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Electronic Data Interchange (EDI)
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ANSI ASC X12N 4010 Specifications: These documents are in
portable document format (PDF) and may be downloaded from this Web site.
 X12N User Guide (1453 KB PDF)
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Billing Requirements:
Institutional (202 KB PDF)
Professional (222 KB PDF)
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CMS HIPAA Site:
This link will take you to the Centers for Medicare and Medicaid Services (CMS)
HIPAA site, where you will find information about deadlines, regulations and
standards, enforcement, upcoming events, educational material, the latest
related news and links to other HIPAA-related sites.
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CMS
Online Presentations: This link will take you to a
selection of Centers for Medicare and Medicaid Services (CMS) informational
presentations on topics such as basic HIPAA knowledge, how to get paid, CMS
enforcement, 837I and 837P, and HIPAA security.
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Compliance Statement:
This statement advises providers of the efforts to address the administrative
simplification provisions of HIPAA.
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Contact EDI Services: This
section contains contact information.
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Contingency Plan: On
August 4, 2005, CMS announced in Medlearn Matters (MM3956) that Medicare would
be ending its HIPAA Transactions and Code Sets (T&CS) contingency plan for
claims on October 1, 2005. USAble Administrators will follow the lead of
Medicare and end its HIPAA contingency plan on that date as well.
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Electronic Claims Testing:
This information will help lead you through the process you must follow to
become approved for electronic claims submission in the new HIPAA-compliant
format.
Asynchronous Communications Using Hyperterminal (349 KB PDF)
EDI Report User Guide (100 KB PDF)
- Electronic Data Interchange:
Private Business Transaction Companion Document (441 KB PDF) This document provides additional guidance concerning the segments/data elements necessary to successfully process HIPAA-compliant ANSI X12N version 4010A1 270/271, 276/277 and 278 transactions for private business members.
WPC-EDI.com This link will take you to the WPC electronic data interchange health care transactions site.
This site will contain the ANSI X12 implementation guidelines that can be downloaded.
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EDI Forms: All forms must be signed and returned to EDI
Services via mail or fax. These forms are in portable document format (PDF) and
allow you to complete them online, print, sign and mail or fax to the
appropriate address/fax number.
Electronic Remittance Advice (ERA) (767 KB PDF)
Submitter Information Update Form (28 KB PDF)
Trading Partner Agreement (TPA) (59 KB PDF)
- HIPAA Compliant Vendors List (28 KB PDF): A directory of electronic-billing vendors who have successfully tested with us and are in production for the Health Insurance Portability Accountability Act (HIPAA) version of the X12N 837 Health Care Claim.
- HIPAA Transaction and Code Sets Toolkit (2.1 MB PDF): Designed for physicians and other providers of professional health services, this toolkit is arranged in a series of brief chapters that address specific tasks to help you achieve HIPAA compliance.
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