HIPAA EDI

HIPAA EDI Tests Guidelines for Providers (Part 2)

HIPAA EDI Tests will be reviewed by MHHLS staff to determine areas where MHHLS requirements are met and areas where further testing is required. Practitioners may use fictitious patient demographics on test submissions. Some practitioner’s software programs will not allow fictitious patient data to be populated in thepractice management system, so real patient demographics are utilized for the testing phase – either option is acceptable. The use of real patient demographic data is at the risk of the physician and appropriate security measures should be taken to ensure its safe delivery (i.e. encrypting the file).

In order to be accredited, each site must test until demonstrating to MHHLS a satisfactory level of understanding and application of critical areas such as diagnostic codes, tariffs, billing rules and requirements. MHHLS staff will provide detailed feedback to you usually within 10 business days (subject to change) of test receipt. Results will be delivered both verbally (wherever possible) and in writing. Subsequent tests should not be sent until you are contacted with the results of the current test and have received the detailed documentation relating to the errors. If it is necessary to test again, ensure each test contains new data (not corrected data from a previous test).

HIPAA EDI  tests must be submitted until accreditation is received from MHHLS. Once you have successfully passed the testing process, your Electronic User Site Number will be activated (usually within 2-3 business days). Equally as important as submitting claims to MHHLS is the need to acquire an understanding of the claim reconciliation process from the medical billing software vendor. MHHLS is prepared to assist by providing a sample remittance file (upon request) based on claims from a test submission processed by MHHLS. Discuss this with your vendor to determine your strategy.

It is crucial to your ongoing success with medical billing that you download your remittance file and P2 statements for each pay period (twice monthly) and reconcile your accounts. The P2 is the only official statement a practitioner receives from MHHLS regarding how much they have been paid each pay period. The Remittance Advice provides the status of claims (pending, paid, reduced, rejected, etc) and is used to reconcile the claims in your billing system. If you do not check your remittance regularly you may not have sufficient time to resubmit claims that have been rejected, reduced or changed within the required timeframe. Failure to reconcile the claims from your Remittance Advice in your billing system will also make it appear that many claims are outstanding, when in fact they have already been processed and may require further action. Submission files must be all capital letters to be accepted.

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