New Hampshire Developmental Services System. EDS Trading Partner Agreements for NH Medicaid Billing

Transcription

1 New Hampshire Developmental Services System IT Task Force INTAKE, SERVICE CAPTURE AND BILLING SYSTEMS DEVELOPMENT PROJECT Operational Advisory #10 31 July 2003 EDS Trading Partner Agreements for NH Medicaid Billing These Operational Advisories are advance notifications to Area Agencies and users of necessary operational requirements to be implemented for either the Intake or Service Capture/Billing systems. New HIPAA regulations now in effect require all Area Agencies to complete a new trading partner agreement with EDS for NH Medicaid billing. The following pages are meant to guide you through filling out your trading partner agreements. A separate agreement must be completed for each billing system used. So, if your Area Agency is using both the new NHLeads.org Billing system and the CCW Legacy solution to submit claims then you will need to complete a trading partner agreement for each system. Both agreements will look the same with the exception of the Agency or Product name on page 2. Your completed agreements must be sent to: EDS Attn: EDI Coordinator P.O. Box 2040 Concord, NH For Questions or Support, call NHLeads Support at

2 NH Title XIX EDI Registration Purpose: Registration of NH Title XIX Trading Partners to allow access to the NH Medicaid Web Portal for Test and Production Claim transaction uploads, and downloads of Functional Acknowledgements, Submitted Claim Reports, Claim Status Reports and Remittance files. Who must register: Any entity who will utilize the NH Medicaid Web Portal. Requirements: A completed Trading Partner Agreement with NH Title XIX. Identification of the Entity or Process utilized to certify that the Trading Partner is producing standard X12N transactions. Utilization of the New Hampshire Medicaid Companion Guide to ensure that the transactions will meet the Specialty Line of Business requirements of New Hampshire Medicaid. Accurate identification of all of the NH Medicaid Providers, by Provider ID, served by the Trading Partner, and identification of transactions used by each. Timely notification of changes to the Provider and transaction lists. Instructions: Part 1.a. Provide the name, address, and contact information for the entity who will utilize the New Hampshire Medicaid Web Portal to send or receive electronic transactions. This entity may or may not be a New Hampshire Medicaid service provider, but will be required to complete a Trading Partner Agreement with NH Title XIX. Part 1.b. Identify the method of certification that transactions meet X12N standards, and indicate all of the electronic transactions that the Trading Partner will utilize, either now or in the future when they are implemented. Part 2. Complete the Medicaid Provider list to identify each New Hampshire Medicaid Provider that has authorized the Trading Partner to send or receive its transactions. Identify all of the transactions that are authorized for each provider. List only the Providers who will be identified in the claims as the Billing Provider or the Pay-To Provider. Make additional copies if needed. Mark only the transactions that this Trading Partner will process for the NH Medicaid Provider. This information will be used to route transactions to the Claims Processing System and back to Trading Partner directories. Remittance files (835) and Pended Claim Reports (277 Unsolicited) will be available only to one (1) Trading Partner that a Provider has authorized. Providers are able to authorize one Trading Partner to submit their claims, and a different Trading Partner to download the 835 and 277 Unsolicited, by indicating the transactions and authorizations on each Trading Partner s EDI registration form. Note: The 997 Functional Acknowledgement and the Submission Accept/Reject Report will automatically be available for download by the Trading Partner identified as the Submitter. The 277 and 835 transactions will be sorted by the Pay-to Provider, and will require specific instruction as to the identity of the Trading Partner who will be authorized to download them. 1 of 3

3 EDS INTERNAL USE DATE APPROVED BY TRADING PARTNER ID WEB LOGON Part 1.a. NH Title XIX EDI Registration Trading Partner Name Street Address Address 2 City State Zip Primary Contact Name Part 1.b. PreCertification: Please check one. Using Provider Electronic Solutions Version 2.x Certified by Independent Agency (Provide name) Translator Compliance Check (Name product) ClarEDI Utilizing a Certified Vendor/Clearinghouse (Provide name) Other (Describe) Transactions: Check all that apply 837 Institutional Inpatient 837 Institutional Outpatient 837 Institutional Nursing Home 837 Professional 837 Dental 835 Remittance Primary Contact Telephone Agency or Product name: [AA Name] NHLeads.org or Distributed by E.D.S 277 Unsolicited Claim Status 997 Functional Acknowledgement CCW Legacy 276/277 Claim Status Inquiry (Available in the future, Phase II) 270/271 Eligibility Request/Response (Avail. in the future, Phase II) Claim Accept/Reject Report 2 of 3

