New Jersey Medicaid HIPAA 5010 Version Updates
New Jersey Medicaid signifies its ongoing effort to adhere to the HIPAA transaction set requirements. HIPAA provides all healthcare entities a tremendous opportunity to realize many administrative and systemic benefits because it provides a national standard of transaction and code sets for the electronic exchange of healthcare information. New Jersey Medicaid and DXC Technology welcome this historical transition and are committed to the implementation of all HIPAA transaction sets as the sole format for all state and federal programs processed through the New Jersey Medicaid Management Information System (NJMMIS) at DXC Technology.
Since June 29, 2012 HIPAA required all HIPAA covered entities to transition to the next adopted standard known as Version 5010. Any transactions which are not compliant with HIPAA and New Jersey Medicaid will be rejected. Version 5010 covers the HIPAA 5010 Version transaction sets:
- Eligibility Inquiry and Response: ASC X12 270/271 Health Care Eligibility Benefit Inquiry and Response (X279A1) EDI Transactions.
- Claim Transaction Sets: ASC X12 837 Institutional (X223A2), 837 Dental (X224A2) and 837 Professional (X222A1) EDI Transactions.
- Claim Status Response: ASC X12 277P (X228) Health Care Claims Pending Status Information EDI Transactions.
- Remittance Advice: ASC X12 835 Health Care Claim Payment/Advice (X221A1) EDI Transactions.
- Interchange Acknowledgement: ASC X12 999 Implementation Acknowledgment for Health Care Insurance (X231A1) EDI Transactions.
HIPAA also requires the standardization of code sets. Any coded field or data element contained in a HIPAA transaction must adhere to a national set of code set values, including medical services and diagnoses. As such, New Jersey Medicaid is required to discontinue the use of local codes, most notably the Level III HCPCS (procedure codes), which are specific to New Jersey Medicaid. In addition to the transaction and code set aspects, there are other requirements of the “Administrative Simplification” provision of HIPAA.
Although this Companion Guide deals with only one aspect of the entire “Administrative Simplification” provision, it is worth noting that all covered entities (health plans, clearinghouses, and providers) and their business partners are required to adhere to all aspects of the provision.
To learn more about EDI and become a certified EDI Professional please visit our course schedule page.