPAA testing team by the end of business day of when the error event happened Resolution of errors will be reported on a matrix with a narrative restating the problem date completed the problem identifier and the resolution of the problem Acknowledgement of the problem or incident will be made by the HIPAA testing team by the next business day and turn around on the resolution will be considered on a case by case basis Notification will be made if the companion document updates will be needed 7 4 2 Documentation Trading partners will be notified immediately of changes to Companion Documents Until the updated documents can be posted on the Web site interim notification will be provided via email to the addresses provided at the start of testing December 7 2005 7 4 DHS Medicaid EDI Manual v 1 1 doc Hawaii Department of Human Services Med QUEST Division 8 EDI Forms The Med QUEST EDI forms are provided with this chapter For instruction please see Section 3 2 Sign up procedures Provider Vendor Electronic Claim Submission Notification 1 Provider Vendor Name 2 ID Number As representing the Provider Vendor with above name I hereby notify MQD that the Provider Vendor electronic claim submissions will star
60. ructure structure column Where XXXXX the Trading Partner s ID SHIFTP FIP XXXXX CLAIMS ECSIN PROD SHIFIP FIP XXXXX CLAIMS ECSOUT PROD SHIFTP FTP XXXXX CLAIMS ECSIN TEST SHIFIP FIP XXXXX CLAIMS ECSOUT TEST Where XXXXXX the Provider s ID SHIERA FTP XXXXXX CLAIMS REMITSOUT PROD SHIERA FTP XXXXXX CLAIMS REMITSOUT TEST Include the following for the SHIERA FTP table SHIERA FTP XXXXXX EDIAN PROD Trading Partners place the batch 270 production files in this folder SHIERA FTP XXXXXX EDIAN TEST Trading Partners place the batch 270 test files in this folder SHIERA FTP XXXXXX EDI OUT PROD Med QUEST places the 271 batch production files in this folder SHIERA FTP XXXXXX EDI OUT TEST Med QUEST places the 271 batch test files in this folder 5 1 FTP Directory Structure Note 270 271 and 276 277 batch transactions are transmitted via the Internet at DHS Medicaid Online Trading partners should contact ACS for more information ACS will direct all questions related to the 270271 and 276277 batch transactions to the appropriate technical resource Removed 5 2 Transaction Naming Standards 270 271 Eligibility Verification Transaction and Naming standard Replace with Please refer to the 270271 Companion document for detailed information 5 2 Transaction 276 277 Claim Status Removed Naming Standards Transaction and Naming Standard 5 3 Transmission 5 3 Transmission wind
61. s Submission Notification ACS will review the forms for completeness and accuracy and contact the sender if additions orrections are required Once ACS reviews the forms and validates the data they request access codes and passwords from the State as described in Section 3 1 Access Codes and Passwords The State will notify ACS when the process is complete and ACS will in turn notify the Trading Partner as applicable The Trading Partner will receive the following e ID and password to access the FTP server where EDI transactions may be picked up and dropped off e ID and password to access the VPN which provides secure access to the FTP server e Client software for the VPN which the Trading Partner downloads and installs Note Trading Partners can expect the process of reviewing the forms and assigning access codes passwords to take approximately two 2 weeks Trading Partners can contact ACS by return email if they have not received a response within 2 weeks of receiving an email acknowledging receipt of the original forms 3 3 Completing the EDI Forms This section contains the instructions for completing the required forms Chapter 8 EDI Forms contains the actual forms 3 3 1 Provider Vendor Electronic Claims Submission Notification This document notifies MOD of the intent to exchange electronic transactions such as claims and remittance advices It designates those persons authorized to sign electronic c
