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An introduction to electronic business practices
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Since the Health Insurance Portability and Accountability Act (HIPAA) was enacted, DHS has been steadily changing the way we process electronic medical claims. The former DHS Bulletin Board, for example, is no longer considered a secure means of transferring clients’ private health care information. DHS had to change its electronic business practices to conform to the new national standards.
Originally, all covered entities, including state Medicaid programs, were to have HIPAA-compliant electronic business practices in place by October 2003. When overall progress was very slow, CMS allowed a one-year extension until October 2004. Oregon DHS signed a Contingency Plan with CMS for an additional extension to Dec. 31, 2005. The plan ensures Oregon Medicaid will be in compliance by the December date.
The good news is that the HIPAA-compliant transactions (Electronic Data Interchange—EDI) create consistent standards across the health care industry, which means fewer claim errors and more timely interactions. In turn that means faster, more accurate claims adjudication for entities such as DHS providers. If you are new to the EDI concept, please read the introduction below. There is a unique vocabulary associated with HIPAA-compliant electronic submissions and responses that we would like to help you learn. Then “get on board” by choosing an electronic transmission vehicle and signing a Trading Partner Agreement—or contact DHS EDI Support Services at: DHS.EDIsupport@state.or.us or 1-888-690-9888
Basics of electronic data interchange (EDI)
Electronic Eligibility Determination
Electronic Funds Transfer (EFT)
EFT, or direct deposit, is now available to providers who bill on paper claims, in addition to providers who have been successfully billing or receiving payment/EOBs with the HIPAA-compliant EDI transactions. If you’re ready to receive direct payments into your bank account, complete the application form OE3077 (PDF) and return it to DHS with an original signature (no signature stamps or faxes, please).
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