HIPAA Vendor Registration (NJ Medicaid HIPAA Attachment Cover Sheet)
With the inception of HIPAA, there is a conscious effort to reduce the amount of paper required for claim submission. Previously, claims requiring additional information not provided on the hard copy claim forms or in electronic formats had to be submitted with attachments to provide the additional information needed to meet federally prescribed documentation regulations. With the implementation of HIPAA electronic data interchanges in the 837 5010 format these claims may now initially be submitted electronically with the required attachments following in the mail.
NJ Medicaid HIPAA vendors should keep the following items in mind when submitting attachments for HIPAA electronic data interchanges:
- The attachment cover sheet cannot be used as proof of timely filing;
- Attachments must be submitted within 45 days of the electronic claim submission;
- The original 15-digit ICN (Internal Control Number) as reported on the 277P Health Care Claim Pending Status Information transaction that is put on the attachment form must be “in process”;
- The form that is to be submitted can be retrieved through the “Forms & Documents” link found on the NJMMIS Website (www.njmmis.com).
- If the HIPAA Attachment Cover Sheet is not returned with the required attachment within 45 days the claim will deny. Claims that require attachments and are submitted electronically will show as “Claims In Process” on the provider’s 277P Pend report. In addition, there will be two edits posted; edit 0464 – “HIPAA Claim Denied No Attachment” and the edit describing what attachment is needed. If the HIPAA Attachment Cover Sheet is not returned with the required attachment within 45 days, the claim will deny.
Instructions for Completing the HIPAA Attachment Cover Sheet
- Complete all necessary Loops and Segments for the electronic claim including Loop 2300; PWK01=OZ, PWK02=BM (BY MAIL), PWK06=Patient Account Number (from Loop 2300; CLM01)
- Complete and mail the HIPAA Attachment Cover Sheet along with all associated attachments.
- NJ Medicaid Provider ID: Enter the Provider’s provider number as assigned by DXC Technology.
- Current Date: Enter the date completing the HIPAA Attachment Cover Sheet in MMDDCCYY format.
- Provider Name and Address: Enter the Provider’s name and service address.
- Control Number (ICN): Enter the unique 15-digit Internal Control Number (ICN) as assigned to each claim received by DXC Technology. A range of ICN control numbers may only be entered for claims containing consecutive lines for the Attachment Codes below indicated with an * . This option is not available for claims that require manual pricing. Enter the beginning ICN in the Beginning ICN field and the last ICN in the Ending ICN field.
- Medicaid Beneficiary ID: Enter the Medicaid Beneficiary ID exactly as it appears on the Eligibility Identification Card.
- Date of Service: Enter the date or dates the service was provided to the beneficiary.
- Patient Account Number: Enter the unique Patient Account Number as was submitted electronically.
- Attachment Code: Check the appropriate box indicating the attachment code and type of documentation to be accompanied by the form. A maximum of three code boxes can be checked.
To learn more about HIPAA EDI integration and become a certified EDI Professional please visit our course schedule page.