62. s considered universally relevant may be December 7 2005 6 8 DHS Medicaid EDI Manual v 1 1 doc Hawaii Department of Human Services Med QUEST Division Testing DHS Medicaid EDI Manual published on the Web site or shared with other trading partners Data related to such questions will never be shared with anyone other than the trading partner provider that December 7 2005 6 9 DHS Medicaid EDI Manual v 1 1 doc Hawaii Department of Human Services Med QUEST Division 7 Transaction Overview Note Trading partners should be aware that any transaction might require a version update as mandated by federal law Med QUEST is required to support mandated HIPAA transactions 7 1 Inbound Transactions This section provides a summary of inbound transactions currently supported by Med QUEST and ACS 7 1 1 837 Fee for Service Claim The 837 originates with a health care provider or the health care provider s designated agent and provides all necessary information to allow the destination payer to begin adjudication of the claim Med QUEST currently recognizes the following X12 versions of the 837 Txn Name Version 837D Health Care Claim Dental ASC X12N 837 004010X97A1 8371 Health Care Claim Institutional ASC X12N 837 004010X96A1 837P Health Care Claim Professional ASC X12N 837 004010X98A1 Trading partners should download the appropriate Implementation Guides IG from the Washington
63. s new transactions are mandated the EDI manual will be updated accordingly The chapter includes the following sections e Notifying ACS of the intent to begin testing e Preparing test data e Exchanging test transactions e Testing Expectations 6 1 Notifying ACS of the I ntent to Begin Testing Communication is the most important part of the testing process The ACS EDI Team works closely with Med QUEST and Trading Partners to achieve positive testing results Note As stated throughout the manual ACS will not conduct testing with any Trading Partner that is not a current Med QUEST provider or an authorized representative e g contracted billing agent software developer or clearinghouse of a current Med QUEST provider 6 1 1 Demonstrating X12 Certification Med QUEST requires demonstration of certification to Level 4 for all inbound transactions Below are some frequently asked questions regarding certification December 7 2005 6 1 DHS Medicaid EDI Manual v 1 1 doc Hawaii Department of Human Services Med QUEST Division Testing DHS Medicaid EDI Manual Why must I certify TCS testing can be very complicated Certifying your transactions prior to testing with ACS dramatically shortens the time it takes to complete testing What does Level IV mean Med QUEST requires demonstration of certification to Level 4 for all inbound transactions where T1 syntactical integrity T2 Implementation Guide T3 B
64. see appendix For the TA1 Med QUEST complies with the instructions provided in the 837 and 270 Implementation Guides see appendix 7 4 2 997 Functional Acknowledgement For the 997 Med QUEST complies with the instructions provided in the 837 Implementation Guide see appendix For the 997 Med QUEST complies with the instructions provided in the 837 and 270 Implementation Guides see appendix 7 4 3 824 Implementation Guide Reporting For the 997 Med QUEST complies with the instructions provided in the 837 Implementation Guide see appendix For the 824 Med QUEST complies with the instructions provided in the 837 and 270 Implementation Guides see appendix 8 EDI Forms New Include new form Med QUEST Batch 270271 Health Care Eligibility Benefit Inquiry and Response Trading Partner Registration Form December 7 2005 1 12 DHS Medicaid EDI Manual v 1 1 doc Hawaii Department of Human Services Med QUEST Division Change Log and Summary DHS Medicaid EDI Manual Page Section Previously Stated Description of change Problem Reporting New Incorporate Section 8 Problem Reporting and Resolution and Resolution Documentation New Incorporate Section 9 Documentation Global Provider Vendor Global change to reference Trading Partner instead Trading Partner This page is intentionally left blank December 7 2005 1 13 DHS Me
65. sition 5 Signature The following individuals are no longer authorized to sign Electronic Claim Submission documents on behalf of the above mentioned Provider Vendor 6 Position 8 Termination Date 9 Authorized Representative Name Title 10 Date 11 Signature Med QUEST 270 271 Batch Health Care Eligibility Benefit Inquiry and Response Trading Partner Registration Form Provider Information Provider Name Provider ID Street Address1 Street Address2 City State ZIP Trading Partner s Information Vendor Name If applicable Contact Person Name Phone Fax Phone Street Address1 Street Address2 City State ZIP Contact Email Address Authorized Signature of Trading Parter if not Provider Date Provider s Signature Date For Internal Use Only Create Trading Partner s FTP folder on SHIERA Add to TP table for Test amp Prod Batch 270 271 FTP Includes 997 824 TA1 Create a username and password In SHIERA FTP create EDI subfolders Date Received by ACS FA Date received by MQD SO Electronic Provider Agreement Date Completed Translator ID setup Date Completed SHIERA FTP setup Date Completed DHS Medicaid EDI Manual v 1 1 doc DHS Medicaid EDI Manual v 1 1 doc
