Wisconsin Medicaid HIPAA Companion
Document to HIPAA Implementation Guide — X12 834 Benefit
Enrollment and Maintenance
PHC 13048 (9/04)
PDF (224 KB)
Companion Document Audience
Companion documents are intended for information
technology and/or systems staff who will be coding billing
systems or software for compliance with the federal Health
Insurance Portability and Accountability Act of 1996 (HIPAA).
Purpose of Companion Documents
The information contained in this companion document
applies to Wisconsin Medicaid, BadgerCare, and SeniorCare,
although the companion document only refers to Wisconsin
Medicaid.
The companion documents are designed to be used with HIPAA Implementation
Guides. Companion documents provide Wisconsin Medicaid-specific information that
details the way to create HIPAA transactions for Wisconsin Medicaid and explains
how Wisconsin Medicaid creates HIPAA transactions. Companion documents clarify
the HIPAA-designated standards usage but are not intended to supercede them. The
purpose of companion documents is to provide trading partners with a guide to
communicate the Wisconsin Medicaid-specific information required to successfully
exchange transactions electronically with Wisconsin Medicaid.
Companion documents highlight the data elements significant for Wisconsin
Medicaid. For transactions created by Wisconsin Medicaid, companion documents
explain how certain data elements are processed. Please refer to the companion
document first if there is a question about how Wisconsin Medicaid processes a
HIPAA transaction. For further information, contact the Division of Health Care
Financing (DHCF) Electronic Data Interchange (EDI) Department at (608) 221-9036.
VERSION 2 REVISION LOG
Companion Document: 834
Approved: 09/30/04
Modified by: BLB
Version number: X12_834_4010A1_V2
|
Loop/Segment Revised |
Page(s) Revised |
Text Revised |
|
Header / ISA & GS |
3 |
A description of the control segments in the fields ISA06,
ISA08, GS02, and GS03 has been added. |
|
Header / ST02 |
3 |
A description of the transaction set control number has been
added. |
|
2000 / INS03 |
7 |
The maintenance type code with a value of "001" will also be
used when a second 2300 HD loop present. |
|
2000 / INS04 |
9 |
The maintenance reason code with a value of "AI" will also
be used when a second 2300 HD loop is present. |
|
2000 / DTP01 |
12 |
The date / time qualifier with a value of "303" will also be
used when a second 2300 HD loop is present. All retro-active "CONTINUE"
effective dates will be reported so the note to the contrary was removed.
|
|
2100A / N406 |
14 |
The location identifier description was modified to
correctly reflect that the element contains a two-character county code. |
|
2100A / HLH |
14 |
The loop was changed from 2100 to 2100A. |
|
2100A / HLH01 |
15 |
The loop was changed from 2100 to 2100A. |
|
2300 / HD |
17 |
Use of the HD segment has been expanded to report assigned
provider changes. |
|
2300 / HD01 |
17 |
The maintenance type code with a value of "024" will also be
used to report disenrollment from an assigned provider. |
|
2300 / DTP01 |
19 |
The date / time qualifier with a value of "349" will also
be used report disenrollment from an assigned provider. |
|
Trailer / SE02 |
20 |
A description of the transaction set control number has
been added. |
X12 834 Benefit Enrollment and
Maintenance
Attachment 1 —
Summary of MMIS Enrollment Status Reporting to 834 Values
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Documents
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