Wisconsin Medicaid Companion Document to HIPAA
Implementation Guide — 837 Institutional
837 Institutional V5
PHC 13067 (4/08)
PDF (225 KB)
Revision Log
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 and BadgerCare Plus, 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 supersede 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.
Wisconsin Medicaid will accept and process any HIPAA-compliant transaction.
However, a compliant transaction that doesn’t contain Wisconsin
Medicaid-specific information, though processed, may be denied for payment. For
example, a compliant 837 claim created without a Wisconsin Medicaid recipient
identification number will be processed by Wisconsin Medicaid, but will be
denied payment.
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.
Acceptable Characters
All alpha characters used in 837 transactions must be in uppercase format.
All names and codes on Wisconsin Medicaid’s files are stored in uppercase
format. Therefore, claims containing lowercase characters may cause denial edits
to set on the claim/service line where they are submitted.
The 837 transaction must not contain any carriage returns nor line feeds; the
data must be received in one, continuous stream.
Examples
See Appendix 1 of this document for
examples.
X12 837 Institutional Health Care Claim
Appendix 2 — Assigned Contract Information Segment Value
Codes
Appendix 3 — BadgerCare
Plus Required Taxonomy Codes
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