Commonwealth of Massachusetts
Executive Office of Health and Human Services
Office of Medicaid
600 Washington Street
Boston, MA  02111
www.mass.gov/dma	
		MassHealth
		All Provider Bulletin 132
		February 2004
	TO:	All Providers Participating in MassHealth

	FROM:	Beth Waldman, Medicaid Director

	RE:	HIPAA Compliance for Electronic Claims Transactions
	
Original Deadline for	The deadline for compliance with the Health Insurance Portability and
HIPAA Compliance 	Accountability Act of 1996 (HIPAA) transaction and code sets rules was October 16, 2003.

MassHealth	 		In September 2003, MassHealth implemented a contingency plan for providers Contingency Plan 		who would not be ready to submit HIPAA-compliant electronic claims by
	the mandated deadline.  The plan allowed providers to continue submitting MassHealth-proprietary electronic claims for processing as long as they submitted an initial test in the new format by January 30, 2004.

Submitters Who	If you have not yet submitted an initial test file, you must do so
Are Not Yet Testing	immediately.  Failure to submit a test will jeopardize your ability to continue
	submitting electronic claims to MassHealth.

It is critical that all submitters maintain an active profile throughout the testing and approval process.  Test files should be submitted on a regular basis until compliance is achieved.
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Providers Who Use		If you submit your claims through a billing intermediary or clearinghouse, 
Clearinghouses and		contact them immediately to determine whether they are approved for
Billing Intermediaries 	production or are testing the HIPAA-compliant format with MassHealth.
to Submit Claims	A list of software vendors, billing intermediaries, and clearinghouses is available on our provider Web site.  Go to:  www.mahealthweb.com, and click on “HIPAA.”  The list identifies those vendors that are approved for production and those currently testing with MassHealth.

Achieving Compliance 	MassHealth has been aggressively working with the provider community to convert all providers who submit claims electronically to a HIPAA-compliant
format.  We will continue working with those submitters not yet in compliance, including billing intermediaries and clearinghouses.  By working together, we are confident that electronic submitters can achieve compliance no later than April 30, 2004.

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Achieving Compliance 	Providers who have not demonstrated a good-faith effort to achieve
(cont.)	compliance by April 30, 2004, will jeopardize their ability to continue submitting electronic claims to MassHealth.

Provider Claim 	Additionally, we are offering MassHealth providers a free HIPAA-
Submission Software	compliant billing software product—Provider Claim Submission Software (PCSS).  

PCSS generates 837 professional, dental, and institutional transactions, and uploads them directly to MassHealth.  You can submit your claims via modem or diskette—Internet access is not required.  This product can be used as either an interim or permanent solution to meet your HIPAA compliance needs.  For more information on PCSS, contact the MassHealth HIPAA Support Center either by e-mail at mahipaasupport@unisys.com, or by telephone at 1-888-848-5068.  

Providers Who Submit	With the implementation of HIPAA, the health-care industry is moving 
Paper Claims 	toward automation and standardization.  If you currently submit paper claims to MassHealth, now may be the time to consider electronic submission options such as PCSS.  

Questions	For questions about HIPAA testing, documentation, and timeframes, 
	contact us at the appropriate telephone number or e-mail address below. 
	
	Pharmacy Providers:  617-423-9841
	All Other Providers:  1-888-848-5068 or mahipaasupport@unisys.com. 

We encourage you to also visit our provider Web site at: www.mahealthweb.com/HIPAA.htm for additional HIPAA information.