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HIPAA Contingency Strategy
As of 10/03/03
Mercy Health Plans, Inc. (MHP) will deploy the following contingency plan, in
accordance with CMS guidance, in order to ensure continuous cash flow through
the migration to HIPAA standardization. This contingency plan is limited to
claim transactions. All other transactions will be addressed on a case-by-case basis.
Transaction Format
Though we believe this to be a non-issue, MHP will continue accepting claims in the
current format from existing trading partners through an agreed upon date with the following requirements:
- Those providers (or their clearinghouse) that are unable to submit electronic claims
using version 4010A of the HIPAA mandated claim transaction must communicate their contingency plan to MHP.
- The provider’s contingency plan must include anticipated dates for conforming to the
HIPAA standard formats.
- If the provider uses a clearinghouse, the provider is responsible for
communicating their contingency plan with their clearinghouse.
The X12 Version 4010A transaction format is required for all new trading partner
relationships. For more information on establishing a new trading partner relationship with MHP, see the
Claim Submission
guidelines.
MHP will accept transactions in accordance with our
837 Professional 
and
837 Institutional
companion guides
during the initial implementation of HIPAA transactions. The date for accepting all claim types,
including claims with attachments, is targeted for the 3rd quarter
of 2004.
Transaction Content
MHP will accept claims with non-standard data elements through December 31, 2003
with the same requirements as listed above. Over the next several months MHP will monitor
the readiness of providers to comply with the data standardization requirements
set forth in the HIPAA regulations and implementation guides. If determined appropriate, we will instruct
our clearinghouses to enforce data validation edits effective January 1, 2004.
Outreach Efforts
MHP will continue open communication with our providers and clearinghouses to
address and seek out potential problem areas. Throughout the next several months, MHP will closely monitor the claim
rejection rates, research problem areas and work with our providers to resolve
issues.
Some of the specific outreach efforts include:
- Provider newsletters
- Face-to-face communication through the MHP Provider Relations field staff
- Participation in external steering committees with large provider networks
- Participation at Missouri SNIP
Contact Information
For more information regarding MHP’s HIPAA implementation and contingency plans,
please contact John Oleksyn, HIPAA Coordinator at (314) 214-8083.
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