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
Outpatient Hospital Bulletin 46
August 2003

	TO:	Outpatient Hospitals Participating in MassHealth

	FROM:	Douglas S. Brown, Acting Commissioner

	RE:	Implementation of the 837 Institutional HIPAA-Compliant Electronic Claim Format 

New Electronic Claim	Effective September 2, 2003, the Division will implement the 837 Institutional Health
Format and 	Care electronic claim format (837I).  The Health Insurance Portability and 
Specifications 	Accountability Act of 1996 (HIPAA) mandates implementation of this format by October 16, 2003 for all affected MassHealth providers who submit electronic claims.

It is essential that affected providers initiate and complete testing with MassHealth as soon as possible.  The MassHealth 837I Companion Guide, which should be used in conjunction with the Implementation Guide for the 837I, contains MassHealth-specific technical and data element requirements.  The 837I Companion Guide can be downloaded from the MassHealth provider Web site at: www.mahealthweb.com.  Click on “HIPAA,” then “Testing,” to reach the 837I Companion Guide.

Trading Partner 	You must successfully complete the testing process before you can submit claims to
Agreement Required 	MassHealth for processing in the 837I format.  If you use a software vendor or billing
Before Testing 	intermediary, you should contact them immediately, if you have not done so already, to discuss the status of their testing with MassHealth.  A signed Trading Partner Agreement (TPA) is required to be on file before you submit test claims. You must complete a MassHealth TPA (attached), only if you have not already done so and return it to MassHealth at the following address.  

MassHealth
ATTN: HIPAA Support Center
P.O. Box 9101
Somerville, MA  02145

continued on back

Testing and Support	Once you receive a TPA acknowledgement letter and you are ready to begin testing, contact the MassHealth HIPAA Support Center either by telephone at 617-576-4030, or by e-mail at mahipaasupport@unisys.com. The MassHealth HIPAA Support Center will verify the transactions you will conduct and your readiness dates, and provide you with additional information about the testing process, requirements, and schedule.

Trading Partner	All electronic submitters, including billing intermediaries and
Profile Form	clearinghouses, will be requested to complete a Trading Partner Profile (TPP) Form.  The purpose of this form is to collect additional data about which HIPAA transactions you will conduct with MassHealth, your readiness date, and appropriate contact information.

		If you have not already completed the TPP form either in writing or by telephone, contact the MassHealth HIPAA Support Center for assistance. 

Production Claims	Test claims in the 837 Institutional format will not be processed in the weekly production cycle.  You must continue to submit MassHealth claims for processing in the current proprietary format during the testing period.  Once you are approved to submit production claims in the 837 format, you can do so and should discontinue submitting claims in the MassHealth proprietary format.

If you submit paper claim forms, you can continue to do so; however, all providers are encouraged to bill electronically.

Questions	If you have any questions about this, or other HIPAA-related information, contact the MassHealth HIPAA Support Center at 617-576-4030 or by e-mail at mahipaasupport@unisys.com