Commonwealth of Massachusetts
Executive Office of Health and Human Services
Office of Medicaid
600 Washington Street
Boston, MA  02111
www.mass.gov/masshealth	
		MassHealth
		All Provider Bulletin 133
		April 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.
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MassHealth	In February 2004, MassHealth implemented a modification to the 
Contingency Plan 	temporary contingency plan for providers who were not ready to submit HIPAA-compliant electronic claims.  The modified plan allowed electronic submitters to continue submitting MassHealth-proprietary electronic media claims (EMC) for processing as long as they were actively testing in the new format.  This was done to allow those submitters who demonstrated a good- faith effort additional time to become HIPAA-compliant.  The modified plan was implemented with the expectation that all electronic submitters would be compliant by April 30, 2004. 
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Noncompliant		For a limited time, MassHealth will continue to allow electronic claims Submissions After 		to be submitted in our proprietary EMC format.  We are extending 
April 30, 2004			this contingency plan to avoid any interruption in payments to those 
MassHealth providers who are working diligently to achieve HIPAA compliance, and to be in alignment with the Centers for Medicare and Medicaid Services (CMS) contingency plan for Medicare.  We will continue working with those submitters not yet in compliance, including billing intermediaries and clearinghouses.
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Noncompliant 		MassHealth will continue to accept electronic claims submitted in our 
Submissions After 		proprietary format until further notice.  However, beginning July
July 1, 2004	1, 2004, adjudication of noncompliant electronic claims will be delayed beyond the standard payment cycle—the amount of delay will be communicated soon via separate correspondence.  This modification to the contingency plan requires affected providers to become approved in HIPAA formats quickly in order to avoid claims-processing delays.  This is a measured step toward terminating the process of supporting dual formats for electronic claim submissions.  
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Noncompliant 		Pharmacy providers were previously notified by letter that the 
Submissions After		enhanced functions of the HIPAA-compliant NCPDP 5.1 standard 
July 1, 2004	is effective May 1, 2004.  Pharmacy provider submission of
(cont.) 	pharmacy claims in any other format other than NCPDP 5.1 standard will no longer process after this date.
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Achieving Compliance	If you have tested with us and have been approved for production in the HIPAA-compliant format, but are not yet submitting production claims in that format, you must contact the MassHealth HIPAA Support Center immediately at 1-888-848-5068 to discuss your conversion plan.  Pharmacy providers submitting in the NCPDP format should call 
	617-423-9841.  If you have not yet submitted an initial test file, you must do so immediately.  Failure to submit a test will jeopardize your ability to continue submitting electronic claims to MassHealth.  If you have not found an alternative HIPAA-compliant solution, please consider our free software product described below before reverting to paper claim submissions. 

It is critical that electronic submitters are actively engaged throughout the testing and approval process.  Test files should be submitted on a regular basis until compliance is achieved.  Once you are approved for production, all electronic claims should be submitted using only the HIPAA-compliant format.
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Providers Who Use		If you submit your claims through a billing intermediary or Clearinghouses and 	clearinghouse, contact them immediately to determine whether they 
Billing Intermediaries 	are approved for production, or testing the HIPAA-compliant format
to Submit Claims 		with MassHealth.  A list of software vendors, billing intermediaries, 
and clearinghouses is also 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.
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	In an effort to assist you in becoming compliant, we are offering
	MassHealth providers a free HIPAA-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. 
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Provider Claim	If you currently submit paper claims to MassHealth, now is the time to
Submission Software	consider electronic submission options such as PCSS.  For more
	information on PCSS, contact the MassHealth HIPAA Support Center either via e-mail at mahipaasupport@unisys.com or telephone at 
1-888-848-5068.
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Questions	If you have questions about HIPAA testing, documentation, or 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.