Arkansas Medicaid asc x12N/005010X279A




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Arkansas Medicaid

ASC X12N/005010X279A

270/271 HIPAA Transaction Companion Guide


January 1, 2013

Version 1.0

This companion guide is based on the CORE v5010 Master Companion Guide Template. All rights reserved. This guide may be freely redistributed in its entirety provided that this copyright notice is not removed. It may not be sold for profit or used in commercial documents without the written permission of the copyright holder. This document is provided “as is” without any express or implied warranty. Copyright of the underlying ASC X12 Standards is held by DISA on behalf of ASC X12.

2013 © Companion Guide copyright by Hewlett-Packard Enterprise Services.

Modification Log



Rev #

Date

Author

Section

Nature of Change




9/3/13

Mike Morgan




Removed specifications for FTPS (FTP over SSL) protocol
















Preface

This companion guide to the health care eligibility benefit inquiry and response ASC X12N/005010X279 and associated errata ASC X12N/005010X279A1 adopted under HIPAA clarifies and specifies the data content for electronic exchanges with Arkansas Medicaid. Transmissions based on this companion guide used in tandem with the Health Care Eligibility Benefit Inquiry and Response ASC X12N/005010X279A1 are compliant with both ASC X12 syntax and the corresponding guides. This Companion Guide is intended to convey information that falls within the framework of the ASC X12N Implementation Guides adopted for use under HIPAA. This guide is not intended to convey information that in any way exceeds the requirements or usages of data expressed in the implementation guides.

Contents


Modification Log i

Preface ii

Contents iii

Introduction 5

Scope 6

Overview 6



References 6

Additional Information 6

Getting Started 7

Working with Arkansas Medicaid 7

Trading Partner Registration 7

Certification and Testing Overview 7

Testing with the Payer 8

Compliance testing 8

Full-cycle testing 9

Connectivity with Payer Communications 10

Process Flows 10

Transmission and Re-Transmission Procedures 11

Communication Protocol Specifications 11

Passwords 11

Contact Information 12

EDI Help Desk 12

Control Segments/Envelopes 13

ISA-IEA 13

GS-GE 13

ST-SE 13


Payer-specific Business Rules and Limitations 14

Acknowledgements and Reports 14

Trading Partner Agreements 14

Transaction-specific Information 15

270 Eligibility Response 16

271 Eligibility Response 18



Introduction

This companion guide instructs users in registering and setting up compatible systems for Arkansas Medicaid claims processing and eligibility verification. Contact information and resources for the HP Enterprise Services (HPES) EDI help desk are provided. The steps to register and prepare for testing software solutions and connectivity specifications are outlined in the following sections.

Scope

This companion guide is intended for use in conjunction with the ASC X12N/005010X279A1 Implementation Guide (IG). It provides supplemental instructions not included in the IG that must be followed for users to successfully conduct transactions with Arkansas Medicaid. It does not change the requirements of the IG in any way.



Overview

This section of the companion guide provides guidance for establishing a relationship with Arkansas Medicaid for the business purpose of submitting and receiving health care eligibility benefit inquiries and responses.

References

HIPAA Implementation Guides: https://www.wpc-edi.com

Federal Register Final Rules: https://federalregister.gov/a/2011-16834

CAQH CORE: http://www.caqh.org/benefits.php

New Submitter Registration: https://www.medicaid.state.ar.us/Provider/hipaa/regis.aspx

Vendor Resources: https://www.medicaid.state.ar.us/Provider/hipaa/compan.aspx

Additional Information

It is assumed that the trading partner is familiar with IG referenced in this companion guide.

Changes to this guide are published on the Arkansas Medicaid website at https://www.medicaid.state.ar.us.

All X12N transactions submitted to the WebBBS are transferred to the translator for processing immediately.

Getting Started

Working with Arkansas Medicaid

Contact the HPES Electronic Data Interchange (EDI) help desk assistance with electronic file submission and retrieval.

HPES EDI help desk:

In-State Toll Free: 1-800-457-4454

Local and Out-of-State: 501-376-2211

Email: ARKEDI@hp.com

Trading Partner Registration

Vendors and providers must have a test submitter ID and password issued by the EDI help desk to submit electronic batch (EDI X12N and NCPDP 1.1 batch standard) and interactive transactions for testing.

