HIPAA EDI Tests

HIPAA EDI Tests  Information for Providers (Part 1)

HIPAA EDI Tests submissions are required from all Electronic User Site Numbers that are issued including both new sites and existing sites that are changing their medical billing software. This helps MHHLS to ensure that the computer system at each site can bill for all services normally submitted by the practitioner(s), ensure that the system is configured correctly and identify areas where MHHLS can provide additional guidance and support to billing staff.

HIPAA EDI Tests submissions must be submitted on CD, DVD, USB Flash Drive or sent by email to practitionerregistry@gov.mb.ca. Please encrypt your test file and phone in the password to (204) 786-7225

Test submissions sent on CD, DVD or USB Flash Drive should be delivered to MHHLS in person or by Certified Courier clearly marked with “Test Data, Personal & Confidential” and directed to ATTENTION: Practitioner Registry, 3rd floor, 300 Carlton St, Winnipeg, MB, R3B 3M9.
Due to the sensitive nature of the data being transmitted we strongly discourage sending test submissions via unsecured Canada Post mail. Test data submitted on CD, DVD or USB Flash Drive must be accompanied by a support listing (paper printout of test contents). Please keep a copy of the printout for your records as we will contact the User Site Contact once testing is complete to review the content and results together. Only one file may be on the test CD, DVD, USB Flash Drive or email submission.

The test content must reflect a cross section of all services normally billed by the practitioner with a minimum of 15 claims. The written diagnosis must be entered in the “remarks area” for all claims during the testing phase. Omission of the written diagnosis is an automatic failure. Once you have passed testing, the written diagnosis is no longer be required and guidelines will be provided as to which claiming situations may require remarks.

EXAMPLES:

  1. The diagnosis is Abdominal Pain, Generalized. Enter the words “Abdominal Pain, Generalized” in remarks and enter ICD-9-CM code 78907 in the appropriate field.
  2. The diagnosis is Acute Bronchitis. Enter the words “Acute Bronchitis” in remarks and enter ICD-9-CM code 4660 in the appropriate field.
  3. The diagnosis is Conjunctivitis, Unspecified. Enter the words “Conjunctivitis, Unspecified” in remarks and enter ICD-9-CM code 37230 in the appropriate field.
  4. Chiropractic Example – The diagnosis is Acute Cervical Subluxation. Enter the words “Acute Cervical Subluxation” in remarks and enter A10 in the Chiropractic Service Code field. An ICD-9-CM code is not required on chiropractic claims.
  5. Optometrist Example – The diagnosis is Glaucoma. Enter the words “Glaucoma” in the remarks and enter 21 in the Optometry Reason Code field. A general ICD-9-CM code is required on each claim and is generally hard-coded into optometry billing systems by the billing software vendor.

Find more in the next post.

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