EDI Testing and Quick Tips

EDI Testing Questions and Answers

  1. What software vendors are authorized to submit EDI claims to MassHealth?
  2. Do I need to retest after making software or system changes?
  3. Can I retest while in Production mode?
  4. How many claims should I submit in my test file?
  5. Where can I find the Companion Guides?
  6. Who do I contact if I am having trouble submitting my test file or to check on test results?
  7. Is there a limit to the number of claims I can submit in my test file?
  8. How many test files does it take the average submitter to become HIPAA compliant for the 837 transaction?
  9. Will my test file be run through MassHealth editing or just a compliance check?
  10. Will I receive a 997 acknowledgement from my test file?
  11. If I pass testing, do I need to begin billing in the 837 format right away?
  12. Can I use test data in my test or do I need to use real patient data?


1. What software vendors are authorized to submit EDI claims to MassHealth?

MassHealth provides a list of approved software vendors. They can access this information by going to the Vendor List page.

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2. Do I need to retest after making software or system changes?

Yes, any software or system change can affect the outputted claim. To ensure successful claims processing, it is strongly suggested that you retest after any software or system change.

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3. Can I retest while in Production mode?

Yes, if you are still using your previous version of software or have not yet implemented changes to your system, you may test and submit Production EDI claims at the same time.

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4. How many claims should I submit in my test file?

Between 10 and 25 claims are sufficient for testing. If you are planning to submit void and replace and COB claims, you should include those claims in your test file. The claims sample should contain valid claims data and be representative of the types of service and scenarios that your facility typically bills to MassHealth. "Test" claims will not be submitted for production adjudication processing.

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5. Where can I find the Companion Guides?

The MassHealth Companion Guides indicate specific requirements when submitting EDI claims to MassHealth, and can be found by clicking on the link below.
 

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6. Who do I contact if I am having trouble submitting my test file or to check on test results?

Contact MassHealth Customer Service at 1-800-841-2900 or email: hipaasupport@mahealth.net

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7. Is there a limit to the number of claims I can submit in my test file?

No, there is no limit.

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8. How many test files does it take the average submitter to become HIPAA compliant for the 837 transaction?

On average it takes two - three tests for a submitter to be approved for production.

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9. Will my test file be run through MassHealth editing or just a compliance check?

Each test file will be validated for format and content compliance including MassHealth claims adjudication edit testing. Test claims will not process nor will they appear on any MassHealth remittance advice or 835 files. All compliance and adjudication errors will be reported back to you.

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10. Will I receive a 997 acknowledgement from my test file?

Yes, when you receive your test results back from HIPAA Support, the 997 will be e-mailed to you.

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11. If I pass compliance testing, do I need to begin billing in the 837 format right away?

Yes. At this point, it is strongly encouraged that all submitters begin using the 837 format as soon as possible.

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12. Can I use test data in my test or do I need to use real patient data?

You must use real patient data to ensure proper editing during the testing process. Your claims will deny in the test adjudication system if invalid data is used such as a dummy MassHealth member ID number. The test system is secure and HIPAA privacy compliant.

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This information is provided by MassHealth .