Important HIPAA Reminders

• HIPAA Claim Form Requirements

Important Update on HIPAA Contingency Plan (CMS JSM-20, November 25, 2003)

Effective immediately:

• New electronic submitters may only test on the HIPAA format (837 4010A1) for inbound claims;
  
• New electronic submitters may only go into production on the HIPAA format (837 4010A1) for inbound claims;
  
• Current electronic submitters may not begin testing or submitting inbound claims for any new providers in other than the HIPAA-compliant format.
  
• New electronic remittance receivers may only test and go into production on the HIPAA format (835 4010A1); and
  
• Any entity (e.g., clearinghouse) currently receiving electronic remittance advice may not add a new provider receiving electronic remittance advice in a pre-HIPAA format.
  
• Submitters, including clearinghouses and vendors, are expected to move their entire workload into production within 30 days after they have successfully completed testing of the HIPAA claim format.

Quick Links to Important CMS Documents

• (*) What is HIPAA?
  
• (*) Administrative Simplification Information
  
• (*) CMS HIPAA FAQ's
  
• (*) Transactions & Code Sets Information Series
  

Medicare Part A HIPAA Transaction Testing

•  Directory of Billing Vendor/Clearinghouses in Production for HIPAA (Microsoft Excel)
  

More Information (Adobe PDFs)

• From the Office of HIPAA Standards
  
  • HIPAA Update - June 2005
  • HIPAA Update - March 2005
  • HIPAA Update - December 2004
  • HIPAA Update - November 2004
    

• Health care providers are required by law to apply for a National Provider Identifier (NPI). To apply online, visit: https://nppes.cms.hhs.gov or call 1-800-465-3203 to request a paper application.
  
  Visit http://www.cms.hhs.gov/EducationMaterials/05_Archived%20Roundtable%20Transcripts.asp for the latest NPI information including a transcript from CMS' recent National Provider Identifier Roundtable conference call.

• The Centers for Medicare and Medicaid Services announces the following plans for transitioning to the National Provider Identifier (NPI) in the Fee-for Service Medicare Program:

  Between May 23, 2005 and January 2, 2006, CMS claims processing systems will accept an existing legacy Medicare number and reject, as unprocessable, any claim that includes only an NPI.

  Beginning January 3, 2006, and through October 1, 2006, CMS systems will accept an existing legacy Medicare number or an NPI as long as it is accompanied by an existing legacy Medicare number.

  Beginning October 2, 2006, and through May 22, 2007, CMS systems will accept an existing legacy Medicare number and/or an NPI. This will allow for 6-7 months of provider testing before only an NPI will be accepted by the Medicare Program on May 23, 2007.

  Beginning May 23, 2007, our systems will only accept an NPI . For additional information, to complete an NPI application, and to access educational tools, visit https://nppes.cms.hhs.gov on the web.

• HIPAA Security Educational Paper Series

  • Security 101 for Covered Entities

  • Security Standards-Administrative Safeguards

  • Security Standards – Physical Safeguards

  • Security Standards-Technical Safeguards

  • Security Standards-Organizational, Policies and Procedures and Documentation Requirements”.

• Starting May 23, 2005, all health care providers can apply for their National Provider Identifier (NPI). The NPI will replace health care provider identifiers in use today in standard health care transactions. The health plans with whom you do business will instruct you as to when you may begin using the NPI in standard transactions. All HIPAA covered entities except small health plans must begin using the NPI on May 23, 2007; small health plans have until May 23, 2008. For additional information, and to complete an application, visit https://nppes.cms.hhs.gov on the web.

• (*) Transaction and Code Set Final Rule

• ANSI 4010 Supplemental Guide
  
• ANSI 4010 A1 Supplemental Guide