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Elizabeth M. Whitehorn, Director

Provider Notice issued 03/10/03

Health Insurance Portability and Accountability Act (HIPAA) Claim Formats

​To: ​All Enrolled Providers
​Date: ​March 10, 2003
​Re: ​Health Insurance Portability and Accountability Act (HIPAA) Claim Formats

 

The Illinois Department of Public Aid (IDPA) intends to comply with the standards for electronic health care transactions and code sets adopted under Part C of Title XI of the Social Security Act by seeking an extension on conformance with Public Law 107-105 dated December 27, 2001.  The IDPA compliance plan milestone dates are April 16, 2003, for the start of transaction and code sets testing and October 16, 2003, to be HIPAA compliant. 

 

 

The following providers will be required to use the X-12 837 Institutional (837 I) standard, Version 4010 to submit claims for services:

 

Hospitals
Hospices
Home Health Agencies
Ambulatory Surgical Treatment Centers
Office of Alcoholism and Substance Abuse
Renal Dialysis Facilities (hospital based or freestanding) Psychiatric Under 21 Program Treatment Centers Residential Mental Health Rehabilitation Option Providers

 

NOTE:   Hospitals and ambulatory surgical treatment centers will use the X-12 837 Professional (837 P) standard, Version 4010 to bill fee-for-service claims for any service that is currently not billable to the Department on form UB-92.  The Department will make every effort not to expand the required uses of the 837 P for hospitals and ambulatory surgical treatment centers.

 

All other providers will use the X-12 837 Professional standard, Version 4010 to submit claims electronically.  All providers submitting paper claims will continue to use the form they currently use.  Dentists should contact the Department's Dental Program Administrator, Doral Dental of Illinois, Inc. at (888) 281-2076 concerning information on the HIPAA program.

 

Pharmacies will be required to use the National Council for Prescription Drug Programs (NCPDP) Version 5.1 dataset to submit electronic claims.  Providers are encouraged to refer to the Department's website for information regarding HIPAA. The address is:

 

http://www.illinois.gov/hfs/info/legal/HIPAA/Pages/default.aspx

 

This website will be updated regularly with the latest developments as the Department moves toward the implementation of HIPAA.  You will want to visit it frequently.

 

If you have any questions concerning this notice, you may contact the Bureau of Comprehensive Health Services at (217) 782-5565.

 

A. George Hovanec, Administrator
Division of Medical Programs