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).
The information contained in this companion document
applies to Wisconsin Medicaid, BadgerCare Plus, 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
Access and Accountability (DHCAA) Electronic Data Interchange (EDI) Department at (608) 221-9036.
Wisconsin Medicaid will begin reporting the National Provider Identifier (NPI)
on May 19, 2008. The provider’s NPI must be on file with Wisconsin Medicaid in
order for claims to process appropriately utilizing the NPI. Confirmation
letters were sent to providers once their NPI was reported and entered into the
Wisconsin Medicaid system.
| Loop/Segment Revised |
Page(s) Revised |
Text Revised |
NEW:
None/ ISA06/ Interchange sender ID |
4 |
This element is populated with "WISC_DHFS." |
NEW:
None/ ISA08/ Interchange receiver ID |
4 |
This element is the eight-digit numeric vendor number
assigned by Wisconsin Medicaid. |
NEW:
None/ GS02/ Application sender's code |
4 |
This element is populated with "WISC_TXIX" for Wisconsin
Medicaid. |
NEW:
None/ GS03/ Application receiver's code |
4 |
This element is the eight-digit numeric vendor number
assigned by Wisconsin Medicaid. |
NEW:
None/ ST02/ Transaction set control number |
4 |
This element contains a unique transaction set control
number assigned by Wisconsin Medicaid. |
| None/ TRN02/ Check number |
4 |
This is the check number. If there is no check number,
Wisconsin Medicaid populates this element with ‘NO CHECK,’ followed by the
remittance and status number. |
| 1000A/ N403/ Payer postal zone or ZIP code |
5 |
This is the ZIP code of the payer, 53784. |
| 1000B/ REF/ Payee additional identification |
5 |
This segment is populated if the billing provider's
Medicaid identification number or the payee’s identification was submitted
on the claim. |
| 1000B/ REF01/ Reference identification qualifier |
5 |
This element is 1D, indicating that the next element is the
billing provider's Medicaid identification number. |
| 1000B/ REF02/ Reference identification |
5 |
This element is the Medicaid identification number. |
| 2100/ CLP02/ Claim status code |
5 |
This element is one of the following:
- 1 – Processed as primary.
- 2 – Processed as secondary.
- 4 – Denied.
- 22 – Reversal claim.
|
| 2100/ CLP05/ Patient responsibility amount |
5 |
This is the sum of copay, spenddown, SeniorCare deductible,
patient liability, and nursing home personal needs allowance. |
| 2100/ REF01/ Reference identification qualifier |
6 |
This element is populated with any of the following:
- EA - Indicating that the next element is the medical record number (MRN).
For professional claims that came in on the proprietary electronic format,
EA indicates patient control number (PCN).
- G1 – Indicating that the next element is the prior authorization
number.
- F8 - Indicating that the next element is the adjustment ICN.
|
| 2100/ REF/ Rendering provider identification |
7 |
This segment is populated if a Medicaid identification
number was submitted on the claim. |
| 2100/ REF01/ Reference identification qualifier |
7 |
This element is 1D, indicating that the next element is the
performing provider's Medicaid identification number. |
| None/ SE02/ Transaction set control number |
8 |
This element contains a unique transaction set control
number assigned by Wisconsin Medicaid. This value is the same value
indicated in ST02. |