66. stance response transactions and or messages with the e mail which can expedite resolution of the issue December 7 2005 2 2 DHS Medicaid EDI Manual v 1 1 doc Hawaii Department of Human Services Med QUEST Division Before You Begin DHS Medicaid EDI Manual 2 3 Prerequisites Since the October 16 2003 implementation of HIPAA Transactions and Code Sets TCS Med QUEST accepts and receives only ANSI X12 transactions as mandated by HIPAA Exceptions to this include contingency participants which will convert to HIPAA transactions as soon as their testing has completed and electronic transactions that Med QUEST determines to be outside the scope of HIPAA Trading Partners providers and or vendors must obtain copies of the Implementation Guides IG and develop transactions according to the IG specifications Where applicable Med QUEST has developed an accompanying Companion Document which is used in conjunction with the IG to provide specifications for transmitting HIPAA compliant transactions that can be processed by the Med QUEST system The IGs can be downloaded from the Washington Publishing Company Web site at http Avww wpc edi com hipaa HIPAA 40 asp Trading Partners are required to submit certified HIPAA transactions to Med QUEST Chapter 6 Testing describes how to demonstrate certification to ACS prior to beginning the testing process Chapter 7 Transaction Overview provides basic information
67. t Data Itis critical to understand that testing relates not only to validating the compliance of a HIPAA transaction but also to validating the correctness of the data submitted as part of the transaction For instance ACS and Med QUEST want to be sure a Trading Partner can submit claims that process and pay correctly not just pass HIPAA validation edits December 7 2005 6 2 DHS Medicaid EDI Manual v 1 1 doc Hawaii Department of Human Services Med QUEST Division Testing DHS Medicaid EDI Manual Outbound transactions such as the 835 Electronic Remittance Advice are subject to the same testing criteria This section describes preparing test data for inbound and outbound transactions and offers testing tips and guidelines Chapter 7 Transaction Overview describes each transaction accepted or produced by Med QUEST and provides a link for the Companion Document where applicable 6 2 1 Preparing for I nbound Transactions Trading Partners trading partners are encouraged to prepare inbound transactions that contain valid test data The simplest way to accomplish this is to use production data to build the test transactions such as test claims At a minimum Trading Partners should use valid recipient IDs procedure diagnosis codes provider IDs and other vital data to submit aninbound transaction such as an 837 Fee for Service Claims or 270 Eligibility Verification Request Use of valid test data provides the following benef
68. t for link on Med QUEST website 6 2 3 Testing Tips Med QUEST Approach to lt Removed gt and Guidelines Group 2 Testing found under the Getting Started link http med December 7 2005 1 5 DHS Medicaid EDI Manual v 1 1 doc Hawaii Department of Human Services Med QUEST Division Change Log and Summary DHS Medicaid EDI Manual Page Section Previously Stated Description of change quest us HIPAA festing Ande x html 6 2 3 Testing Tips New Include and Guidelines There are various tools available to ensure you are producing a compliant HIPAA EDI standard transaction Running a test production transaction through a HIPAA EDI compliance checker assists with ensuring that a clean file is being processed and lessens the potential errors that could occur 6 3 1 Testing cycles and transmission schedules The 837 270 and 276 test files will be accepted and processed through all adjudication and or validation processes on a daily basis Electronic claims submissions will be accepted for the current day s test processing between 6 00 a m and 4 00 p m Arizona Standard Time AST Please note this is three 3 hours ahead of Hawaii Standard Time HST 270 and 276 batch requests must be submitted by 6 00 p m HST for processing that night The 270 and 276 transactions are limited each to 1 batch submission per day The latest file uploaded prior to the cutoff time will be proc
