Frequently Asked Questions
EDI Services
What are the HIPAA standard transactions for electronic submitters?
Will AmeriHealth support the standard transactions?
Will AmeriHealth conduct standard electronic transactions with trading partners?
Will AmeriHealth provide instructions for submitting standard transactions?
When was AmeriHealth ready to accept the standard transactions?
When did AmeriHealth begin testing with external trading partners?
Which ANSI version was required for compliance on or after October 16, 2003: 4010 or 4010A1?
Will AmeriHealth require certification of all trading partners?
Who should I contact to submit HIPAA-compliant electronic transactions? Who should I contact to schedule testing with AmeriHealth?
How will AmeriHealth assist providers with compliance? How will you work with providers?
How will AmeriHealth share information related to HIPAA-compliance status with providers?
Do you expect to send and/or receive Functional Acknowledgements?
Will you include specifications for transactions that explain the specific components AmeriHealth will require from providers to process information?
Do you intend to have the HIPAA-compliant transactions "certified" by an independent testing service prior to their release?
What is your cutoff date for accepting non-4010 compliant formats? Any exceptions (i.e., continued use of paper, phone or other systems)?
Will you continue to receive paper claims?
What are the HIPAA standard external code sets?
Where can I find more information about HIPAA?
Can I submit my secondary claims electronically?
What are the HIPAA standard transactions for electronic submitters?
The standard transaction formats and associated code sets that are mandated by HIPAA are the following:
- Health Care Claim Institutional (837I)
- Health Care Claim Professional (837P)
- Health Care Claim Dental (837D)
- Health Care Claim Payment/Advice (835)
- Health Care Eligibility Benefit Inquiry and Response (270/271)
- Health Care Claim Status Request and Response (276/277)
- Health Care Services Request for Review and Response (278)
- Benefit Enrollment and Maintenance (834)
- Payroll Deducted and Other Group Premium Payment for Insurance Products (820)
- Version 5.1 of the NCPDP Standards
- Coordination of Benefits
Will AmeriHealth support the standard transactions?
AmeriHealth will support all of the transaction formats and associated code sets as mandated by HIPAA with the exception of the Health Care Claim Dental (837D).
Will AmeriHealth conduct standard electronic transactions with trading partners?
AmeriHealth will conduct standard transactions with trading partners as mandated by the regulations. However, if a transaction is not mandated, we will be happy to work with trading partners to determine if engaging in the standard transaction is in both parties' best interests.
Will AmeriHealth provide instructions for submitting standard transactions?
AmeriHealth has published companion guides on its corporate website.
When was AmeriHealth ready to accept the standard transactions?
AmeriHealth was ready to accept all standard electronic transactions no later than October 16, 2003, but "went live" with those trading partners with whom it had successfully completed testing at earlier dates.
When did AmeriHealth begin testing with external trading partners?
AmeriHealth began testing the 4010A1 version required for compliance by Oct. 16th, 2003.
Which ANSI version was required for compliance on or after October 16, 2003: 4010 or 4010A1?
AmeriHealth was ready to accept all standard electronic transactions no later than October 16, 2003, but "went live" with those trading partners with whom it had successfully completed testing at earlier dates.
Will AmeriHealth require certification of all trading partners?
AmeriHealth strongly encourages, but will not require certification of its trading partners.
Who should I contact to submit HIPAA-compliant electronic transactions? Who should I contact to schedule testing with AmeriHealth?
If you wish to schedule testing with AmeriHealth or to submit HIPAA-compliant electronic transactions, please contact EDI Business Help Desk at 215-241-2305 or claims.edi-admin@amerihealth.com.
How will AmeriHealth assist providers with compliance? How will you work with providers?
We are already educating providers about changes HIPAA will bring and what AmeriHealth is doing. We look for their commitment to work together to achieve a smooth transition. AmeriHealth will focus on communicating the transactions, code sets and other changes that impact our business relationships. Providers should consult their associations, societies or legal counsel about changes that they need to make in their offices.
How will AmeriHealth share information related to HIPAA-compliance status with providers?
AmeriHealth will continue to communicate HIPAA news in our provider newsletters: Partners in Health and Partners in Health Update. In addition, the AmeriHealth provider portal will be updated as information becomes available.
Do you expect to send and/or receive Functional Acknowledgements?
Yes. A TA1, 997, and U277, which is unique to AmeriHealth, will be sent and may be received for all X12 batch transactions.
Will you include specifications for transactions that explain the specific components AmeriHealth will require from providers to process information?
Yes. AmeriHealth has posted companion documents that identify specific technical requirements for all mandated transactions on the company website.
Do you intend to have the HIPAA-compliant transactions "certified" by an independent testing service prior to their release?
AmeriHealth will use CLAREDI software to test and confirm our ability to meet HIPAA standards.
What is your cutoff date for accepting non-4010 compliant formats? Any exceptions (i.e., continued use of paper, phone or other systems)?
Please refer to the HIPAA Contingency Plan section for more information.
Will you continue to receive paper claims?
Nothing in HIPAA precludes the submission of paper claims. However, the spirit and intent of the legislation is to encourage electronic commerce in health care to reduce administrative costs.
What are the HIPAA standard external code sets?
There are numerous coding systems that have been designated as standard, or acceptable for use when using the HIPAA mandated transactions. The regulations specify under what circumstance each type of coding is required. Some of these requiring external code sets include:
- ICD-9-CM Volume 1 and 2: Diagnosis Coding
- ICD-9-CM Volume 3: Inpatient Hospital Service Coding
- CPT-4: Physician Services Coding
- CDT-3: Dental Services Coding
- DRG: Diagnosis Related Groups
- NDC (National Drug Codes): Retail Pharmacy
- HCPCS: Other Health Related Services Coding
Where can I find more information about HIPAA?
- Association for Electronic Health Care Transactions
- Department of Health & Human Services Administrative
U.S. Department of Health and Human Services,
200 Independence Ave. S.W., Washington, D.C. 20201.
202-619-0257
Toll-Free 877-696-6775
HIPAA Toll-Free Privacy Hotline: 866-627-7748
- Centers for Medicare and Medicaid Services
This website provides information regarding the impact of HIPAA on Medicare
and Medicaid programs.
HIPAA Toll-Free Hotline: 866-282-0659
Email: askhipaa@cms.hhs.gov
- HIPAA Advisory
This website, sponsored by Phoenix Health Systems, offers a variety of HIPAA-related news articles, industry surveys, etc. You may also register to participate in various HIPAA forums.
Can I submit my secondary claims electronically?
Yes! Effective November 2008, professional providers and facilities may submit coordination of benefits (COB) information electronically using the 837P and 837I format. For instructions on how to bill electronically, please visit EDI Forms and Guides. You may also refer to our announcement in the November 2008 Partners in Health Update for additional information.