To register for a production submitter registration ID, visit the Arkansas Medicaid website: https://www.medicaid.state.ar.us/Provider/hipaa/regis.aspx

Certification and Testing Overview

Compliance testing

Compliance testing validates submitted X12N transactions for syntax and format and ensures that the Arkansas Medicaid system can receive the transactions through the translator.



Full-cycle testing

Full-cycle testing processes the submitted X12N transactions through the Arkansas Medicaid system. Although test claims will not be processed for payment, they will be validated against production files so they must contain valid patient, procedure, diagnosis, and provider information. We recommend that test claims contain a variety of claims (up to 25) that represent the types of claims normally submitted.

Testing with the Payer

Compliance testing



Testing environment

The following table describes the environment and access information necessary for compliance testing.



WebBBS

See the Web Batch Submission Instructions manual.

Test Bed Data

Not required. Compliance testing only validates format and syntax.

Required Fields

Use the instructions in the National Electronic Data Interchange Transaction Set Implementation Guide and the appropriate Arkansas Medicaid transaction companion guide.

Testing process

  • Log on using your test submitter ID and password.

  • Upload your X12N transactions and download your X12N responses using the Web Batch Submission Instructions manual.

    • If you receive a 271 response, your transaction was successfully processed and the format was syntactically correct. You can now visit the Arkansas Medicaid website to register for a production submitter ID and password at https://www.medicaid.state.ar.us/Provider/hipaa/regis.aspx.

    • If you receive a 999 or TA1 response, your transaction contains errors. A 999 response indicates that the transaction was successful but had errors. A TA1 response indicates that there was an error in the envelope standard submitted. Depending on the error response received, you must correct and resubmit the transaction until you receive a successful (271) response.

Full-cycle testing

During full-cycle testing, a 271 message is provided in response to a successful submission. If a syntax error is encountered, a 999 or TA1 response will be sent.



Testing environment

The following table lists the environment and access information necessary for full-cycle testing.



WebBBS

See the Web Batch Submission Instructions manual.

Test Bed Data

Use test bed data in compliance with ACA 1104 Eligibility Verification rules. This can be found on the CAQH CORE website in the reference section.

Required Fields

Use the required fields identified in the National Electronic Data Interchange Transaction Set Implementation Guide and the appropriate Arkansas Medicaid transaction companion guide.

Testing process

  • Log on using your test submitter ID and password.

  • Upload your X12N transactions and download your X12N responses using the Web Batch Submission Instructions manual.

  • One of the following responses will be returned: 271-Eligibility Response, 277-Claim Status Response, 278-Referrrals and Authorizations, 835-Remittance Advice, or 999-Functional Acknowledgement.

Connectivity with Payer Communications

Process Flows

Arkansas Medicaid’s WebBBS interfaces are maintained and operated by HP Enterprise Services and support three of the most commonly used channels of communication HTTP/S (web) and SFTP (FTP over SSH) giving clients a variety of interfaces to develop robust interchange solutions. The web interface is comprised of three independent HTTP/S application interfaces; two legacy applications that support only batch ASC X12 transactions; and a new CORE compliant interface (available January 1, 2013) capable of accepting real-time and batch transactions. A diagram of interaction flow can see below.

The SFTP interface supports batch file uploads and downloads only. Users may use SFTP (SSH) clients such Filezilla, Putty, and WS_FTP Pro to transfer files or develop software that will logon and transfer files programmatically using SSH protocol. Complete specifications for such software can be found in this document under the SFTP specification sections.



Transmission and Re-Transmission Procedures

For information regarding transmission and re-transmission procedures, see the Web BBS documentation:

https://www.medicaid.state.ar.us/Provider/hipaa/compan.aspx

Communication Protocol Specifications

For communication protocol specifications, see the Web BBS documentation: https://www.medicaid.state.ar.us/Provider/hipaa/compan.aspx

Passwords

Vendors and providers must have a test submitter ID and password issued by the EDI help desk to submit electronic batch (EDI X12N and NCPDP 1.1 batch standard) and interactive transactions for testing. To register for a production submitter registration ID, visit the Arkansas Medicaid website at https://www.medicaid.state.ar.us/Provider/hipaa/regis.aspx.

