Nebraska Medicaid Program

Nebraska Medicaid
HIPAA Administrative Simplification
Operating Rules - Phase I and II
Eligibility and Claims Status (AS-ECS) Project

 All HIPAA covered entities, including providers, clearinghouses and payers, are required to comply with the Affordable Care Act (ACA) requirements to implement the CORE Phase I and Phase II Operating Rules for two HIPAA transactions:

  • Eligibility for a Health Plan (270/271)
  • Health Claim Status (276/277).

Nebraska Medicaid is working toward incorporating these changes.  The AS-ECS Project is being implemented in two Tracks.

 Notifications to Providers and Trading Partners

Track 1 (Operating Rules 154, 258, 259 and 260):

  • This was implemented July 28, 2013.
  • The data content of the 270/271 Eligibility Status Transaction was expanded.
    • Prior to the change, Medicaid only returned one Service Type Code (STC).  Now, all CORE mandated STCs and related financial information is returned.
    • Multiple Subscriber AAA segments will also be returned, if appropriate.
    • Patient Last Name is normalized to improve match probability.

Track 2 (Operating Rules 152, 153, 155, 156, 157, 250 & 270):

  • Edifecs was contracted in December 2013 to provide the technical solution for this implementation.
  • Connectivity methods for the 270/271 Eligibility Status and 276/277 Health Claim Status transactions will be expanded.
  • Real-time responses for individual requests (one client or one claim at a time within 20 seconds) will be available.
  • Companion Guide template will change.

There will be no change required for the current batch processing of the 270/271 eligibility status or the 276/277 claim status transactions.

Nebraska Medicaid will continue to support Internet Access for Providers to Medicaid Claim Status Inquiry (MCCS) and Medicaid Client Eligibility Verification (RFS6).  This service allows providers immediate access to claim status and client eligibility information.  For more information, see http://dhhs.ne.gov/medicaid/Pages/med_internetaccess.aspx.

Communication

  • To assist in delivery of information, a dedicated email address has been created for questions and answers specific to the Administrative Simplification projects.  This email address is:  DHHS.ACAEDIAdminSimp@Nebraska.gov.

Resources

If you are not familiar with the Operating Rules, known as CORE Phase I and Phase II, they are available at no charge from the Council for Affordable Quality Healthcare (CAQH) Committee on Operating Rules for Information Exchange® (CORE) Web site at:  http://caqh.org/ORMandate_Eligibility.php.

Phase I Rules
Phase II Rules

 


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