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 pleased to announce that it has received a CAQH CORE® health plan certification seal and exchanges electronic administrative data in compliance with the CORE rules.
CAQH CORE®, the CORE-certification/Endorser Seals and logo are registered trademarks of CAQH® Copyright 2010, Council For Affordable Quality Healthcare®. All rights reserved..
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):
- This was implemented March 9, 2015.
- Connectivity methods for the 270/271 Eligibility Status and 276/277 Health Claim Status transactions were expanded to include the addition of Hypertext Transfer Protocol Secure (HTTP/S).
- Real-time responses for individual requests (one client or one claim at a time within 20 seconds) are now available.
- Companion Guide template has changed.
- A static IP address is required by Trading Partners for each machine the Trading Partner uses for HTTP/S connectivity.
Trading Partners interested in testing these transactions should contact the EDI Help Desk at DHHS.MedicaidEDI@nebraska.gov or 866-498-4357.
There is no change required of the current batch processing of the 270/271 eligibility status or the 276/277 claim status transactions through SFTP or for other HIPAA X12 transactions.
Nebraska Medicaid continues 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.
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
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