HIPAA October 2003 Notes - Revised 11/12/03

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Abstract

Revised 11/12/03

Getting Ready for Medicaid HIPAA

If you have not already done so, it is now imperative that you complete the CSC Medicaid Trading Partner Agreement and that you register with EDIFECS for Medicaid HIPAA testing.

Our client service staff is ready to assist you.


Table of Contents

 

I. For New York State facilities: Important Date
II. For New York State facilities: Completing the Computer Services Corporation (CSC)  Medicaid Trading Partner Agreement.
III. For New York State facilities: Registering on the EDIFECS website to complete the Medicaid User Account Request form and to sign up for transaction testing.
IV. Preparing your data for HIPAA compliance - Prior to testing
1.  Physicians:
a.  Get a list off all residents who do not have a physician assigned to them.
b.  Assign a physician to all resident who do not have one.
c.  Fixing the Doctors' name in the Physician Table File.
d.  Adding taxonomy and other information to the Physician ID Table File.
e.  Setting a default physician (Optional).
2. Resident Addresses
3. Contact information - Contact
V. Preparing Diagnosis Codes for HIPAA compliance - During testing


I.  Important Date

February 19, 2004: All electronic submissions with the New York State Medicaid must be HIPAA compliant.


 

II.  Completing the Computer Services Corporation (CSC) Medicaid Trading Partner Agreement.

If you have not already done so, sign and return your Medicaid Trading Partner Agreement to Computer Services Corporation (CSC). A copy may be obtained from the eMedNY website https://www.nyhipaadesk.com/ , clicking on News and Resources (on the top) and then clicking on Trading Partner Agreements (on the left) and then on NYSDOH Trading Partner Agreement and follow instructions. 

Alternately this form can be obtained from the CSC Inquiry Unit by calling 1-866-840-3445.

Instructions to help you complete this form are available in our Letter Sent to Clients dated May 19, 2003.


III. Registering on the EDIFECS website to complete the NYS Medicaid User Account Request form and to sign up for transaction testing.

To submit your HIPAA claims electronically you must first complete the on-line agreement. This will enable Medicaid to send you the logon and password you will need for billing.  Go to the following web site:https://www.nyhipaadesk.com/

Click on #1 - Register for a NYS DOH Community Account.

The following responses are recommended for CHARTS billing:

ISA05 - Interchange ID Qualifier*: ZZ
ISA06 - Interchange Sender ID*: Your Tape Supplier Number
GS02 - Application Sender's Code*: Your Tape Supplier Number
ETIN (Formerly TSN): Your Tape Supplier Number

/ 837 Professional Healthcare Claim (004010x098A1)
/ 837 Institutional Healthcare Claim (004010x096A1)
/ 835 Health Care Claim Payment/Advice (004010x091A1)
/ 835 Claim Payment Advice NYSDOH Supplementary File


IV. Preparing You Data for HIPAA Compliance - Prior to Testing

IV.1.a Get a list of all residents who do not have a physician assigned to them.

HIPAA requires that the resident's physician be specified on each claim. To find out which resident in your facility are not assigned a physician do the following:

From any CHARTS menu type PMGEN. Complete the screen as follows:


                 Title:     Report Generator▬▬▬▬▬▬▬▬▬▬▬▬▬▬▬▬
   From Resident:  A▬▬▬▬▬▬▬▬▬▬▬▬▬▬▬▬▬▬▬ To: ZZZ▬▬▬▬▬▬▬▬▬▬▬▬▬▬▬▬▬▬

