Health Partners HIPAA

Health Partners HIPAA Transactions and Code Sets FAQs

Health Partners HIPAA transactions FAQs may be useful both for new vendors and new partners who are going to exchange Health Partners HIPAA transactions. Health Partners HIPAA transactions subject to HIPAA standards set for health care industry. Find the second part of Health Partners HIPAA transactions FAQs below.

Q: Can Health Partners Plans currently accept HIPAA standard transactions?

A: Yes, Health Partners Plans has been ready to accept HIPAA standard transactions since October 16, 2003.

Q: Can Health Partners Plans currently accept claims in non-HIPAA compliant legacy format?

A: As identified in our Contingency Plan, Health Partners Plans will accept claims in current legacy formats for a limited time after the October 16, 2003 deadline. Providers who currently submit electronic claims should not change legacy submission formats.

Q: Is Health Partners Plans currently accepting Medical Assistance local codes (WCodes)?

A: No, Health Partners Plans stopped accepting W-Codes on December 31, 2003, as per the local code waiver to state Medicaid plans by CMS.

Q: Will Health Partners Plans require the use of NDC codes for all pharmaceuticals?

A: Health Partners Plans will not accept the use of NDC codes by non retail pharmacies. J codes are required unless otherwise specified in the provider contract.

Q: Must specialists include the Primary Care Physicians (PCPs) NPI number when submitting claims?

A: Yes, the Primary Care Physician’s NPI number must be submitted on all specialist claims.

Q: What about a detailed status for each claim?

For all claims (CMS-1500/837P and UB-04/837I) submitted electronically through the Emdeon clearinghouse, Health Partners Plans can electronically return a detailed status for each claim. The status message will show which claims were accepted, rejected and/or pending, and provide the amount paid on the submitted claim once it has been finalized. If you are an Emdeon submitter and you do not have the ability to receive Emdeon claims status, please contact your billing software vendor for more information.

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