EmblemHealth 5010 HIPAA Transaction Standard Companion Guides

Date Issued: 5/22/2012

In response to the increased use of electronic transactions in the field of health care, the federal government passed the Health Insurance Portability and Accountability Act (HIPAA) in 1996. This legislation mandates procedures and protections required by the government for transmitting health care data electronically. Standard transactions and code sets have been developed and must be implemented consistently across all organizations involved in the electronic exchange of health information.

These companion guides to the ASC X12N Implementation Guides adopted under HIPAA clarify and specify the data content necessary to electronically transmit data to EmblemHealth. They contain specifications for transactions, contact information, and other information that is helpful. Our companion guides are intended for EmblemHealth providers and trading partners wishing to exchange HIPAA-compliant X12 5010 HIPAA transactions with EmblemHealth. They are intended to furnish information within the framework of the ASC X12N Implementation Guides. Transmissions generated using the companion guides in tandem with the X12N Implementation Guides will be compliant with X12 syntax. The companion guides are not intended to exceed the requirements for use of data outlined in the implementation guides.

270/271 — Health Care Eligibility Benefit Inquiry and Response — Revised January 2014

276/277 — Health Care Claim Status Request and Response — Revised January 2014

278 — Health Care Services Review — Request for Review and Response — Revised June 2015

834 — Benefit Enrollment and Maintenance Transactions

835— Health Care Payment Advice

EmblemHealth Shared Administrative Advantage (EHSAA) Cost-Sharing Exchange 837P — Health Care Claim Professional Transaction

EmblemHealth Shared Administrative Advantage (EHSAA) Cost-Sharing Exchange 837I — Health Care Claim Institutional Transaction

837D — Health Care Claim Dental Transaction

837I — Health Care Claim Institutional Transaction

837P — Health Care Claim Professional Transaction