Medi-Cal: HIPAA: HIPAA Linking Paper Attachments Questions and Answers

1. Who should complete the survey?

All providers who submit claims with supporting documentation or attachments are encouraged to complete the survey so that we may obtain accurate results.

2. What is the purpose of the survey?

The purpose of the survey is to:

Determine the number of providers currently submitting paper claims with attachments.
Determine the number of providers capable of submitting claims in ANSI 837 X12N Version 4010A1 claim format.
Estimate the interest level of using this new method to submit paper attachments when filing claims electronically.
Obtain participants for pilot testing.

3. How long will it take to complete the survey?

The survey is brief and should only take a few minutes to complete.

4. Is the survey anonymous?

Survey responses are anonymous unless the provider chooses to participate in pilot testing, at which point they would be required to provide their contact information.

5. What is ANSI 837 X12N Version 4010A1?

It is the standard set for Electronic Data Interchange (EDI) claims transactions as specified in the HIPAA Final Rule for Transactions and Codes Sets.

6. Is the information shared confidential?

Yes, all information provided is confidential and will only be used for the purpose of this project.

7. What if the number of electronic claims with paper attachments submitted per month is not known?

If you are unsure of the exact number, please submit the closest possible estimate.

8. Is participation mandatory?

Participation is not mandatory, but is highly encouraged so that we may obtain accurate results.

9. How will participants be selected for the pilot program?

Participants will be selected based on results obtained from the survey and the requirements of the project.

10. What is the purpose of the pilot program?

The purpose of the pilot program is to:

Validate that systems are functioning as designed and conform to the new process.
Validate the process of linking paper attachments to electronic claims.
Minimize the risk of error in claims processing.
Gain acceptance for the new process from the provider community.
Help prepare users for the new paper attachment process.
Coordinate with third-party software vendors for a smooth transition to the paper attachment process.

11. What does participating in the pilot program involve?

Providers will be requested to submit an Attachment Control Form via mail along with the supporting paper documents related to the claim. The Attachment Control Number located on this form will need to be entered in the paperwork (PWK) segment of the electronic claim as well. This will allow the attachments to be linked to the corresponding electronic claim.

12. How will providers obtain the Attachment Control Form used in the pilot program?

EDS will provide Attachment Control Forms beginning in January 2005.

13. How long will the pilot program last?

The pilot program will last approximately two months.

14. What is the process to submit a claim electronically with paper attachments?

For each claim, a single and unique Attachment Control Form must be submitted via mail along with any supporting attachments. Providers/submitters will be required to use the 11-digit Attachment Control Number from the Attachment Control Form to populate the paperwork (PWK) segment of 837 HIPAA transactions.

Only the first occurrence of PWK01 = ’OZ’ (Attachment Report Type Code), PWK02=’BM’ (Attachment Transmission Code) and PWK05= ’AC’ (Identification Code Qualifier) will be accepted for attachments corresponding to the electronic claim submission. Attachments must be mailed to: Fiscal Intermediary, P.O. Box 526022, Sacramento, CA 95852.

15. Why is this new process being put into place?

Under HIPAA, an electronic (837) claim cannot be rejected because it requires an attachment. Modifications needed to be made to process paper attachments submitted in conjunction with an electronic (837) claim.

16. Do providers/submitters need to sign an agreement for this new process?

No, providers/submitters do not need to sign an agreement.

17. Will an Attachment Control Form be required for all claim types?

Currently, only long term care, inpatient, outpatient, medical and vision claim types will require the submission of an Attachment Control Form to submit supporting documentation for electronic claims.

18. What is the time frame for submitting supporting documents for an electronic claim?

All attachments MUST be received within 30 calendar days of the electronic claim submission in order to be matched to the electronic claim. The original Attachment Control Form must accompany the attachments. Paper attachments cannot be matched after 30 calendar days of the electronic claim submission.

19. How are Attachment Control Forms obtained?

When the forms become available, they can be requested by calling the Telephone Service Center (TSC) at 1-800-541-5555. They will also be accessible through the Medi-Cal Web site.

20. When will Attachment Control Forms be available to providers/submitters?

Providers/submitters will be notified in Medi-Cal Updates or by e-mail when forms are available.

21. How long will it take to receive Attachment Control Forms once ordered?

The delivery time for Attachment Control Forms will be the same as for all other claim forms.

22. Are there any fees associated with the Attachment Control Form?

No, Attachment Control Forms and envelopes will be provided free of charge to all providers/submitters who submit 837 v.4010A1 claims.

23. What happens if a provider/submitter fails to submit an Attachment Control Form along with the attachments?

Attachments that do not have an Attachment Control Form or that are submitted using anything other than the original Attachment Control Form will be returned to the provider/submitter along with a rejection letter (if return address information is available).

24. What if the provider forgets to enter the Attachment Control Number on the electronic claim?

If an 837 v.4010A1 electronic transaction is received that requires an attachment, and there is no Attachment Control Number, the claim will be denied.

25. Can a copy of the Attachment Control Form be submitted if the original Attachment Control Form is damaged?

No, copies of the Attachment Control Form will not be accepted.

26. Can Attachment Control Forms and the attachments be faxed?

Currently, there is no method other than mail by which attachments and the Attachment Control Form can be submitted.