TMHP HIPAA EDI Claim Guides
TMHP HIPAA EDI transactions are assigned an eight-character Batch ID immediately upon receipt by the TMHP EDI Gateway. The batch ID format allows electronic submitters to determine the exact day and year that a batch was received. The batch ID format is JJJYSSSS, where each character is defined as follows:
- JJJ – Julian date. The three J characters represent the Julian date that the file was received by the TMHP EDI Gateway. The first character (J) is displayed as a letter, where I = 0, J = 1, K = 2, and L = 3. The last two characters (JJ) are displayed as numbers. All three characters (JJJ) together represent the Julian date. For example, a Julian date of 143 would be J43.
- Y – Year. The Y character represents the last digit of the calendar year when the TMHP EDI Gateway receives the file. For example, a “2” in this position indicates the year 2012.
- SSSS = The unique 4-character sequence number assigned by EDI to the batch filed.
Modifier Requirements for TOS Assignment
Modifiers for TOS assignment are not required for Texas Health Steps (THSteps) Dental claims (claim type 021) and Inpatient Hospital claims (claim type 040). Additionally, procedures submitted by specific provider types such as genetics, eyeglass, and THSteps medical checkup are assigned the appropriate TOS based on the provider type or specific procedure code, and will not require modifiers. Most procedure codes do not require a modifier for TOS assignment, but modifiers are required for some services submitted on professional claims (claim type 020) and outpatient hospital claims (claim type 023).
To learn more about HIPAA EDI claims procedures and become a certified EDI Professional please visit our course schedule page.