 |
Electronic Media Claims and HIPAA
|
The Health Insurance Portability and Accountability Act (HIPAA) final rule on Transaction Standards and Code Sets mandates that all health care providers, plans, and clearinghouses must use new standard formats when conducting certain transactions electronically. HIPAA standards were put into place on October 16, 2003, enabling health care providers to submit standard electronic transactions for eligibility, authorization, referrals, claims, or claims status. For your TRICARE claims, the following standard formats must be used:
-
ASC X12N 837—Health Care Claim: Professional, Version 4010 and Addenda
-
ASC X12N 837—Health Care Claim: Institutional, Version 4010 and Addenda
When fully implemented, TRICARE contractors and other health care payers will be prohibited from accepting or issuing transactions that do not meet the new standards. In order to avoid future cash flow disruptions, it is imperative that you begin working with your software vendor, clearinghouse, and PGBA now to convert to the HIPAA-compliant claims formats.
PGBA is ready to receive your TRICARE claims in the HIPAA standard formats. In order to transition successfully to the new formats, you should do the following:
If you submit your claims through a clearinghouse or other vendor, contact them and find out what steps are necessary in order for your TRICARE claims to be transmitted to PGBA in the HIPAA standard claims format. If you submit directly to PGBA, your system will have to be able to produce the HIPAA standard claims format. Contact your software vendor to determine what changes are needed in your system and plan to test your updated software and migrate to the new formats as soon as possible.
If you need any assistance with transitioning to the new HIPAA standard formats for TRICARE, you may call the PGBA EMC Help Desk. Don’t wait until it’s too late. Take action today to ensure that you will be able to continue to benefit from the many advantages of filing your TRICARE claims electronically.
HIPAA Resources
Provider Trading Partner Agreement - required by TRICARE for providers submitting electronic claims.
TRICARE Web site - offering additional information concerning HIPAA. |
