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Overview
Begin Testing Now
Convert to Industry Standards
Create a Plan for Testing
If you submit claims directly to payers:
If you use a third party vendor to submit claims:
The Michigan Department of Community Health (MDCH) is ready to
test your 837A1 transaction files now for Business-to-Business (B2B)
compatibility. You should submit your test claims with the current
codes until MDCH notifies you of any changes. MDCH began testing
837 v.4010A1 claim formats (Professional, Institutional, Dental)
during the third quarter of 2003.
MDCH will begin testing the remaining HIPAA compliant transactions
by April 2003. All MDCH electronic trading partners should be prepared
to begin testing by this date.
Begin Testing Now
The key to a successful conversion is to get your claims in now
for testing. MDCH is encouraging providers to conduct two stages
of testing to assure HIPAA compliance. Stage one, Integrity Testing,
assures your transaction files will be HIPAA compliant. Stage two,
B2B Testing, assures that transactions between payer and provider
systems are compatible.
After you have passed both testing stages, your practice will be
ready to submit HIPAA compliant 837 v.4010A1 claim transactions
to MDCH, and MDCH will be ready to accept and process your transactions.
Convert to Industry Standards
Healthcare Providers are specifically named in the HIPAA law as
a covered entity. As a covered entity it is your responsibility
to convert all covered electronic data interchange to approved industry
standard formats no later than October 16, 2003.
If you submit electronic claims directly to payers you must convert
your system and assure its compliance. If you use a billing company
or clearinghouse, you must assure that the claims they process
on
your behalf are compliant. If your electronic claims are not compliant,
they won’t be processed and hence cannot be paid.
Create a Plan for Testing
Now is the time for all MDCH trading partners to assess HIPAA preparedness
and establish an internal testing plan.
Your test plan should determine how your claims will be submitted
to payers. You have two options: to submit claims directly, or hire
a third party vendor (billing company, clearinghouse, practice management
group, etc.) to submit claims on your behalf.
If you submit claims directly to payers:
- Will you submit electronic claims using software purchased from
a vendor?
Or, will you prepare electronic claims internally and submit directly
to payers? If so, are you already enrolled as an electronic biller
with MDCH?
- Do you know where to gather information needed to successfully
test?
Do you know how to assemble resource materials needed for successful
testing?
- Are your transactions syntactically correct?
- Do you understand procedures for submitting files to the Data
Exchange Gateway (DEG) and how to retrieve and understand file
acknowledgements?
- Are you familiar with output that will be generated through
the test process?
If you use a third party vendor to submit
claims:
- Do you have a contract with a third party billing agent who
will file HIPAA compliant transactions on your behalf?
Or, will you utilize a clearinghouse for file submission?
- Make sure your vendor successfully completes B2B Testing with
Medicaid and all of your other payers. Then, insist that your
vendor submits a small sample of test claims on your behalf to
assure that your claims are HIPAA compliant and can be paid.
- Request your vendor supply you with a copy of the final B2B
test results from each payer.
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Brochure
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