Commonwealth of Massachusetts
Executive Office of Health and Human Services
Division of Medical Assistance
600 Washington Street
Boston, MA  02111
www.mass.gov/dma	
	MassHealth
	All Provider Bulletin 126
	September 2003

	TO:	All Providers Participating in MassHealth

	FROM:	Douglas S. Brown, Acting Commissioner

	RE:	HIPAA Compliance for Electronic Claim Submissions		

Deadline for HIPAA	The deadline for compliance with the HIPAA (Health Insurance Portability 
Compliance	and Accountability Act) of 1996 transaction and code set rules is October 16, 2003.  The Centers for Medicare and Medicaid Services require that after October 15, 2003, all electronic claims be submitted in a HIPAA-compliant format.  This bulletin provides information for electronic submitters who will not be ready to submit HIPAA-compliant electronic claim transactions by October 16, 2003.

	If you are approved for production and are submitting Professional (837P), Dental (837D), or Institutional (837I) claim transactions or are certified to submit claims in the NCPDP 5.1 pharmacy claim format, you are submitting HIPAA-compliant claims.  

Accommodating	We recognize that, for a variety of reasons, some electronic submitters
Providers Who Are Not 	will not be ready to submit HIPAA-compliant electronic claims by October  
Yet Submitting	16, 2003.  We will, therefore, continue to accept, for a limited period of 
HIPAA-Compliant Claims	time, MassHealth-proprietary electronic claims from non-HIPAA-compliant providers who request an extension.  Providers receiving an extension will not have to force their claims to paper, and can instead focus their efforts on achieving HIPAA compliance for claim submissions. 

	In order to request an extension to the deadline, providers must contact us at the appropriate phone number listed below as soon as possible, but no later than October 15, 2003, to report the earliest possible date they expect to begin testing.  This date must be no later than January 30, 2004.  

		Pharmacy Providers:  617-423-9841
		All Other Providers:  1-800-438-4480

If you have confirmed a testing date, but believe that you will not meet your scheduled date, you must advise us of the new date upon which you will submit your initial test file.

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Confirmation of 	If you do not contact us by October 15, 2003, you may, in fact, not be 
Extension	allowed to continue submitting MassHealth-proprietary electronic claims.  Upon receipt of your call, we will send a confirmation letter documenting the information that you provided to us.  This letter will confirm that you have been scheduled for testing and allow you to continue submitting electronic claims in the MassHealth-proprietary format as you work toward HIPAA compliance.

Providers Who Use	If you submit your claims through an intermediary, contact them now to 
Clearinghouses and	determine their status on HIPAA compliance.  A list of software vendors, 
Billing Intermediaries	billing intermediaries, and clearinghouses that plan to support HIPAA-
to Submit Claims	compliant transactions to MassHealth is also available on our provider Web site.  Go to www.mahealthweb.com, then click on HIPAA.  The list identifies vendors that are approved for production in the 837P, 837D, and 837I formats and those who have started testing or plan to start testing with us soon.

Providers Who Submit	If you currently submit paper claims, but are working toward converting to Paper Claims 		HIPAA-compliant electronic claim transactions, please let us know when 
you expect to be ready to submit a test file.  If you submit fewer than 2,400 claim lines a year, you may be interested in the free software package called Provider Claims Submission Software (PCSS) that we offer.  This software will enable you to submit HIPAA-compliant electronic claims to MassHealth.  For more information about PCSS, contact the HIPAA Support Center at 1-888-848-5068, or by e-mail at mahipaasupport@unisys.com.

E-mail Your	We look forward to the new efficiencies that HIPAA-compliance for 
Ideas for 	transactions and code sets will bring to both the Division and MassHealth 
Improvement 	providers.  Through HIPAA and otherwise, we continue to pursue ways in which we can reduce administrative burdens and become a better business partner.  We encourage you to e-mail your suggestions to improve@nt.dma.state.ma.us.

Questions	If you have any questions about the information in this bulletin, call MassHealth Provider Services at 617-628-4141 or 1-800-325-5231.