Important Information for All EDI Claims Submitters
How to Submit Electronic Claims in HIPAA 837 Format
If you submit electronic claims to ValueOptions®, please note that as of January 1st 2012, ValueOptions will begin to accept claims transactions in standard HIPAA 837 5010 format.
5010 Compliance Testing
5010 Compliance Testing is open to ALL Providers and Trading Partners. Instructions can be found at:
- 5010 File Submission and Testing Instructions
- About HIPAA
- Information For Users of ValueOptions® EDI Claims Link for Windows® Software, Users of a Practice Management System or a 3rd Party Biller
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.Top
Information for Users of ValueOptions EDI Claims Link for Windows® Software, Users of a Practice Management System or 3rd Party Biller
ValueOptions offers EDI Claims Link at no charge to providers who wish to submit electronic batch claims. Our software is certified HIPAA-compliant, compatible with Intel PCs and can be used to submit HCFA and UB claims. There is no need to recertify the ECLW software prior to testing with ValueOptions®. Information regarding upgrading EDI Claims Link software to the 5010 version will be available late December 2011.
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.
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 applicable addenda/supplements, but does not replace or contradict, any requirements in the Implementation Guides.
Testing With ValueOptions® (5010 Claims only)
All providers are encouraged to submit a test file to ensure a smooth transfer of data through HIPAA-compliant systems before sending a production file.
ValueOptions’ Electronic Transport System (ETS) will be used to validate test files. Results of the ETS validation will be sent to you via e-mail or by logging onto ProviderConnect. If your claim(s) or file fails validation, an explanation will be provided. If this explanation is unclear to you, please contact us at (888) 247-9311 for help.
Submitting Compliant Claims (5010 Claims only)
Upon passing testing with ValueOptions®, you can begin submitting HIPAA 837 claims to us.
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.
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.
To help you address your HIPAA EDI obligations as efficiently as possible, ValueOptions® recommends Claredi™, 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
If you need technical assistance, please contact us at (888) 247-9311, option #4.