Nicola Carter 9/25/18 Implementation Updated Added within sixty (60) days of Date text/document operation, the Systems PIHP’s information shall be ready to submit encounter data to in a LDH’s FI HIPAA compliant COB format Nicola Carter FI Updated Added FI will be 9/25/18 LDH’s Responsibilities text/document responsible for accepting, editing information and storing PIHP 837 encounter data. Nicola Carter X12 Reporting Updated Added: The TA1 9/25/18 text/document acknowledgment response file is information used to report receipt of an 837 file and notify the sender that the 837 included a valid envelope or that there were problems with the interchange control structure Nicola Carter Proprietary Appendix Update Appendix corrected from to 9/25/18 “D” Reports “C” Nicola Carter Prepaid Inpatient Appendix Update Appendix corrected from to 9/25/18 “E” Health Plan “D” (PIHP) Resp. Nicola Carter Transaction Set Updated Added updated 837 formats and 9/25/18 Supplemental text/document location to find Instructions- information information/guidance. Intro Nicola Carter Table of Page Numbers Page Numbers Updated 9/26/18 Contents Updated Nicola Carter 9/26/18 CMS Approval Updated Introduction updated. LDH FI Companion text/document Supplemental Instructions Guide and information updated. Billing Instructions N. Carter Identifying Updated Atypical providers may not be 9/26/18 Atypical text/document assigned an NPI. If a provider has Providers information an NPI, the PIHP must send the NPI in Loop 2010AA NM109 (the typical place to send the Billing NPI in 837s). Provider’s When the provider does not have an NPI, the provider’s LA Medicaid Legacy Provider ID, is sent in Loop 2010BB REF*G2
Nicola Carter Implementation Date Updated text/document information Added within sixty (60) days of operation, the PIHP’s Systems shall be ready to submit encounter data to LDH’s FI in a HIPAA compliant COB format 9/25/18 Nicola Carter FI Responsibilities Updated text/document information Added LDH’s FI will be responsible for accepting, editing and storing PIHP 837 encounter data. 9/25/18 Nicola Carter X12 Reporting Updated text/document information Added: The TA1 acknowledgment response file is used to report receipt of an 837 file and notify the sender that the 837 included a valid envelope or that there were problems with the interchange control structure 9/25/18 Nicola Carter Proprietary Reports Appendix Update Appendix corrected from “D” to “C” 9/25/18 Nicola Carter Prepaid Inpatient Health Plan (PIHP) Resp. Appendix Update Appendix corrected from “E” to “D” 9/25/18 Nicola Carter Transaction Set Supplemental Instructions- Intro Updated text/document information Added updated 837 formats and location to find information/guidance. 9/25/18 Nicola Carter Table of Contents Page Numbers Updated Page Numbers Updated 9/26/18 Nicola Carter CMS Approval FI Companion Guide and Billing Instructions Updated text/document information Introduction updated. LDH Supplemental Instructions updated. 9/26/18 N. Carter Identifying Atypical Providers Updated text/document information Atypical providers may not be assigned an NPI. If a provider has an NPI, the PIHP must send the NPI in Loop 2010AA NM109 (the typical place to send the Billing Provider’s NPI in 837s). When the provider does not have an NPI, the provider’s LA Medicaid Legacy Provider ID, is sent in Loop 2010BB REF*G2 9/26/18