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Important Information for All Current EDI Submitters

How to Submit Electronic Claims in HIPAA 837 Format

If you submit electronic claims to ValueOptions, please note that as of October 16, we will only accept claims transactions in standard HIPAA 837 format.

So, the time is now for you or your software vendor to start internally testing your software and computer systems! Testing now will ensure that your software is capable of sending electronic claims in the standard HIPAA 837 format by October.

About HIPAA

The Health Insurance Portability and Accountability Act (HIPAA) was passed in 1996 in an effort to reduce the administrative costs of health care. The legislation requires health insurance payers to comply with the Electronic Data Interchange (EDI) standards for health care, as established by the Secretary of Health and Human Services. In order to achieve the potential administrative costs savings with EDI, standard transactions and code sets have been developed and will be implemented by all covered entities engaged in the electronic exchange of data. HIPAA mandates the use of standard transactions and code sets for covered entities that choose to conduct business electronically.

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Becoming Compliant: For Users of ValueOptions EDI Claims Link for Windows® Software

ValueOptions will release new EDI Claims Link for Windows® (ECLW) 3.0 software to current ELCW users in May. The updated software will be certified HIPAA-compliant, compatible with Intel PCs and can be used to submit HCFA and UB claims.

The 837 Companion Guide provides the information necessary to submit claims/transactions electronically to ValueOptions. The Companion Guide should be used in conjunction with the ANSI X 12N Implementation Guides and supplements, but does not replace or contradict, any requirements in the Implementation Guides.

HIPAA Certification

ValueOptions will obtain certification that our software is compliant with HIPAA standards from Claredi(tm), the certifying agency selected by Centers for Medicare and Medicaid Services. There is no need to recertify the ECLW software prior to testing with ValueOptions.

Testing With ValueOptions

All providers will need to submit a file during our testing phase to ensure a smooth transfer of data through HIPAA-compliant systems. ValueOptions will begin calling EDI Submitters in May to schedule testing appointments. If you are ready to test and have not heard from us, please contact us at (888) 247-9311 (choose option 3) for help.

Note: you must obtain a test ID and password prior to submitting a test file.

ValueOptions' Electronic Transport System (ETS) will be used to validate test files. Entire files will either pass or fail validation. Results of the ETS validation will be sent to you via e-mail, or can be viewed by either logging into the Bulletin Board system or logging onto the Online Provider Service. If your file fails validation, an explanation will be provided. If this explanation is unclear to you, please contact us at (888) 247-9311 (choose option 3) for help.

Submitting Compliant Claims

Upon passing testing with ValueOptions, you can begin submitting HIPAA 837 claims to us. Be sure to contact us at (888) 247-9311 (choose option 3) before submitting your first production file so that we can update your submitter id into a production mode rather than one in "test mode."

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Becoming Compliant: for Users of a Practice Management System

If you currently use a Practice Management System (PMS), you will need the ANSI X 12N Implementation Guide, and applicable addenda, which details specific requirements for processing electronic data within payer systems.

All EDI Submitters also need the ValueOptions 837 Companion Guide, which provides the information necessary to submit claims/transactions electronically to ValueOptions and is used in conjunction with the ANSI X 12N Implementation Guide. Our Companion Guide supplements, but does not replace or contradict any requirements in, the Implementation Guide.

HIPAA Compliance Testing

According to the Centers for Medicare and Medicaid Services (CMS), you are responsible for ensuring that EDI transactions comply with HIPAA regulations. ValueOptions requires that all providers obtain certification for their practice management software before scheduling an appointment to test electronic claims transactions.

To help you address your HIPAA EDI obligations as efficiently as possible, ValueOptions recommends Claredi(tm), the nation's leading provider of HIPAA transaction and code set testing and certification.

Claredi, an independent certifying agency, is the testing and certification entity selected by CMS for their own compliance. Using the same certification organization as ValueOptions reduces the potential for any transaction discrepancies.

For information on Claredi's services, just visit Claredi's Web site at www.claredi.com, or call (866) 444-0339, Option 6. A Claredi representative can answer any questions you may have.

ValueOptions Acceptance Testing

All providers will need to submit a file during our testing phase to ensure a smooth transfer of data through HIPAA-compliant systems. ValueOptions will begin calling EDI Submitters in May to schedule testing appointments. If you are ready to test and have not heard from us, please contact us at (888) 247-9311 (choose option 3) for help.

Note: you must obtain a test ID and password prior to submitting a test file.

ValueOptions' Electronic Transport System (ETS) will be used to validate test files. Entire files will either pass or fail validation. Results of the ETS validation will be sent to you via e-mail, or can be viewed by either logging into the Bulletin Board system or logging onto the Online Provider Service. If your file fails validation, an explanation will be provided. If you do not understand this explanation, please contact us at (888) 247-9311 (choose option 3) for help.

Submitting Compliant Claims

Upon passing testing with ValueOptions, you can begin submitting HIPAA 837 claims to us. Be sure to contact us at (888) 247-9311 (choose option 3) before submitting your first production file so that we can update your submitter id into a production mode rather than one in "test mode."

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Contact Information

If you need technical assistance, please contact us at (888) 247-9311 (choose option 3)

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