69. t on or about 3 4 Check one ECSOnly ECS and ERA ERA Only 5 Provider Vendor Street Address 6 City State amp Zip Code 7 Telephone amp Fax Number 8 Contact Person Name 9 Contact Person Phone No 10 Contact Person E mail 11 Technical Support Name 12 Technical Support Phone No 13 Technical Support E mail The following individuals are authorized to sign Electronic Claim Submission documents for the above mentioned Provider Vendor 14 Position 15 Name 16 Signature FOR STATE USE ONLY Provider Name Electronic Supplier Number User ID Password By EN Permissions Granted Read Write To Prod 4 The Provider Vendor named above estimates that the monthly average maximum electronic claim submission volume will be Average Maximum 17 HCFA 1500 Claims 18 UB 92 Claims 19 Dental Claims The Provider Vendor named above will be submitting electronic claims or retrieving electronic remittance advices on behalf of the following providers Attach additional sheets if necessary Provider Name ID Number 20 21 22 23 24 25 26 2d 28 20 The Provider Vendor named above agrees to submit only clean electronic data and correct any submission errors identified by MQD or its representatives
70. tance Advice ERA and automated clearing house ACH payments The Provider Vendor must complete this notification form before testing and receiving 835s from MQD Field No Instructions 1 Enter the name of the Provider Vendor 2 If applicable enter the Provider ID number assigned by MQD 3 Enter the Provider Vendor Tax ID 4 Enter the Provider Vendor street address 5 Enter the Provider Vendor city state and zip code 6 Enter the Provider Vendor telephone and fax numbers 7 Enter the name of the Provider Vendor contact person 8 Enter the Provider Vendor contact s telephone number 9 Enter the Provider Vendor contact s e mail address 10 Enter the name of the bank and account number where ACH payments should be deposited 11 Enter the bank street address city state and zip code 12 Enter the bank phone number 13 Enter the business name attached to the bank account 14 Enter the routing number of the bank account 15 Enter the name and title of the Provider Vendor authorized representative 16 Enter the date the form was signed 17 Authorized signature 3 3 4 Electronic Claim Data Authorized Signature This form should be completed and mailed to the Fiscal Agent whenever Provider Vendor signatory personnel changes occur This form will serve as notification to MOD of those individuals who become authorized or are no longer authorized to sign Electronic Claims Subm
71. transaction 6 2 3 Testing Tips and Guidelines The Med QUEST HIPAA EDI Web site contains a page devoted to testing the 837 and 835 transactions The URL is http nmed quest us HIPAA Aesting Andex html Of particular note is the following document e Helpful Hints for TPs found under the Asking Questions link http med quest us HIPAA esting questions html The ACS EDI Team will also be able to provide Trading Partners trading partners with helpful information Please ensure that ISA15 Usage Indicator indicates the correct file type T 2 Test or P Production There are various tools available to ensure you are producing a compliant HIPAA EDI standard transaction Running a test production transaction through a HIPAA EDI compliance checker assists with ensuring that a clean file is being processed and lessens the potential errors that could occur 6 3 Exchanging Test Transactions This section describes testing cycles transmission schedules and file naming standards It also describes the process for reviewing results December 7 2005 6 4 DHS Medicaid EDI Manual v 1 1 doc Hawaii Department of Human Services Med QUEST Division Testing DHS Medicaid EDI Manual 6 3 1 Testing Cycles and Transmission Schedules The HPMMIS will run according to normal production schedules This means all scheduled daily processes will be executed daily all weekly processes will run weekly and so forth T

DHS Medicaid EDI Manual v 1.1 - Department of Human Services

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