HIPAA Policies & Guidelines

Participating health plans have been working together to reach a common understanding and to agree upon conventions about how the HIPAA transactions will be implemented. Companion Document are designed to help providers in their efforts to:

1. Become familiar with the HIPAA transaction and how that transaction will be processed by participating health plans.
2. Develop software to implement & exchange the HIPAA transaction with participating health plans.
3. Develop specification materials for their vendor(s) who will implement the transaction.
4. Resolve possible issues that might arise in the process of exchanging the transaction with participating health plan.

Qustions about exchanging the transactions with a particular health plan can be directed to the appropriate health plan as outlined in the following table:

Companion Documents are currently available for the following HIPAA electronic transactions:

» 270/271 — Eligibility Benefits Inquiry & Response

270/271 - Developing, Posting From & Troubleshooting
(.pdf | 142K | 7.11.05)

270/271 - Expanded Data Requirements
(.pdf | 488K | 7.11.05)

» 837D — Claims Dental

837D Developing & Troubleshooting
(.pdf | 104K | 4.5.05)

837D Health Plan Specific Data Requirements & Scenarios
(.pdf | 158K | 4.5.05)

837D Expanded Data Requirements
(.pdf | 701K | 4.5.05)

» 276/277 — Claims Status Request & Response (Batch)

276/277 Developing & Troubleshooting
(.pdf | 102K | 12.17.04)

276/277 Health Plan Specific Data Requirements & Scenarios
(.pdf | 72K | 12.17.04)

276/277 Expanded Data Requirements
(.pdf | 296K | 1.6.04)

» 835RA - Remittance Advice

835RA Posting From & Troubleshooting
(.pdf | 73K | 11.5.04)

835RA Health Plan Specific Data Requirements, Scenarios & Coding Table
(.pdf | 132K | 11.28.05)

835RA Expanded Data Requirements
(.pdf | 345K | 11.28.05)

» 837P - Claims Professional

837P Developing & Troubleshooting
(.pdf | 59K | 9.20.04)

837P Health Plan Specific Data Requirements & Scenarios
(.pdf | 88K | 9.20.04)

837P Expanded Data Requirements
(.pdf | 1.4MB | 10.8.04)

» 837I - Claims Institutional

837I Developing & Troubleshooting
(.pdf | 66K | 9.20.04)

837I Health Plan Specific Data Requirements & Scenarios
(.pdf | 87K | 9.20.04)

837I Expanded Data Requirements
(.pdf | 1.4MB | 10.8.04)

» 820 - Group Premium Payments (.pdf | 203K | 1.06.04)

» 834 - Benefit Enrollment & Maintenance (.pdf | 338k | 6.1.05)

» 278 - Health Care Service Review (.pdf | 78k | 03.27.03)