May 19, 2003

Dear Client,

The purpose of this letter is to help you complete the Computer Sciences Corporation, Trading Partner EDI Information Form, needed for HIPAA, dated April 30, 2003.

Page 1, Section 1:

Complete all questions. ETIN is your Electronic Transmitter Identification Number formerly known as the TSN (Tape Supplier Number). This number can be found by typing NHMA from any CHARTS screen and pressing ENTER. The field labeled Tape Supplier # (on line 2) contains your 3 character ETIN (TSN) number.

Page 1, Section 2:

Complete all questions.

Page 1, Section 3:

Complete all questions. The Technical / EDI Contact, Name, should be an employee of your facility not Reliable Health Systems, Inc. The Technical/EDI Contact Name may be the same individual you listed in Business Contact, Name.

Page 2, Section 4.1:

In the Check if sent column, place a (T) alongside transaction type 837I and complete that line only as follows:

Check if sent

Transaction

Version

ISA05

ISA06

GS02

T

837I

004010X96A1

ZZ

Tape Supplier Number

Tape Supplier Number

Page 3:

In the NYS MMIS Electronic Gateway column place a (T) alongside transaction type 837I as follows:

Transaction

NYS MMIS Electronic Gateway

Physical Media Reel Tape

Physical Media Cartridge Tape

Physical Media Diskette

Other

837I

T

Page 4:

Alongside Transaction type 837I complete both boxes as follows:

Transaction

Receive NYS Medicaid Generated 997?

Receive NYS Medicaid Generated Proprietary HIPAA Compliance Error?

837I

Yes

Yes

If you are NOT currently receiving electronic cash receipt remittance tapes from Medicaid you are finished.

If you currently receive electronic remittance tapes from Medicaid place a check in the Check if received column alongside transaction typed 835 and complete as follows:

 

Check if received

Transaction

Version Physical Media Reel Tape

Sent 997s to NYS Medicaid Physical Media Cartridge Tape

Receive Proprietary Supplemental Information?

T

835

004010X092A1

YES

YES

Thank you.

Sincerely yours,

Client Services

 


Reliable Health Systems, Inc., 2610 Nostrand Avenue, Brooklyn, NY 11210
(718) 338 - 2400, Fax (718) 338 - 2741, www.ReliableHealth.com