Electronic Receipt and Transmission of Health Care Claim Information - Medicare and Medicaid Claims

State of New Jersey DEPARTMENT OF BANKING AND INSURANCE LEGISLATIVE AND REGULATORY AFFAIRS PO BOX 325 TRENTON, NJ 08625-0325 Tel (609) 984-3602 Fax (609) 292-0896 Visit us on the Web at www.njdobi.org New Jersey is an Equal Opportunity Employer • Printed on Recycled Paper and Recyclable JAMES E. MCGREEVEY Governor HOLLY C. BAKKE Commissioner BULLETIN NO. 04-02 TO: ALL NEW JERSEY HEALTH INSURANCE COMPANIES; HOSPITAL SERVICE CORPORATIONS; MEDICAL SERVICE CORPORATIONS; HEALTH SERVICE CORPORATIONS; HEALTH MAINTENANCE ORGANIZATIONS; DENTAL SERVICE CORPORATIONS; DENTAL PLAN ORGANIZATIONS; PREPAID PRESCRIPTION SERVICE ORGANIZATIONS; ORGANIZED DELIVERY SYSTEMS; AND OTHER INTERESTED PARTIES FROM: HOLLY C. BAKKE, COMMISSIONER RE: ELECTRONIC RECEIPT AND TRANSMISSION OF HEALTH CARE CLAIM INFORMATION – MEDICARE AND MEDICAID CLAIMS The purpose of this Bulletin is to advise health plans, health care providers, health care clearinghouses and other interested parties that the Department of Banking and Insurance (Department) intends to amend its standard for electronic claim acknowledgement. In the near future, the Department will propose amendments to N.J.A.C. 11:22-3.7 consistent with the following. Subject to N.J.A.C. 11:22-3.7(d), N.J.A.C. 11:22-3.7(c) currently requires payers receiving an electronically filed claim to individually acknowledge receipt of each claim by responding with a 227 Transaction ANSI ASC X12.317, version 223070, release 7, sub-lease 0, October 1996 acknowledgement. The Department is aware that such an acknowledgement never came into being. N.J.A.C.11:22-3.7(d) contemplates the use by providers and payers of a mutually agreeable alternative means of acknowledgement when use of the adopted standard acknowledgement is not feasible. 2 The Department recognizes that the currently accepted version of the 277 form is # 004040x167. Therefore, in order to satisfy the requirements for Electronic Health Care Claim Status Notification, payers may either utilize a mutually agreeable alternative means of acknowledgement as outlined in N.J.A.C. 11:22-3.7(d), or the ASC X12N227 (004040X167), standard acknowledgement form for electronic claims. The exclusive use of the 004040X167 version of the 227 acknowledgement should commence on or before September 1, 2004. Pharmacy claims do not use the typical HIPAA ASC X12N format. Rather, electronic pharmacy claims are processed using the NCPDP format, which should continue to be used for electronic acknowledgement of pharmacy claims. ____2/10/04 /s/ Holly C. Bakke Date Holly C. Bakke, Commissioner DHT04-01/INOORD