University Health Plans, Inc. is in the process of accepting test files from the major clearinghouses (such as Emdeon) as well as our direct-connect providers to assure that all inbound 837 transactions are HIPAA Level 5 compliant by May 1, 2009.

What is HIPAA Level 5 Compliance?

• Applies to inbound 837 transactions (electronic claims and encounter submissions.)
• Validates code sets and ensures that the usage is appropriate for a particular transaction and to the coding guidelines which apply to the specific code sets.
• Validates external tables, such as CPT, ICD-9, CDT, NDC, status codes, adjustment reason codes and their appropriate use within the transaction.

In addition, if an inappropriate code set is used within a transaction, only the particular claim will be rejected; not the entire file as would have occurred under HIPAA Level 4. UHP currently employs several edits that allow acceptance of files that may not meet HIPAA level 4 standards; these edits will be removed effective May 1, 2009. This means that claims that do not meet HIPAA Level 4 compliance will be rejected.

If you have questions, please contact us at:

• The UHP/Centene EDI Help Desk at 1-800-225-2573, extension 25525
• The UHP/Centene EDI Help Desk at EDIBA@centene.com

This entry is filed under News.