FAQ'S

FAQs

Q:  When will Wyoming implement the HIPAA Transactions and Codes Sets?

Wyoming will implement the HIPAA Transactions and Codes Sets on October 1, 2003.

Q:  If a provider currently submits Medicaid transactions electronically, are there any changes expected due to the HIPAA-mandated formats?

Yes, Wyoming will only support the HIPAA-mandated ANSI X12N transaction formats.  The details regarding these formats are found in the HIPAA Implementation Guides and the Companion Guides.  The Companion Guides are published on our website http://wwww.acs-gcro.com.

Q:  What are the HIPAA standardized formats?

The American National Standards Institute (ANSI) Accredited Standards Committee (ASC) X12N (insurance subcommittee) standards, version 4010A, were mandated under the Health Insurance Portability and Accountability Act (HIPAA).  The standardized electronic transaction formats are:

• Health care claim and equivalent encounter
• Dental claim - ASC X12N 837 Dental
• Professional claim - ASC X12N 837 Professional
• Institutional claim - ASC X12N 837 Institutional
• Enrollment and disenrollment in a health plan - ASC X12N 834
• Eligibility for a health plan - ASC X12N 270 and (request) - ASC X12N 271 (response)
• Health care payment and remittance advice - ASC X12N 835
• Health plan premium payments - ASC X12N 820
• Health claim status - ASC X12N 276 (request) - ASC X12N 277 (response)
• Referral certification and approvals - ASC X12N 278

For more information please refer to the CMS website http://www.cms.hhs.gov/.

Q:  What are code sets?

Code sets are defined by the Transaction and Code Set Rule as 'a set of codes used to encode data elements, such as tables of terms, medical concepts, medical diagnostic codes, or medical procedure codes.  A code set includes the codes and the descriptions of the codes.'  The electronic transactions under the HIPAA mandate must contain codes from the Medical Data code sets defined in the rule and the Non-Medical Data code sets listed in the X12N implementation guides.

Medical codes sets named in the rule include:

• Internal Classification of Diseases, 9th Edition, Clinical Modification -Volumes 1, 2, and 3 (ICD-9- CM)
• Code on Dental Procedures and Nomenclature (CDT)
• Health Care Financing Administration Common Procedure Coding System (HCPCS)
• Current Procedural Terminology, Fourth Edition (CPT-4)
• Non-Medical Code sets named in the X12N implementation guides include codes such as the Claim Adjustment Reason codes, Place of Service codes, and Member Status codes.

Providers may learn about the codes that are included under HIPAA by reviewing the Transaction and Code Set rule as well as the Implementation Guides published by the X12N standards organization.  This information may be downloaded from the following website http://www.wpc-edi.com/.

Q:  When will Wyoming begin enrollment for its electronic submitters?

Wyoming begins enrolling its submitters in July.

Q:  How long does it take to enroll with ACS EDI Gateway, Inc.?

Once a complete package is received, EDI confirmation will be mailed within one week of receipt.

Q:  Will existing practice management systems have to change due to the mandated formats?  If so, will data clarifications for EDI submissions be provided?

Yes.  Companion Guides, which software vendors, billing agents, and clearinghouses use to program their applications, will be made available through the EDI website, http://www.acs-gcro.com, in July.

Q:  When does submitter testing begin with ACS EDI Gateway?

Submitter testing will begin the last week of August 2003.

Q:  If I am a vendor, clearinghouse, or billing agent, and have questions regarding specifications or testing, who do I contact?

For answers to questions regarding data clarifications and testing, please contact our EDI Business Analysts at (850) 201-1171.

Q:  Who do I contact if I have a question regarding the ACS EDI Trading Partner Enrollment Form or need technical assistance concerning electronic claim submission?

You may contact the ACS EDI Support Unit Monday through Friday, from 8:00 a.m. to 5:00 p.m. EST, at 1-800-672-4959.

Q:  Who do I contact if I have questions regarding billing, codes, or to check the status of a claim that I have submitted?

Please contact the Wyoming Provider Services at 1-800-251-1268.