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Frequently Asked Questions About Transactions & Code Sets
What is HIPAA?
The Health Insurance Portability and Accountability Act of
1996 (HIPAA) is legislation enacted by the federal government to:
- Ensure health insurance portability
- Reduce health care fraud and abuse
- Guarantee the integrity and confidentiality of health information
- Improve the operations of health care systems
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What are the some of
the benefits of industry-wide implementation of HIPAA?
HIPAA compliance throughout the health care industry will result in:
- Enhanced privacy and security of patient and member personal health information.
- Provider and health plan overhead cost reductions through standardization.
- More consistent processes among health plans as electronic transactions will be uniform throughout the health care industry.
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Who must comply with the HIPAA regulations?
HIPAA applies to Covered Entities. Covered Entities are health care providers conducting electronic
transactions, health plans, and health care clearinghouses.
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What are the HIPAA standard transactions?
The standard transactions that are mandated by HIPAA are the following:
- Health Care Claim Institutional (837I)
- Health Care Claim Professional (837P)
- Health Care Claim Dental (837D)
- Health Care Claim Payment/Advice (835)
- Health Care Eligibility Benefit Inquiry and Response (270/271)
- Health Care Claim Status Request and Response (276/277)
- Health Care Services Review Request for Review and Response (278)
- Benefit Enrollment and Maintenance (834)
- Premium Payment (820)
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Will MHP support the standard transactions?
MHP will support all of the transaction formats and associated code sets as mandated by HIPAA.
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Will MHP require certification from all trading partners?
MHP strongly encourages, but does not require certification of its trading partners.
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Will MHP seek certification of its electronic transactions?
MHP is currently using Claredi to test and confirm our ability to meet the HIPAA standards.
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Will MHP accept non-standard procedure codes beyond
10/16/03?
MHP will accept non-standard procedure codes beyond 10/16/03. MHP
will monitor the volume of claims submitted with non-standard codes and work
with our providers to transition to standard coding. After a reasonable transition period, MHP will enforce an edit to
validate for standard procedure codes.
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When will MHP be ready to accept the standard
transactions?
MHP will be prepared to accept HIPAA Compliant 837 Institutional and 837
Professional transactions on October 16th in accordance with our
companion guides. Providers or clearinghouses that are not capable of providing a HIPAA Compliant 837 should
refer to MHP's Contingency Strategy for guidance.
MHP is prepared to accept a HIPAA Compliant 834 on October 16th in
accordance with our companion guide. Initial testing and remediation is required prior to the submission of
production files.
MHP is prepared to send a HIPAA Compliant 835 on October 16th in
accordance with our companion guide. Initial testing and remediation are required prior to sending production
data.
MHP will be prepared to accept a HIPAA Compliant 820 on October 16th. Initial testing and remediation are
required prior to sending production data.
The target date for all inquiry and response transactions (270/271, 276/277 &
278) to be HIPAA Compliant is 4th quarter 2003.
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Will MHP continue to receive paper claims?
Nothing in HIPAA precludes the submission of paper claims. However, the intent of the legislation is to encourage electronic commerce in health care to reduce administrative costs. At this time, there is no charge for paper claims submission.
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Whom should I contact at MHP?
Please contact our HIPAA Coordinator at (314) 214-8100.
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