  Activity Info.  From Date: 09/03/2003 To: 09/03/2003   Detail/Master(A/M): M
  Active as of  1/1/02▬▬▬▬ - 12/31/03▬▬ Latest Bill Code: ▬▬   Print Option: S
                Field      From Range     To Range    sort
         1) 18▬▬▬▬▬▬▬▬▬▬▬  ▬▬▬▬▬▬▬▬▬▬▬   ▬▬▬▬▬▬▬▬▬▬▬   ▬      At Sort Break: ▬
         2) 30▬▬▬▬▬▬▬▬▬▬▬  ▬▬▬▬▬▬▬▬▬▬▬   0▬▬▬▬▬▬▬▬▬▬   ▬         Y = skip line
         3) ▬▬▬▬▬▬▬▬▬▬▬▬▬  ▬▬▬▬▬▬▬▬▬▬▬   ▬▬▬▬▬▬▬▬▬▬▬   ▬         P = skip page
         4) ▬▬▬▬▬▬▬▬▬▬▬▬▬  ▬▬▬▬▬▬▬▬▬▬▬   ▬▬▬▬▬▬▬▬▬▬▬   ▬
         5) ▬▬▬▬▬▬▬▬▬▬▬▬▬  ▬▬▬▬▬▬▬▬▬▬▬   ▬▬▬▬▬▬▬▬▬▬▬   ▬
         6) ▬▬▬▬▬▬▬▬▬▬▬▬▬  ▬▬▬▬▬▬▬▬▬▬▬   ▬▬▬▬▬▬▬▬▬▬▬   ▬
         7) ▬▬▬▬▬▬▬▬▬▬▬▬▬  ▬▬▬▬▬▬▬▬▬▬▬   ▬▬▬▬▬▬▬▬▬▬▬   ▬
         8) ▬▬▬▬▬▬▬▬▬▬▬▬▬  ▬▬▬▬▬▬▬▬▬▬▬   ▬▬▬▬▬▬▬▬▬▬▬   ▬
         9) ▬▬▬▬▬▬▬▬▬▬▬▬▬  ▬▬▬▬▬▬▬▬▬▬▬   ▬▬▬▬▬▬▬▬▬▬▬   ▬
        10) ▬▬▬▬▬▬▬▬▬▬▬▬▬  ▬▬▬▬▬▬▬▬▬▬▬   ▬▬▬▬▬▬▬▬▬▬▬   ▬
        11) ▬▬▬▬▬▬▬▬▬▬▬▬▬  ▬▬▬▬▬▬▬▬▬▬▬   ▬▬▬▬▬▬▬▬▬▬▬   ▬
  Print if All/Any fields are applicable (All/Any) : ALL
  Must include Field# : ▬  number of lines to skip : 0    No.Lines on page: ▬▬
  To Print on Disk  FileName ▬▬▬▬▬▬▬▬ Device Addr: 000    Create Filter(Y/N) ▬

In Active as of type 01/1/02  12/31/03.

At Field 1 type 18      At Field 2 type 30 and at the To Range type the number 0.

At Print if All/Any fields are applicable (All/Any) type ALL.

Leave all other fields as initialized.

This report will give you a list of all residents who do not have a physician assigned to them.


IV.1.b.  Assign a physician to all resident who do not have one.

To assign a physician to a resident who does not have one go to program CHGPAT, go to the second screen, and type the physician's initials in the field MD.

Alternately you can accomplish the same by going to program UB92INFO and typing the physician's initials in filed MD.



IV.1.c.  Fixing the Physician's name in the Physician Table File (remove blanks).

HIPAA is very strict about unnecessary extra spaces in the physician's name. Any physicians whose name is not entered properly in the Physician Table File will need to be changed.

Get a list of your current physicians.

At ENTER MENU NUMBER type PTF to Print a Table File.

Type 1 for Census.

Type 11 for Physicians.

Review the print-out listing to identify physicians whose name is not entered properly. For example, a Physician whose name is Dr. John A Doe, should be entered as Doe,John A   Do not type "Dr." as part of the name, and do not put a space after the comma. Also a physicianr must have a first name.

Modify the Physician's Name:

At ENTER MENU NUMBER type CTF to Change a Table File.

Type 1 for Census.

Type 11 for Physicians.

At Description type the physician's name in the format of Doe,John (no "Dr." and no space after the comma).

Press ENTER to save the modification.



IV.1.d.  Adding taxonomy and other information to the Physician ID Table File.

At ENTER MENU NUMBER type ATF to Add a Table File record (or CTF to change an existing record.).

Type 1 for Census and press ENTER.         Type 16 for Physician ID and press ENTER.

The following screen appears:

                                   PHYSICIAN ID                    Add (164-DID)

  Enter Main Key : ▬▬▬                    Secondary Key: ▬▬▬▬▬▬▬▬ [UPIN Code]

  Description    : ▬▬▬▬▬▬▬▬▬▬▬▬▬▬▬▬▬▬▬▬ [Dr. name - Lastname,Firstname Initial
                                                    ie. Jones,Sam A.  ]
  Medicaid Id Number       : ▬▬▬▬▬▬▬▬▬▬▬▬▬▬▬
  Medicare Id Number       : ▬▬▬▬▬▬▬▬▬▬▬▬▬
  Federal Employer Id No   : ▬▬▬▬▬▬▬▬▬▬▬▬▬
  Drug Dispense Id         : ▬▬▬▬▬▬▬▬▬▬▬▬▬
  License Number           : ▬▬▬▬▬▬▬▬▬▬▬▬▬
  License in/out state code: ▬▬
  Taxonomy Code            : ▬▬▬▬▬▬▬▬▬▬

  Cell Phone Number        : ( ▬▬▬ ) ▬▬▬▬▬▬▬▬
  Beeper / Pager Number    : ( ▬▬▬ ) ▬▬▬▬▬▬▬▬

    Enter (F) To File (I) To Ignore:  F

At Enter Main Key: type the Physicians initials.
At Secondary Key: type the physician's UPIN number.

