HIPAA: General
Q:Is the new HIPAA-compliant 837 4010A1 electronic format the only way to submit claims after the September 22, 2003 HIPAA implementation date?
A:
No. EDS will continue to accept paper claims as well as the new 837 HIPAA-compliant 4010A1 format. EDS will also continue to accept the current non-standard and proprietary EDI format for those current Computer Media Claims submitters who are not ready to implement the new 837 HIPAA-compliant 4010A1 format.
Q: If Medi-Cal requires some claims to be submitted electronically with the local codes after October 16, 2003, won’t Medi-Cal be violating HIPAA’s compliance deadline?
A:
The Centers for Medicare and Medicaid Services (CMS) is aware of Medi-Cal’s phased-in approach to the transactions and code sets compliance that goes beyond October 16, 2003. The Department of Health Care Services is working collaboratively with its trading partners to ensure a successful transition to become fully HIPAA compliant. The most critical aspects of this transition are that payment to providers and care of recipients is not interrupted. Therefore, Medi-Cal has extended a phase-out period for proprietary and non-standard electronic formats.
Q: How is a "HIPAA Certificate of Credible Coverage" that would reflect the eligibility of a Medi-Cal recipient who either is or was on Medi-Cal requested?
A:
The "HIPAA Certificate of Credible Coverage" is sent to the Medi-Cal recipient. The certificate may be obtained from a county eligibility worker. If the county doesn't have the information necessary to provide the certificate, the county has been instructed to contact Ana Felines from the Medi-Cal Eligibility Branch at (916) 552-9507 to request a certificate. More information is available online at http://www.dhs.ca.gov/mcs/mcpd/MEB/ACLs/PDFs/ACWDLs/2000ACLs/60s/00-66.pdf, or contact the HIPAA Hotline at 1-800-541-5555, prompt option "4."
Q: Will the Claims Inquiry Form (CIF) be used after October 16, 2003 when HIPAA is implemented?
A:
Yes. CIFs will continue to be used to inquire on a claim, to request an adjustment or to void a claim. Phasing out hardcopy CIFs is not anticipated at this time. After October 2003, Medi-Cal plans to allow CIFs to be submitted electronically through the ASC X12N 837 004010X098A1 and ASC X12N 837 004010X096A1 claim replacements and ASC X12N 276/277 004010X093A1 claim status standards. Testing and implementation dates will be published in Medi-Cal Updates and on the HIPAA News Web page.
Q: Is there a plan and timeline for EDS to accept Medicare/Medi-Cal claims electronically from providers?
A:
Yes. For claims that do not cross over electronically, Medi-Cal does plan to accept Medicare/Medi-Cal (coordination of benefits) claims electronically from providers in a phased approach. The specific timeline has not been confirmed. Testing and implementation dates will be published in Medi-Cal Updates and on the HIPAA News Web page.
Q: On what date must our systems be HIPAA compliant?
A:
Health plans, health care clearinghouses, and health care providers that transmit health information in electronic form will have approximately 26 months from the publication of each final rule to implement the standards of that rule. Compliance deadlines will vary based on the date of publication for each rule. For example, the compliance deadline for the final rule on transaction and code sets is October 16, 2002 and the privacy rule is April 14, 2003.
Q: What changes will I have to make to my computer systems to comply with HIPAA regulations?
A:
Providers and vendors are responsible for verifying that their products are HIPAA-compliant. Since computer systems vary from provider to provider, you will need to analyze HIPAA regulations to determine what changes need to be made to your computer system. You should also contact your software vendors and billing services regarding potential upgrades to their products.
Q: How will HIPAA affect Medi-Cal policies?
A:
We anticipate some Medi-Cal policies will change as a result of HIPAA. DHS and EDS are currently analyzing the final rules and will notify you of any policy changes that need to be made through the Medi-Cal bulletins and this Web site as a result of HIPAA.
Q: Can I continue to submit my claims on paper?
A:
Yes. HIPAA mandates standards for electronic claims but does not require providers to submit their claims electronically. However, to further streamline processes, some changes to paper forms and to Medicaid billing requirements for paper claims submission may be made. DHS and EDS encourage providers to bill claims electronically.
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