HIPAA Claim Submission Verification

HIPAA Claim Submission Verification – New Jersey Medicaid Companion Guides

HIPAA Claim submission verification via TA1 Interchange Acknowledgements will be available to the EDI Submitter upon completion of uploading (dropping-off) their interchanges on the Website as long as the submitter stays connected. If the submitter disconnects immediately after dropping-off their interchange and does not receive their TA1, then the EDI Submitter must contact the EDI Unit and request the TA1 Interchange Acknowledgement be put back on the Website for retrieval. The status of the TA1 is posted for viewing.

999 Implementation Acknowledgements will be available for downloading to the EDI Submitter upon completion of uploading (dropping-off) their interchanges on the Website no more than three hours after the file has been submitted. 999 Implementation Acknowledgements are retained for 30 days.

HIPAA Claims Rejected Report files in a semi-colon delimited format will be available for downloading to the EDI Submitter the morning following the nightly preprocessing. HIPAA Claims Rejected Reports are retained for 6 weeks.

If the EDI Submitter has completed an EDI Agreement to retrieve their 835 Health Care Claim Payment/Advice and 277P Claims Pending Status Information interchanges from the Website, these will be available for downloading to the EDI Submitter the following Wednesday after the file has been submitted as long as your submission is received within the published submission deadlines. 835 and 277P Remittance interchanges are retained for 6 weeks.

Submitters will NOT be able to retrieve “paper format” Remittance Advice data from the Website. Only approved Providers will be allowed to retrieve “Paper Format” Remittance Advice data from the Website.

It is strongly recommended that for accurate reconciliation of your 999 Implementation Acknowledgements to the corresponding 837 Interchange that the Group Control Numbers entered in the GS/GE segments be unique for each interchange submitted by an EDI Submitter. The GS06/GE02 – Group Control Number from the incoming 837 is returned in the outgoing 999. If it is your practice to have only one GS segment in an interchange we suggest the GS06/GE02 – Group Control Number be the same as the ISA13/IEA02 – Interchange Control Number. When the same value (0001) is entered as the GS06/GE02 – Group Control Number, it is impossible to reconcile.

To learn more about HIPAA claims submission and become a certified  EDI Professional please visit our course schedule page.

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