TRISPAN HEALTH SERVICES ANSI v4010a1

Transcription

1 TRISPAN HEALTH SERVICES ANSI v4010a1 Provider number(s) must exist on the Part A Intermediary's provider file prior to testing. Provider(s), both new and existing, must have a signed EDI Enrollment Form on file with the Part A Intermediary prior to testing. To obtain a Submitter ID and password for testing or production HIPAA 4010A1 Electronic Media Claims (EMC) or Electronic Remittance Advice (ERA), complete Attachment B and submit via fax to the EMC Help Desk at (601) Test batches must be submitted using claims volume that represents the average number of claims submitted on a monthly basis in a production environment. Test data must have an acceptance rate of ninety-five (95) percent with all segment errors resolved prior to approval for submission of production data. Submitters must successfully retrieve output from each data transmission prior to approval for submission of production data. For assistance with HIPAA 4010A1 testing or production, contact the EMC Help Desk toll free at , extension May

2 TRISPAN HEALTH SERVICES 4010A1 837 ISA/GS Segment Information ISA Segment Authorization Information Qualifier = 00 Authorization Information = spaces Security Information Qualifier = 00 Security Information = spaces Interchange ID Qualifier = ZZ Interchange Sender ID = Submitter ID Interchange Receiver ID = GS Segment Application Sender s Code = Submitter ID Application Receiver s Code = May

3 TRISPAN HEALTH SERVICES Asynchronous Communication Specifications Technical Requirements Zmodem, Kermit, Ymodem, Xmodem K Parity = None Data Bits = 8 Stop Bit = 1 Hayes Compatible Modem Access Number (601) Data Requirements Submitter ID, Password, Batch ID, and line commands must be entered using all CAPS. A unique Logon ID (Submitter ID) and password will be assigned to your facility to be used when you connect to the system. The BID (up to 24 characters) or Batch ID is an identifier representing the type of data being transmitted or received (claims, reports, remittances). See Attachment A for a list of BIDs. The following commands are used to control the flow of data between the remote (provider) and the Host (BCBS). Each of these commands can be entered at the cmd> prompt. $$ADD ID=XXXXXXXX BID= XXXXXXXXXXXXXXXXX This command is used to tell the system that you want to transmit a file. $$DIR ID=XXXXXXXX This command can be used to verify what files are available on the host system. $$REQUEST ID=XXXXXXXX BID= XXXXXXXXXXXXXXXXX This command is used to retrieve data from the host, such as confirmation reports and electronic remittance advice files. May

4 To Dial In, Logon, and Transmit Batch of Claims: 1. Initiate session by dialing appropriate phone number (601) Enter assigned Logon ID (Submitter ID) at the cmd> prompt: XXXXXXXX 3. Enter Password at the cmd> prompt: ****** Your password will not display as it is entered 4. The following message will be displayed. Welcome to the Connec t:enterprise UNIX Async Server. Copyright , Sterling Commerce, Inc. All rights reserved. Protocol: ZMODEM Read for commands. cmd> 5. Enter the following command to transmit a batch of claims. $$ADD ID=XXXXXXXX BID= XXXXXXXXXXXXXX After this command is sent, we are ready to receive your file. 6. Enter the following command to logoff the system. $$LOGOFF This will terminate your session and disconnect the modem. May

5 To Dial In, Logon, and Retrieve Confirmation or ERA: 1. Initiate session by dialing appropriate phone number (601) Enter assigned Logon ID (Submitter ID) at the cmd> prompt: XXXXXXXX 3. Enter Password at the cmd> prompt: ****** Your password will not display as it is entered 4. The following message will be displayed. Welcome to the Connec t:enterprise UNIX Async Server. Copyright , Sterling Commerce, Inc. All rights reserved. Protocol: ZMODEM Read for commands. cmd> 5. Enter the following command to transmit a batch of claims. $$REQUEST ID=XXXXXXXX BID= XXXXXXXXXXXXXXXXX After this command is sent, you are ready to receive your file. This file will download into a file name XXXXXXXXX.dat. 6. Enter the following command to logoff the system. $$LOGOFF This will terminate your session and disconnect the modem. May

6 Attachment A Asynchronous Communication Specifications Batch Identifiers (BIDs) ANSI 837 Medicare Claims Test: BID='TMANSI837' Production: BID='PMANSI837' ANSI 837 Medicare Claims Confirmation Report BID='MCR837RPTS' ANSI 835 Medicare Electronic Remittance Advice (ERA) BID='MEDICARE 835' ANSI 276 Medicare Claims Status Request Test: BID='TMANSI276' Production: BID='PMANSI276' ANSI 276 Medicare Claims Status Request Confirmation Report BID='MCR276RPTS' ANSI 277 Medicare Claims Status Response BID='MEDICARE 277' ANSI 997 Functional Acknowledgement BID='MEDICARE 997' May

7 Attachment B TRISPAN HEALTH SERVICES MEDICARE PART A HIPAA 4010A1 Transaction Setup Request Please ensure that the information on this form is both legible and accurate. Submitter ID and Password assignment will be based solely on information taken directly from this form. Completed form may be sent via fax to the EMC Help Desk at (601) Check One: HIPAA 4010A1 Testing HIPAA 4010A1 Production Provider Name Submitter Name Phone Number Fax Number Address Contact Name Please List All Medicare Part A Provider Number(s) Check One Who Will Submit/Retrieve Data? If different from the provider list the entity name. Fax Number Provider Vendor Clearinghouse Billing Agent Home Office Indicate HIPAA Transaction(s) for Setup 837 Electronic Claim 835 Electronic Remittance Advice 276/277 Claims Status / Response 997 Functional Acknowledgement Indicate Submitter ID currently used or to be used for indicated transaction(s) Software Vendor Name *** Do Not Write Below This Line *** PROVIDER NUMBER(S) EDI ENROLLMENT RATES AUTHORIZATION 837 EMC Setup Check File-Aid Add Submitter ID To File-Aid ( Y in 837 Indicator) Setup Submitter ID on box Trading Partner File Inquiry Setup 276/277 Status Add Submitter To File-Aid ( Y in 276 Indicator) Setup Submitter ID on box Trading Partner File Inquiry Setup Submit Project Request to Move ERA Run Job HPTP835 (MS0LSMI1) on MEDACOMM Setup Trading Partner File (Based on HPTP835) Set ERA Indicators on Financial Master (Based on HPTP835) Rerun Job HPTP835 (MS0LSMI1) (Print Output) Submit Project Request 997 Functional Acknowledgement Submit Project Request to Move 997 SUBMITTER ID PASSWORD RESPONSE DATE: ESR INITIALS: EMC COORDINATOR: DATE: Revised May 2005