As Horizon system users are making the switch to send electronic claims to Medicaid and/or Medicare in the new ANSI standard HIPAA-compliant formats, a few common questions are coming up. We will repeat the common situations here so that others who haven't yet made the switch can be prepared for what might be ahead.

-- When testing the connection to Medicaid, my signon and password are rejected.

Check the values that you've got in your Medicaid Electronic HIPAA configuration for 'signon' and 'password' to assure that they match what was assigned to you by EDS on the letter you received from them. Use what they list as "submitter ID" for both the Trading Partner and Signon fields - the "trading partner agreement sequence #" refers to a file number on your actual hard copy agreement and has nothing to do with logging on to the bulletin board. The values are case sensitive, so be sure that you've typed lower case letters in the password. If you have the correct information and still can't get logged on, give us a call and we'll try signing on with your information from here.

-- Don't we get a transmission confirmation number on the #6 log from EDS anymore? How do I know the claims went through?

The transmission log that you print with #6 merely prints out the interaction/dialog that occurred between your computer and the EDS bulletin board when you last connected and sent claims. The 'old' EDS ECS bulletin board had a different dialog, that is, asked for and returned different information than the 'new' EDS HIPAA bulletin board does. The new bulletin board only replies with "transfer successful" when your claim file is received. This is what you look for now when you print #6. To get more information on whether the file was accepted into processing, do #8 to dial back for the response.

-- The response from NC Medicaid/EDS looks like gibberish - whether the screen listing the responses says 'accept' or 'reject', the report just has a bunch of letters and *'s that I can't make any sense of. What is this?

This is the ANSI 997, which is the most basic response to a claim transmission that the intermediary can return. The directory listing on the Horizon software screen tells you the batch was accepted or rejected by scanning the ANSI 997 to find the AK5 line, which will contain an 'A' if the claims were accepted and an 'R' if they were rejected. If you have 'accept' in the directory listing, you're good to go; the claims were accepted (you can see the 'A' in the AK5 line if you view the response). If you see 'reject' in the response directory listing, the claims were rejected, and the other lines in the response file, in a very cryptic way, identify what was wrong with the claims. If you get a 'reject' response, print out the response file by viewing it and pressing F6, and fax it to us; we have a copy of the secret decoder manual (smile) for the ANSI 997 and can decipher the response and let you know where the errors were in the batch of claims.

-- When testing the connection to EDS/Medicaid for HIPAA claims by doing #8 for response, it seems to connect and log in but I get a "no response found-try later" message. Is this ok?

Yes, this is what you expect. Since you've not yet sent claims to the new HIPAA bulletin board, there is no response for you to download. You're simply testing the setup to assure that your system can dial the new EDS HIPAA bulletin board, log in successfully, and ask for a download.

-- Is the AK5 line in the ANSI 997 that indicates accept/reject all we'll get from Medicaid? Don't they return a claim list or at least a count of claims like Medicare does?

That's all you'll get from Medicaid.

-- My claims were rejected by Medicaid and the AK3 line has PER listed - what is this?

Two agencies have already encountered this error so we'll pass it along so others can avoid it. This means that the telephone number is missing in the 'contact person' segment of the claim batch. The format program gets this information from the agency configuration screen. Before you start sending HIPAA claims to Medicaid, check your configuration to be sure the phone number is listed. In PROMISE this is under Agency Info/Configuration, and for EDI-only users it's under Configuration/Basic.

-- I've heard that the Patient Relationship codes changed for HIPAA, for example, 'self' used to be '01' and with HIPAA is changed to '18' - but the old codes are still showing up in the search list in PROMISE - do we need to do anything?

Keep using the 'old' codes for patient relationship to insured for now and let the software handle the translation. The format program (#4) that you run just before sending claims will convert the codes if you're sending HIPAA-compliant claims. Since you have the capability of sending both old and new claim formats, we opted to leave the old codes in effect so you don't have to think about which code set to use or try to switch back and forth. The system will assume you're using old patient relationship codes and simply pass those through if you're formatting in pre-HIPAA format or convert to the new codes if you're doing HIPAA claims.

-- When testing the connection to Medicare's GP-Net, I get "Access denied".

Check the values that you've got in your EMC configuration for 'signon name' and 'password' to assure that they match what was assigned to you by PGBA on the letter you received from them. The values are case sensitive, so be sure that you've typed all caps. If you have the correct information and still can't get logged on, you need to call the EDI help desk at PGBA; apparently there's a problem with how they've set up your new access.

-- When I tried to download ERA's (electronic remittances) from GP-Net, nothing came across, but if I switch back and try the old bulletin board, there are RA's that I can download.

Be sure that you've sent the fax to PGBA asking for parallel posting of your remittances on both bulletin boards as instructed in the HIPAA conversion letter we sent. If you have requested parallel posting and its been at least a week, then you need to call the EDI help desk to ask about the status of your request.