HIPAA CODING STATUS
Covered Transactions - Description HIPAA Transaction Standard Supported? Will Be Supported?
First Report of Injury - To satisfy medical providers jurisdictional reporting requirements. Primary Trading Partners are medical providers, representing intermediaries, and state and federal jurisdictions. This transaction is intended for workers' compensation and occupational injuries, illnesses, and incidents. No No N/A To HSPC Business Operations
The eligibility for a health plan is the transmission of either of the following: A) an inquiry from a health care provider to a health plan, or from one health plan to another health plan, to obtain any of the following information about a benefit enrollee: 1. Eligibility to receive health care under the health plan, 2. Coverage of health care under the health plan, 3. Benefits associated with the benefit plan, B) A response from a health plan to a health care providers (or another health plan's) inquiry described in paragraph A) of this section. ASC X12N 270/271 Health Care Eligibility/Benefit Inquiry and Information Response, Version 4010 No N/A To HSPC Business Operations
Claims Attachments - Transaction rules do not currently support claims attachments. Although the rules do allow for the electronic submission of the claim and an authorization request, the supporting documentation cannot be sent electronically within the transaction rules as currently finalized. ASC X12N 275 Patient Information Request and Response, Version 4010 No Support Date TBD
The 276 is used to transmit request(s) for status of specific health care claim(s). The 277 may be used for any of the following: (1) as a response to a health care claim status request (276); (2) as a notification about health care claim(s) status, including front end acknowledgments; and (3) as a request for additional information about a health care claim(s). ASC X12N 276/277 Health Care Claim Status Request and Response, Version 4010 No Support Date TBD for 276 Inbound and 277 Outbound
The referral certification and authorization transaction is any of the following transmissions: A) A request for review of health care to obtain an authorization for the health care, B) A request to obtain authorization for referring an individual to another health care provider, C) A response to a request described in paragraph A) or paragraph B) of this section. ASC X12N 278 Health Care Services Review Notification and Request for Review Inquiry/Response, Version 4010 No N/A To HSPC Business Operations
The health plan premium payment transaction is the transmission of any of the following from the entity that is arranging for the provision of health care or is providing health care coverage payments for an individual to a health plan: A) Payment, B) Information about the transfer of funds, C) Detailed remittance information about individuals for whom premiums are being paid, D) Payment processing information to transmit health care premium payments including any of the following: 1) Payroll deductions, 2) Other group premium payments, 3) Associated group premium payment information. ASC X12N 820 Payroll Deducted and Other Group Premium Payment for Insurance Products, Version 4010 No N/A To HSPC Business Operations
The enrollment and disenrollment in a health plan transaction is the transmission of subscriber enrollment information to a health plan to establish or terminate insurance coverage.. If the Eligibility Roster which is mentioned in so many HIPAA documents becomes a standard transaction, that file type would be more applicable to HealthSmart Business Operations. ASC X12N 834 Benefit Enrollment and Maintenance, Version 4010 No N/A To HSPC Business Operations
The health care payment and remittance advice transaction is the transmission of either of the following for health care: A) The transmission of any of the following from a health plan to a health care provider's financial institution; 1) Payment, 2) Information about the transfer of funds, 3) Payment processing information, B) The transmission of either of the following from a health plan to a health care provider; 1) Explanation of benefits, 2) Remittance advice. ASC X12N 835 Professional Health Care Claim Payment/Advice, Version 4010 No N/A To HSPC Business Operations
The health care payment and remittance advice transaction is the transmission of either of the following for health care: A) The transmission of any of the following from a health plan to a health care provider's financial institution; 1) Payment, 2) Information about the transfer of funds, 3) Payment processing information, B) The transmission of either of the following from a health plan to a health care provider; 1) Explanation of benefits, 2) Remittance advice. ASC X12N 835 Institutional Health Care Claim Payment/Advice, Version 4010 No N/A To HSPC Business Operations
The health care payment and remittance advice transaction is the transmission of either of the following for health care: A) The transmission of any of the following from a health plan to a health care provider's financial institution; 1) Payment, 2) Information about the transfer of funds, 3) Payment processing information, B) The transmission of either of the following from a health plan to a health care provider; 1) Explanation of benefits, 2) Remittance advice. ASC X12N 835 Dental Health Care Claim Payment/Advice, Version 4010 No N/A To HSPC Business Operations
Claims, Coordination of Benefits, Payment Information ASC X12N 837 Health Care Claim: Professional, Version 4010 Yes Yes; Direct and Clearinghouse
Claims, Coordination of Benefits, Payment Information ASC X12N 837 Health Care Claim: Institutional, Version 4010 Yes Yes; Direct and Clearinghouse
Claims, Coordination of Benefits, Payment Information ASC X12N 837 Health Care Claim: Dental, Version 4010 No Support Date TBD
Pharmacy Claim NCPDP Telecommunication Standard Implementation Guide, Version 5, Release 1, September 1999, and Equivalent NCPDP Batch Standard Batch No N/A To HSPC Business Operations
Pharmacy Remittance and Payment Advice NCPDP Telecommunication Standard Implementation Guide, Version 5, Release 1, and Equivalent NCPDP Batch Standard Batch Implementation Guide, Version 1, Release 0, February 1, 1996 No N/A To HSPC Business Operations
1. Diseases, 2. Injuries, 3. Impairments, 4. Other health problems and their manifestations, and 5. Causes of Injury, Disease, Impairment, or other Health Problems. ICD-9-CM Volumes 1, 2, and 3 (Including The Official ICD-9-CM Guidelines for Coding and Reporting Yes Yes
1. Drugs, 2. Biologics NDC Codes and HCPCS HCPCS Only HCPCS are supported; awaiting final word on NDC Codes
Services include but not limited to: 1. Physician Services, Physical & Occupational Therapy, 3. Radiologic Procedures, 4. Clinical Laboratory Tests, 5. Other Medical Diagnostic Procedures, 6. Hearing & Vision Services, and 7. Transportation Services Including Ambulance. CPT-4 Current Procedural Terminology, 4th Edition and HCPCS Health Care Financing Administration Common Procedure Coding System Yes Yes
Codes on Dental Procedures and Nomenclature, as updated and distributed by the American Dental Association, for dental services CDT-3/version 2000 Official version is available from the American Dental Association Yes Yes