Contact Information

EDI Help Desk

In-State Toll Free: 1-800-457-4454

Local and Out-of-State: 501-376-2211

Email: ARKEDI@hp.com

If you are experiencing retrieval issues, please contact the EDI help desk. If you need assistance installing PES on your network or resolving transmission problems when using PES on your network, contact the technical support representative in your office. EDI does not support network issues.

For further information and answers to frequently asked questions, visit: https://www.medicaid.state.ar.us/Provider/faq/faq.aspx#questions about electronic billing.

Control Segments/Envelopes

ISA-IEA


Loop ID – Loop Name

SEG

Element

Comments

Page

ISA/IEA – Interchange Control Header

ISA

ISA01

Value = 00

C.4

ISA03

Value = 00

C.4

ISA05

Value = ZZ

C.4

ISA06

Value = Submitter ID

C.4

ISA07

Value = 30

C.5

ISA08

Value = 716007869

C.5

ISA15

Value = P

C.6

GS-GE

Loop ID – Loop Name

SEG

Element

Comments

Page

GS/GE – Functional Group Header

GS

GS02

Value = same as ISA06

C.7

GS03

Value = same as ISA08

C.7

ST-SE

As defined by X12.

Payer-specific Business Rules and Limitations

Specific business rules and limitations for Arkansas Medicaid can be found in the provider manuals on the Arkansas Medicaid website: https://www.medicaid.state.ar.us/Provider/docs/docs.aspx

The manuals provide detailed information regarding billing for specific services and provider types and payer-specific editing and auditing.

Acknowledgements and Reports

A 999 response indicates a rejected transaction or accepted with errors due to the X12 data being transmitted. A TA1 response indicates a rejected transaction due to envelope standards used. A supplemental data report and a reject response report will be incorporated into the 271 eligibility response where applicable.

Trading Partner Agreements

An EDI Trading Partner is defined as any Arkansas Medicaid customer (provider, billing service, software vendor, employer group, financial institution, etc.) that transmits to or receives electronic data from Arkansas Medicaid.

Other than the trading partner registration process outlined in the “Trading Partner Registration” section of this document, there are no additional agreements made by a trading partner of Arkansas Medicaid.

Transaction-specific Information

The ASC X12N Implementation Guides (IGs) adopted under HIPAA is laid out using tables. The tables contain a row for each segment that requires additional information for compliance with Arkansas Medicaid. That information might:



  1. Limit the repeat of loops or segments

  2. Limit the length of a simple data element

  3. Specify a sub-set of the IGs internal code listings

  4. Clarify the use of loops, segments, composite, and simple data elements

  5. Be tied directly to a loop, segment, composite, or simple data element pertinent to trading electronically with Arkansas Medicaid

In addition to the row for each segment, additional rows describe Arkansas Medicaid usage for composite and simple data elements and for any other necessary information, including transaction-specific details.

Notes and comments are placed at the deepest level of detail. For example, a note about a code value is placed on a row specifically for that code value, not in a general note about the segment.



270 Eligibility Response

Page #

Loop ID

Reference

Name

Codes

Length

Notes/Comments

64

BHT

BHT02

Beginning of Hierarchical Transaction







Arkansas Medicaid will not process 01 (cancellation).

64

BHT

BHT03

Beginning of Hierarchical Transaction




30

Arkansas Medicaid’s translator requires that either BHT03 or 2000C/TRN02 be entered and that at least one of these elements is unique per file. The translator will reject files that do not meet this requirement.

65

BHT

BHT06

Beginning of Hierarchical Transaction







Arkansas Medicaid does not support this functionality.

69

2100A

NM101

Information Source Name

PR







70

2100A

NM102

Information Source Name

2







70

2100A

NM203

Information Source Name







Payer/Processor = Arkansas Medicaid

71

2100A

NM108

Information Source Name

FI







71

2100A

NM109

Information Source Name

716007869







77

2100B

NM108

Information Receiver Name

SV or XX







78

2100B

NM109

Information Receiver Name




9 or 10

If NM108 = SV, length = 9 (Medicaid Provider ID)

If NM108 = XX, length = 10 (NPI)

91

2000C

TRN02

Subscriber Level







Arkansas Medicaid’s translator requires that either TRN02 or BHT03 be entered and that at least one of these elements is unique per file. The translator will reject files that do not meet this requirement.

93

2100C

NM103

Subscriber Name




15




93

2100C

NM104

Subscriber Name




10




94

2100C

NM105

Subscriber Name




1



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