At Description  type the physicians name as Doe,John A. (No "Dr." and no space after the comma.)

At Medicaid Id Number type the physician's Medicaid number if available.

Please note: For New Jersey facilities, if the physician does not have a Medicaid number you will need to enter in the Mediciad Id Number field 6666666 if he is a NJ state physician, or 5555555 if he is an out of state physician.

At Federal Employer Id No type the physician's Federal ID number - this is required.

At License Number type the physician's License number. (This will be used in the event that the doctor has no Medicaid number)

At License in/out state code type 01 for a NYS doctors, or 11 for an out of state physician.

At Taxonomy Code type the physician's Taxonomy code: (As of January, 2003 taxonomy code 207RG0300X is valid for Internal Medicine; Geriatric Medicine)

Press ENTER to file and to go on to the next physician.


IV.1.e.  Setting a default physician (Optional).

CHARTS  allows you to set-up a default doctor, who is in overall charge of your facility's residents, and whose ID will be used as a default when no physician is specified for the resident. If you assigned a physician to each resident there is no need to set up this default. If you do set up a default physician a message will appear on the billing journal alerting you that a default physician is being used.

To set up a default physician do the following:

At ENTER MENU NUMBER type UP for User Parameters and press ENTER.

Type 2 for Medicaid Information and press ENTER.

The following screen appears:

                           M E D I C A I D  INFORMATION
 Provider ID:           Locator Code:     Category of Service      Census Ind
 Rate Codes-Elig B:       Not Elig:       Tape Supplier#:       Schd Billing:
 Address- 3":     5":     Tape:      Billing on 3/5/Tape:       Use Defaults: Y 7

At Use Defaults type Y and press ENTER.

At ENTER MENU NUMBER type UP for User Parameters and press ENTER.

Type 3 for MC PVT etc. and press ENTER.

The following screen appears:


  Medicare Int B-BC/T-Trav                  Med         Volume Library  Filename
   Trav/Chk Digit            RecID          Rec: CPfile
   Blue Cross Id           Oth Id                MRec'd
   Private / Semi Part A Rev Code                MField
   Part A Dr Code      B Rcvd From MA            MInput
   Bill B Pvt S-Con All/M-Rec              Diet: Nutri
   Default UPIN#    ▬▬▬▬▬▬▬▬ 7                    Descr

At Default UPIN# type the UPIN # of the default physician and press ENTER.

Make sure that an entry for this physician exists in the Physician ID table discussed above.



IV.2.  Resident Address

To receive payment on an invoice, HIPAA requires the full address of the resident.

If the resident's address is entered in full (Address, City, State Zip), CHARTS will use it. Be aware that there is an edit on the zip code, an incorrect zip code will cause the claim to be denied.

If any part of the address is missing, CHARTS will use the facility's address and notify you of same on the printout.



IV.3  Contact Information - Contact

At ENTER MENU NUMBER type ATF and press ENTER

Type 18 for System and press ENTER.

Type 10 for Contact and press ENTER. The following screen appears:

                               Contact Information                 Add (185-CNT)

  Main Key: _________ Secondary Key: _________ Description: ____________________

                      Name ▬▬▬▬▬▬▬▬▬▬▬▬▬▬▬▬▬▬▬▬▬▬▬▬▬▬▬

                      Phone ▬▬▬▬▬▬▬▬▬▬▬▬▬▬▬ Ext: ▬▬▬▬

                      e-mail ▬▬▬▬▬▬▬▬▬▬▬▬▬▬▬▬▬▬▬▬▬▬▬▬▬▬▬▬▬▬▬▬▬▬▬▬▬▬▬▬

                      Fax No ▬▬▬▬▬▬▬▬▬▬

                      Preferred Method of Notification: 1
                                         (1:e-mail 2:Fax 3:Postal 4:OWR)

                                ID number for Billing
                              Receiver : ▬▬▬▬▬▬▬▬▬▬▬▬▬▬▬
                              Submitter: ▬▬▬▬▬▬▬▬▬▬▬▬▬▬▬
    Enter (F) To File (I) To Ignore:  F

At Main Key type your facility's Medicaid Provider Number (which can be found at UP, 2, the first field).  At Secondary Key type your facility's name (abbreviated) and press ENTER.

At Name type the name of your facility.

At Phone type the telephone number of your facility, without dashes, parenthesis or spaces. (e.g. 8001234567).

At e-mail type your facility's email address.    At Fax No leave blank.

At Preferred Method of Notification type 1.

The Receiver and Submitter numbers depend on the state in which your facility is located as follows:

ID # for Billing New York Connecticut Indiana New Jersey
Receiver: 141797357 061274678 HCP  610515
Submitter: Tape Supplier # Assigned by EDS Assigned by EDS Assigned by UNISYS

  Press ENTER.