4 TRADING PARTNER ID NH Title XIX EDI Registration NH Medicaid Provider List [List each Provider Numbers on a separate line] Check mark each transaction that is authorized by the Provider for this Trading Partner. NH Provider ID Provider Name 837 Dent 837 Inst 837 Prof 997 Claim Acc/Rej / / 277 Authorized signature of NH Medicaid Provider, to indicate consent for the described access. [NH ProviderID] [AA Name] [Authorized Signature] 3 of 3

5 NH MEDICAID ELECTRONIC TRANSACTION STANDARD TRADING PARTNER AGREEMENT FORM This agreement is made by and between the New Hampshire Department of Health and Human Services (hereinafter, Department ) and [Area Agency Name] (hereinafter, Trading Partner ). (Provider or Electronic Billing Service Name) relative to the electronic transmission of health information in connection with a transaction covered by 45 CFR Parts 160 and 162 that is exchanged between the Trading Partner and the Department, its fiscal agent or pharmacy benefits manager. This Agreement is made part of the New Hampshire Medicaid Program Provider Enrollment Agreement between the parties, which is hereby incorporated by reference. The Trading Partner agrees to the following: 1. The Trading Partner holds the Department, its fiscal agent or its pharmacy benefits manager harmless and indemnifies against any liability to the Trading Partner, the Department, its fiscal agent, its pharmacy benefits manager or to any Medicaid Provider arising out of the entering into this agreement or electronic transmission of health information in connection with Medicaid claims submitted electronically. 2. The Trading Partner will prepare and submit electronic submissions in conformance with New Hampshire Medicaid Companion Guides, to the extent that Medicaid-specific data elements do not change the meaning or intent of any of the Health and Human Services (HHS) Transaction Standard s implementation specifications or do not change any definition, data condition or use of a data element or segment as set forth in the HHS Transaction Standard Regulation. (45 CFR Part 162, Subparts I through N). Trading Partner further agrees that it will not change any definition, data condition or use of a data element or segment nor add any data elements or segments to the maximum data set as proscribed in the HHS Transaction Standard Regulation. 3. Unless Trading Partner utilizes Provider Electronic Solutions (PES) software to promote successful transactions, Trading Partner shall adequately test all business rules appropriate to their types and specialties with the Department s fiscal agent and or pharmacy benefits manager. Trading Partner further agrees and understands that HHS may modify and set compliance dates for the HHS Transaction Standards modifications. Trading Partner agrees to incorporate by reference into this Agreement any such modifications or changes. (45 CFR ). 4. Trading Partner agrees to comply with all applicable privacy and security standards as set forth in 45 CFR Parts 160, 162 and If the Department or its fiscal agent or its pharmacy benefits manager determines that Trading Partner submissions fail to conform to New Hampshire Medicaid Companion Guides and the HHS Transaction Standard s implementation specifications as set forth HHS Transaction Standard Regulation (45 CFR Part 162, Subparts I through N), the Department or its fiscal agent or its pharmacy benefits manager may terminate this agreement (5) working days after the Trading Partner has received a written termination notice. 1 of 2

6 6. This agreement will terminate automatically and without prior notice upon a request from the State of New Hampshire to its fiscal agent or pharmacy benefits manager to stop processing claims for the Trading Partner. 7. This Agreement shall survive in the event the contract between the Department and its current fiscal agent or pharmacy benefits manager expires or terminates and shall be valid with regard to future fiscal agents or pharmacy benefits managers unless otherwise modified or terminated. AUTHORIZED SIGNATURE OF TRADING PARTNER: [AA Authorized Signature] DATE: [Today s Date] AUTHORIZED SIGNATURE OF DEPARTMENT: DATE: TRADING PARTNER NUMBER: (To be assigned by Department) 2 of 2