HIPAA: Provider Cutoff Date for Proprietary and Non-HIPAA Standard Electronic Claim Formats - December 1, 2006
March 28, 2006Medi-Cal is currently accepting both HIPAA compliant and non-HIPAA compliant electronic claims transactions as part of a contingency plan to assist submitters in transitioning to full compliance. However, due to the required implementation in support of the National Provider Identifier (NPI) Medi-Cal must discontinue acceptance of proprietary and non-HIPAA standard electronic formats for electronic claim transactions.
Beginning December 1, 2006, proprietary and non-HIPAA standard electronic claim formats submitted by any provider will no longer be accepted.
Medi-Cal offers Computer Media Claims (CMC) filing using the ASC X12N 837 v.4010A1 transaction format. Acceptable media submission types are dial-up, tape or Internet. Both CMC and paper claims must continue to meet Medi-Cal policy and billing requirements.
Information for 837 Transaction Applicants
The “HIPAA Update” and “HIPAA News” pages on the Medi-Cal Web site
include links to a variety of important information for 837
transaction submitters and applicants, including technical
specifications, implementation instructions, user guides,
frequently asked questions (FAQs) and biller updates.
Application/Agreement Form
Providers may submit 837 transactions directly or employ a billing
service to prepare and submit their 837 transactions. To become
an authorized 837 transactions submitter, providers and billing
services must first complete, sign and mail an
application/agreement to the CMC Unit. The
Medi-Cal Telecommunications Provider and Biller
Application/Agreement (DHCS 6153) is available on
the Medi-Cal Forms page. More information can also be found in
the
CMC Enrollment Procedures section in the Part 1
manual.
Self-Service HIPAA Transaction Utility Tool
To support your transition needs, Medi-Cal has implemented a
self-service transaction validation environment – the HIPAA
Transaction Utility Tool. You are invited to join the Medi-Cal
HIPAA Transaction Utility Tool user community. This tool is
being offered at no cost, and provides everything needed for
exchanging Electronic Data Interchange (EDI) files with
Medi-Cal.
This Web-based validation tool allows providers to test transaction compliance with Medi-Cal specifications. The tool also contains documentation such as EDI specifications (Companion Guides) in a format that can be viewed online or easily downloaded. The utility tool offers transaction validation (inclusive of Companion Guide-level editing), troubleshooting and reporting features that enhance, but do not replace, Medi-Cal’s current testing and media activation requirements.
The HIPAA Transaction Utility Tool is accessed from the sysdev Medi-Cal Web site Transaction Services page. We strongly encourage you to take advantage of this service.
- Click the “Transaction Login” link from the sysdev Medi-Cal home page.
- Enter your current Medi-Cal submitter ID and password. (Your submitter ID must be prefixed with “CMCSUB” and the password is the same password used for CMC dial-up access.) Click “Submit.”
- The “Transaction Services” menu will appear. Click the “HIPAA Transaction Utility Tool” link. A separate window will open for the application.
- When Transaction Utility Tool application is open, click the “User Guide” link located in the left navigation bar for step-by-step use and instruction.
If you have any questions, please feel free to contact the Medi-Cal Telephone Service Center at 1-800-541-5555, then select Option 16 followed by Option 11 for CMC.
Note:
If you cannot view the MS Word or PDF (Portable Document Format) documents correctly, please visit the Web Tool Box to link to a download site for the appropriate reader.