Preparing Your Diagnosis Codes for HIPAA Compliance - During Testing

The ICD-9 codes have been refined over the years. What was acceptable a few years ago may no longer be valid and will cause your HIPAA claims to be denied.

HIPAA requires that you submit both the admitting diagnosis found in the Activity file, and the master file diagnosis in the Resident file. When you submit a test, HIPAA will tell you which diagnosis are invalid and need to be adjusted.

A new program in CHARTS gives you the ability to make global changes from one diagnosis code to another (up to 16 at a time). PLEASE NOTE THAT THIS NEW PROGRAM IS ON THE OCTOBER 2003, PATCH007 RELEASE UPDATE.

From any menu enter SY (System)

Type 1 (Change records)

Type 15 (Additional item)

Type 15 (Additional Chg )

Type 12 (Update Diagnosis)

The following screen appear:

                              Update Diagnosis Codes
                                                    Date to
                         Previous      Current    start change
                     1   ▬▬▬▬▬▬▬▬▬    ▬▬▬▬▬▬▬▬▬    ▬▬▬▬▬▬▬▬▬▬
                     2   ▬▬▬▬▬▬▬▬▬    ▬▬▬▬▬▬▬▬▬    ▬▬▬▬▬▬▬▬▬▬
                     3   ▬▬▬▬▬▬▬▬▬    ▬▬▬▬▬▬▬▬▬    ▬▬▬▬▬▬▬▬▬▬
                     4   ▬▬▬▬▬▬▬▬▬    ▬▬▬▬▬▬▬▬▬    ▬▬▬▬▬▬▬▬▬▬
                     5   ▬▬▬▬▬▬▬▬▬    ▬▬▬▬▬▬▬▬▬    ▬▬▬▬▬▬▬▬▬▬
                     6   ▬▬▬▬▬▬▬▬▬    ▬▬▬▬▬▬▬▬▬    ▬▬▬▬▬▬▬▬▬▬
                     7   ▬▬▬▬▬▬▬▬▬    ▬▬▬▬▬▬▬▬▬    ▬▬▬▬▬▬▬▬▬▬
                     8   ▬▬▬▬▬▬▬▬▬    ▬▬▬▬▬▬▬▬▬    ▬▬▬▬▬▬▬▬▬▬
                     9   ▬▬▬▬▬▬▬▬▬    ▬▬▬▬▬▬▬▬▬    ▬▬▬▬▬▬▬▬▬▬
                     10  ▬▬▬▬▬▬▬▬▬    ▬▬▬▬▬▬▬▬▬    ▬▬▬▬▬▬▬▬▬▬
                     11  ▬▬▬▬▬▬▬▬▬    ▬▬▬▬▬▬▬▬▬    ▬▬▬▬▬▬▬▬▬▬
                     12  ▬▬▬▬▬▬▬▬▬    ▬▬▬▬▬▬▬▬▬    ▬▬▬▬▬▬▬▬▬▬
                     13  ▬▬▬▬▬▬▬▬▬    ▬▬▬▬▬▬▬▬▬    ▬▬▬▬▬▬▬▬▬▬
                     14  ▬▬▬▬▬▬▬▬▬    ▬▬▬▬▬▬▬▬▬    ▬▬▬▬▬▬▬▬▬▬
                     15  ▬▬▬▬▬▬▬▬▬    ▬▬▬▬▬▬▬▬▬    ▬▬▬▬▬▬▬▬▬▬
                     16  ▬▬▬▬▬▬▬▬▬    ▬▬▬▬▬▬▬▬▬    ▬▬▬▬▬▬▬▬▬▬
           Note: Will Change Diagnosis in both Activity and Master Files

To globally change all residents from one diagnosis code to another type the old invalid diagnosis code under Previous, and place the corresponding new valid code under Current. This will change the diagnosis code for all resident in your facility who have that code in their files. Under Date to start change type the date as of which the diagnosis should be changed. (This is necessary because, for example, until 10/1/94, 414.0 was valid. Therefore the code should not be changed to 414.00 for any A/D/T information prior to 10/1/94)

In testing that we performed with some of our clients we found that the following codes needed to be changed. The following is for illustration only. Your experience may differ.

Previous Current Date to
(Invalid) (Valid) Start Change
208.9 208.90 10/1/91
296.4 296.40  
303.9 303.90  
401 401.0  
414.0 414.00 10/1/94
436.0 436  
438 438.0 10/1/97
522.11 522.1  
535.5 535.50 10/1/91
733.0 733.00  
785 785.0  
V43.6 V43.60  

Please note that this program will change diagnosis codes in both the Activity File (A/D/T) and the Master File.


END